Roland-Morris Disability Questionnaire and Oswestry Disability Index: Which Has Better Measurement Properties for Measuring Physical Functioning in Nonspecific Low Back Pain? Systematic Review and Meta-Analysis

Background Physical functioning is a core outcome domain to be measured in nonspecific low back pain (NSLBP). A panel of experts recommended the Roland-Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) to measure this domain. The original 24-item RMDQ and ODI 2.1a are recommended by their developers. Purpose The purpose of this study was to evaluate whether the 24-item RMDQ or the ODI 2.1a has better measurement properties than the other to measure physical functioning in adult patients with NSLBP. Data Sources Bibliographic databases (MEDLINE, Embase, CINAHL, SportDiscus, PsycINFO, and Google Scholar), references of existing reviews, and citation tracking were the data sources. Study Selection Two reviewers selected studies performing a head-to-head comparison of measurement properties (reliability, validity, and responsiveness) of the 2 questionnaires. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of these studies. Data Extraction The studies' characteristics and results were extracted by 2 reviewers. A meta-analysis was conducted when there was sufficient clinical and methodological homogeneity among studies. Data Synthesis Nine articles were included, for a total of 11 studies assessing 5 measurement properties. All studies were classified as having poor or fair methodological quality. The ODI displayed better test-retest reliability and smaller measurement error, whereas the RMDQ presented better construct validity as a measure of physical functioning. There was conflicting evidence for both instruments regarding responsiveness and inconclusive evidence for internal consistency. Limitations The results of this review are not generalizable to all available versions of these questionnaires or to patients with specific causes for their LBP. Conclusions Based on existing head-to-head comparison studies, there are no strong reasons to prefer 1 of these 2 instruments to measure physical functioning in patients with NSLBP, but studies of higher quality are needed to confirm this conclusion. Foremost, content, structural, and cross-cultural validity of these questionnaires in patients with NSLBP should be assessed and compared.

[1]  J. Chenot,et al.  Non-Specific Low Back Pain. , 2017, Deutsches Arzteblatt international.

[2]  C. Terwee,et al.  Validity and measurement precision of the PROMIS physical function item bank and a content validity-driven 20-item short form in rheumatoid arthritis compared with traditional measures. , 2015, Rheumatology.

[3]  H. Abbey.  Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis , 2015 .

[4]  M. Ward,et al.  Domain-specific transition questions demonstrated higher validity than global transition questions as anchors for clinically important improvement. , 2015, Journal of clinical epidemiology.

[5]  D. Knol,et al.  Minimally important change values of a measurement instrument depend more on baseline values than on the type of intervention. , 2015, Journal of clinical epidemiology.

[6]  C. Terwee,et al.  Core outcome domains for clinical trials in non-specific low back pain , 2015, European Spine Journal.

[7]  L. Strand,et al.  Reconsidering the Roland-Morris Disability Questionnaire: Time for a Multidimensional Framework? , 2015, Spine.

[8]  J. van Limbeek,et al.  The Oswestry Disability Index (Version 2.1a): Validation of a Dutch Language Version , 2015, Spine.

[9]  C. Terwee,et al.  A core outcome set for clinical trials on non-specific low back pain: study protocol for the development of a core domain set , 2014, Trials.

[10]  A. Algarni,et al.  Validation of an Arabic version of the Oswestry index in Saudi Arabia. , 2014, Annals of physical and rehabilitation medicine.

[11]  A. Garratt,et al.  Which Roland-Morris Disability Questionnaire? Rasch analysis of four different versions tested in a Norwegian population. , 2013, Journal of rehabilitation medicine.

[12]  C. Terwee,et al.  Definition of the construct to be measured is a prerequisite for the assessment of validity. The Neck Disability Index as an example. , 2013, Journal of clinical epidemiology.

[13]  P. Hunter,et al.  Meta-analysis identifies Back Pain Questionnaire reliability influenced more by instrument than study design or population. , 2013, Journal of clinical epidemiology.

[14]  Michelle Kümin,et al.  Reliability and validity study on the Hungarian versions of the Oswestry Disability Index and the Quebec Back Pain Disability Scale , 2013, European Spine Journal.

[15]  Bernadette A. Thomas,et al.  Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[16]  R. Hays,et al.  Content validity of patient-reported outcome measures: perspectives from a PROMIS meeting , 2012, Quality of Life Research.

[17]  Pu Wang,et al.  Content comparison of questionnaires and scales used in low back pain based on the international classification of functioning, disability and health: a systematic review , 2012, Disability and rehabilitation.

[18]  Martin Underwood,et al.  Non-specific low back pain , 2012, The Lancet.

[19]  N. Leidy,et al.  Content validity--establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report: part 1--eliciting concepts for a new PRO instrument. , 2011, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[20]  Elizabeth Molsen,et al.  Content validity--establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO Good Research Practices Task Force report: part 2--assessing respondent understanding. , 2011, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[21]  Christophe Demoulin,et al.  Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland‐Morris Disability Questionnaire (RDQ) , 2011, Arthritis care & research.

[22]  M. McGirt,et al.  Evaluating Common Outcomes for Measuring Treatment Success for Chronic Low Back Pain , 2011, Spine.

[23]  Caroline B. Terwee,et al.  Measurement in Medicine: A Practical Guide , 2011 .

[24]  C. Terwee,et al.  Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist , 2011, Quality of Life Research.

[25]  J. Anema,et al.  The Trend in Total Cost of Back Pain in the Netherlands in the Period 2002 to 2007 , 2011, Spine.

[26]  Yong Chul Kim,et al.  Psychometric Characteristics of the Korean Version of the Roland-Morris Disability Questionnaire , 2011, Journal of Korean medical science.

[27]  H. Kautiainen,et al.  Reliability and Validity Study of the Finnish Version 2.0 of the Oswestry Disability Index , 2011, Spine.

[28]  C. Terwee,et al.  The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. , 2010, Journal of clinical epidemiology.

[29]  Jeremy S. Lewis,et al.  Outcome measures in chronic low back pain , 2010, European Spine Journal.

[30]  C. Terwee,et al.  The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study , 2010, Quality of Life Research.

[31]  A. Nitz,et al.  Psychometric properties of the Roland-Morris Disability Questionnaire compared to the Oswestry Disability Index: a systematic review , 2009 .

[32]  T. Christensen,et al.  Qualitative research and content validity: developing best practices based on science and experience , 2009, Quality of Life Research.

[33]  C. Terwee,et al.  Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments , 2009, Quality of Life Research.

[34]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions : Explanation and Elaboration , 2009 .

[35]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[36]  M. Davidson,et al.  Rasch analysis of 24-, 18- and 11-item versions of the Roland-Morris Disability Questionnaire , 2009, Quality of Life Research.

[37]  S. Stewart-Brown,et al.  Responsiveness of a Patient Specific Outcome Measure Compared With the Oswestry Disability Index v2.1 and Roland and Morris Disability Questionnaire for Patients With Subacute and Chronic Low Back Pain , 2008, Spine.

[38]  Linda Reichwein Zientek,et al.  Book Review: Exploratory and Confirmatory Factor Analysis: Understanding Concepts and Applications , 2007 .

[39]  M. Ferreira,et al.  Responsiveness of the Brazilian–Portuguese version of the Oswestry Disability Index in subjects with low back pain , 2008, European Spine Journal.

[40]  M. Davidson.  Rasch analysis of three versions of the Oswestry Disability Questionnaire. , 2008, Manual therapy.

[41]  R. Hays,et al.  Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. , 2008, Journal of clinical epidemiology.

[42]  R. Abouqal,et al.  Translation, Adaptation, and Validation of the Moroccan Version of the Roland Morris Disability Questionnaire , 2007, Spine.

[43]  J. Hartvigsen,et al.  Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients , 2006, BMC musculoskeletal disorders.

[44]  Mohamad Parnianpour,et al.  The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions , 2006, Spine.

[45]  S. Chatterji,et al.  Content Comparison of Low Back Pain-Specific Measures Based on the International Classification of Functioning, Disability and Health (ICF) , 2006, The Clinical journal of pain.

[46]  Steven P. Reise,et al.  Item Response Theory , 2005 .

[47]  N. Vøllestad,et al.  Functional Status and Disability Questionnaires: What Do They Assess?: A Systematic Review of Back-Specific Outcome Questionnaires , 2005, Spine.

[48]  N. Vøllestad,et al.  Concurrent Comparison of Responsiveness in Pain and Functional Status Measurements Used for Patients With Low Back Pain , 2004, Spine.

[49]  R. D. de Bie,et al.  ICF Core Sets for low back pain. , 2004, Journal of rehabilitation medicine.

[50]  P. A. van den Brandt,et al.  24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. , 2004, Journal of clinical epidemiology.

[51]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[52]  N. Vøllestad,et al.  Cross-cultural adaptation of the Norwegian versions of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index. , 2003, Journal of rehabilitation medicine.

[53]  P. Boscainos,et al.  Greek Versions of the Oswestry and Roland-Morris Disability Questionnaires , 2003, Clinical orthopaedics and related research.

[54]  Brett Hanscom,et al.  Is a Condition-Specific Instrument for Patients with Low Back Pain/Leg Symptoms Really Necessary?: The Responsiveness of the Oswestry Disability Index, MODEMS, and the SF-36 , 2003, Spine.

[55]  A. Garratt.  Rasch Analysis of the Roland Disability Questionnaire , 2003, Spine.

[56]  L. Göeken,et al.  Concurrent Validity of Questionnaire and Performance-Based Disability Measurements in Patients with Chronic Nonspecific Low Back Pain , 2002, Journal of Occupational Rehabilitation.

[57]  R. Niskanen.  The Oswestry Low Back Pain Disability Questionnaire a Two-Year Follow-Up of Spine Surgery Patients , 2002, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[58]  J. Fritz,et al.  A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. , 2001, Physical therapy.

[59]  C. Bombardier,et al.  Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. , 2000, Spine.

[60]  M. Roland,et al.  The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. , 2000, Spine.

[61]  P. Pynsent,et al.  The Oswestry Disability Index. , 2000, Spine.

[62]  L. Manchikanti.  Epidemiology of low back pain. , 2000, Pain physician.

[63]  Lex M Bouter,et al.  Responsiveness of general health status in chronic low back pain: a comparison of the COOP Charts and the SF-36 , 1999, PAIN.

[64]  M. Foy,et al.  Responsiveness of common outcome measures for patients with low back pain. , 1999, Spine.

[65]  R A Deyo,et al.  Outcome Measures for Low Back Pain Research: A Proposal for Standardized Use , 1998, Spine.

[66]  R. Leclaire,et al.  A Cross‐sectional Study Comparing the Oswestry and Roland‐Morris Functional Disability Scales in Two Populations of Patients With Low Back Pain of Different Levels of Severity , 1997, Spine.

[67]  D. Wilson,et al.  Management of low back pain. , 1996, Clinical radiology.

[68]  A. Beurskens,et al.  Responsiveness of functional status in low back pain: a comparison of different instruments , 1996, Pain.

[69]  P. Stratford,et al.  The Quebec Back Pain Disability Scale: measurement properties. , 1995, Spine.

[70]  P. Stratford,et al.  Assessing change over time in patients with low back pain. , 1994, Physical therapy.

[71]  A. Jette,et al.  Physical disablement concepts for physical therapy research and practice. , 1994, Physical therapy.

[72]  M. S. Patel,et al.  An introduction to meta-analysis. , 1989, Health Policy.

[73]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[74]  M. Roland,et al.  A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. , 1983, Spine.

[75]  J C Fairbank,et al.  The Oswestry low back pain disability questionnaire. , 1980, Physiotherapy.

[76]  H. Kraus,et al.  Diagnosis and treatment of low back pain. , 1952, GP.

[77]  Stefan J Cano,et al.  Using classical test theory, item response theory, and Rasch measurement theory to evaluate patient-reported outcome measures: a comparison of worked examples. , 2015, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[78]  J. Fairbank.  Why are there different versions of the Oswestry Disability Index? , 2014, Journal of neurosurgery. Spine.

[79]  L. Letts,et al.  A Systematic Review of Head-to-Head Comparison Studies of the Roland-Morris and Oswestry Measures' Abilities to Assess Change. , 2013, Physiotherapy Canada. Physiotherapie Canada.

[80]  Ets Spc,et al.  Item Response Theory , 2013 .

[81]  Caroline B. Terwee,et al.  Measurement in Medicine: Index , 2011 .

[82]  M. Monticone,et al.  Responsiveness of the Oswestry Disability Index and the Roland Morris Disability Questionnaire in Italian subjects with sub-acute and chronic low back pain , 2011, European Spine Journal.

[83]  A. Sadosky,et al.  Assessing Dimensionality and Responsiveness of Outcomes Measures for Patients with Low Back Pain , 2011, Pain practice : the official journal of World Institute of Pain.

[84]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[85]  J. Caro,et al.  A systematic review of low back pain cost of illness studies in the United States and internationally. , 2008, The spine journal : official journal of the North American Spine Society.

[86]  C. Terwee,et al.  Quality criteria were proposed for measurement properties of health status questionnaires. , 2007, Journal of clinical epidemiology.

[87]  Bryce B. Reeve,et al.  Applying item response theory modelling for evaluating questionnaire item and scale properties , 2005 .

[88]  A. Mannion,et al.  Development of a German version of the Oswestry Disability Index. Part 2: sensitivity to change after spinal surgery , 2004, European Spine Journal.

[89]  A. Mannion,et al.  Development of a German version of the Oswestry Disability Index. Part 1: cross-cultural adaptation, reliability, and validity , 2004, European Spine Journal.

[90]  K. Jordan,et al.  Does questionnaire structure influence response in postal surveys? , 2003, Journal of clinical epidemiology.

[91]  Jennifer L Keating,et al.  A comparison of five low back disability questionnaires: reliability and responsiveness. , 2002, Physical therapy.

[92]  Adams Ah,et al.  Functional outcomes of low back pain: comparison of four treatment groups in a randomized controlled trial. , 1992 .

[93]  K. Jacobs.  Functional outcomes of low back pain: comparison of four treatment groups in a randomized controlled trial. , 1992, Journal of manipulative and physiological therapeutics.

[94]  Christine E. DeMars,et al.  Item Response Theory , 2010, Assessing Measurement Invariance for Applied Research.