Researchers from the Rothman Institute in Philadelphia think we can come up with a better spine surgery outcome measure and maybe it’s time to update the venerable Oswestry Disability Index (ODI).
Their recent study “Which Domains of the ODI Best Predict Change in Physical Function in Patients After Surgery for Degenerative Lumbar Spondylolisthesis?” appears in the June 1, 2018 edition of Spine.
Co-author Kris Radcliff, M.D., a spine surgeon at Rothman, told OTW “The ODI is an important (perhaps the most important) disease specific outcome measure in lumbar surgery.”
“However, upon inspection of the ODI, we felt that some of the questions were duplicative and some questions were not reflective of common complaints of patients with lumbar problems.”
“The ODI was written and validated in physical therapy literature before many of the modern evidence-based medicine outcome techniques were developed.”
“For example, the scoring of the ODI equally weighs all answers (and therefore topics). Thus, an improvement in social life carries as much weight as an improvement in pain. For these reasons, we performed our study to determine which items contributed most to the overall improvement in ODI score and the interrelationship of ODI items.”
“We found that there are substantial correlations among some domains of the ODI (such as social life and sex life) so those concepts are being counted twice.”
“We also found that not all items of the ODI improve equally after spine surgery in patients with degenerative spondylolisthesis (surprisingly, the largest improvements were in standing, social life, and sex life). We also found that a more complex, regression-based scoring algorithm with unique coefficient weights for a few items better predicted overall health related quality of life (PCS score) than the traditional ODI composite score.”
“As a spine community, we need a better disease-specific lumbar outcome measure. The current item bank and composite scoring of the ODI are insufficient for evaluating quality of life after surgical treatment of degenerative spondylolisthesis since some questions are duplicative and some do not correlate (such as personal care). We need a new outcome measure that captures the important topics that are identified by various stakeholders (including patients, surgeons, therapists, pain physicians).”
“It is best to report individual ODI item sub scores (e.g. preop standing score 3.5 that improved to 4.5 postop) so that readers can understand what aspects of the ODI drove the overall improvement.”
