Changes in the Oswestry Disability Index that predict improvement after lumbar fusion

Clinical article

Restricted access


Clinical studies use both disease-specific and generic health outcomes measures. Disease-specific measures focus on health domains most relevant to the clinical population, while generic measures assess overall health-related quality of life. There is little information about which domains of the Oswestry Disability Index (ODI) are most important in determining improvement in overall health-related quality of life, as measured by the 36-Item Short Form Health Survey (SF-36), after lumbar spinal fusion. The objective of the study is to determine which clinical elements assessed by the ODI most influence improvement of overall health-related quality of life.


A single tertiary spine center database was used to identify patients undergoing lumbar fusion for standard degenerative indications. Patients with complete preoperative and 2-year outcomes measures were included. Pearson correlation was used to assess the relationship between improvement in each item of the ODI with improvement in the SF-36 physical component summary (PCS) score, as well as achievement of the SF-36 PCS minimum clinically important difference (MCID). Multivariate regression modeling was used to examine which items of the ODI best predicted achievement for the SF-36 PCS MCID. The effect size and standardized response mean were calculated for each of the items of the ODI.


A total of 1104 patients met inclusion criteria (674 female and 430 male patients). The mean age at surgery was 57 years. All items of the ODI showed significant correlations with the change in SF-36 PCS score and achievement of MCID for the SF-36 PCS, but only pain intensity, walking, and social life had r values > 0.4 reflecting moderate correlation. These 3 variables were also the dimensions that were independent predictors of the SF-36 PCS, and they were the only dimensions that had effect sizes and standardized response means that were moderate to large.


Of the health dimensions measured by the ODI, pain intensity, walking, and social life best predicted improvement in overall health-related quality of life, as measured using the SF-36 PCS.

Abbreviations used in this paper:MCID = minimum clinically important difference; ODI = Oswestry Disability Index; PCS = physical component summary; SF-36 = 36-Item Short Form Health Survey.

Article Information

Address correspondence to: Leah Carreon, M.D., M.Sc., 210 East Gray Street, #900, Louisville, Kentucky 40202. email:

Please include this information when citing this paper: published online September 21, 2012; DOI: 10.3171/2012.8.SPINE12614.

© AANS, except where prohibited by US copyright law.




Bombardier C: Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976) 25:310031032000


Cohen J: Statistical Power Analysis for the Behavioral Sciences ed 2Hillsdale, NJLawrence Earlbaum Associates1988


Copay AGGlassman SDSubach BRBerven SSchuler TCCarreon LY: Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8:9689742008


Fairbank JCTPynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:294029522000


Glassman SGornet MFBranch CPolly D JrPeloza JSchwender JD: MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience. Spine J 6:21262006


Glassman SDBranch CL Jr: Evidence-based medicine: raising the bar. Spine J 7:5135152007


Glassman SDCarreon LYDjurasovic MDimar JRJohnson JRPuno RM: Lumbar fusion outcomes stratified by specific diagnostic indication. Spine J 9:13212009


Guyatt GWalter SNorman G: Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 40:1711781987


Jensen MPTurner JARomano JM: Correlates of improvement in multidisciplinary treatment of chronic pain. J Consult Clin Psychol 62:1721791994


Liang MHLarson MGCullen KESchwartz JA: Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research. Arthritis Rheum 28:5425471985


McCaffery MBeebe A: Pain: Clinical Manual for Nursing Practice ed 2BaltimoreV.V. Mosby1993


Patrick DLDeyo RA: Generic and disease-specific measures in assessing health status and quality of life. Med Care 27:3 SupplS217S2321989


Ware JEKosinski MKeller SK: SF-36 Physical and Mental Health Summary Scales: A User's Manual BostonThe Health Institute, New England Medical Center1994


Cited By



All Time Past Year Past 30 Days
Abstract Views 35 35 31
Full Text Views 46 46 14
PDF Downloads 53 53 16
EPUB Downloads 0 0 0


Google Scholar