Injured Workers are frequently given questionnaires and indexes to fill out as part of their workers’ compensation treatment and evaluations. These questionnaires and indexes can play an important role with respect to workers’ compensation benefits.
One of the indexes that an Injured Worker may encounter is the Owestry Disability Index. This article will discuss the Owestry Disability Index (ODI), what it is used for, how is it scored, problems with scoring, and how it is used for in the workers’ compensation setting.
Why Are Indexes Used?
Indexes are a quick way of address one’s disability state. Sometimes, simple questions can provide an accurate picture as to an Individual’s physical state and their capabilities. In Workers’ Compensation, due to the employment of the American Medical Association Guide to the Evaluation of Permanent Impairment, 5th Edition, there is a focus on an Individual’s “Activities of Daily Living.” For an article on Activities of Daily Living, click here.
What is the Oswestry Disability Index?
“The Oswestry Disability Index (ODI) is one of the most commonly used outcome measures for individuals with low back pain (LBP)”Psychometric properties and clinical usefulness of the Oswestry Disability Index, Michael Vianin J Chiropr Med. 2008 Dec; 7(4): 161–163.
doi: 10.1016/j.jcm.2008.07.001 PMCID: PMC2697602 PMID: 19646379
“The ODI is a self-administered questionnaire that requires 5 minutes to complete and 1 minute to score. Scores are associated with degree of disability ranging from minimal to bedbound. The ease of administering, scoring, and interpreting renders the ODI a potentially meaningful tool in clinical practice.” Supra.
What is the Owestry Disability Index Used For?
As noted above, the Owestry Disability Index is used to make assessments for Low Back Injuries. Essentially, it is the self-reporting of the Patient.
For workers’ compensation purposes, functional status is important in assessing a variety of workers’ compensation issues. These issues can include disability status- temporary total, permanent and stationary, permanent total disability, and credibility. Credibility can speak towards the truthfulness of the Injured Worker’s complaints versus possible malingering. A physician encountering malingering may use that finding as a basis to cut-off temporary disability benefits or assign a low level of impairment/permament disability.
“The ODI is a valid, reliable, and responsive condition-specific assessment tool that has withstood the test of time and scrutiny.3 So far, it has been used mostly in chronic and severely disabled populations, but shows good indicators for the assessments of less severe complaints.” Supra.
How Does Owestry Approach Back Injuries?
The Owestry Disability Index looks at the Injured Worker’s ability to perform Activities of Daily Living. The Index focuses on 10 sections designed to make such an assessment. Each section is scored with a 0-5 number. 0 being the least disability and 5 being the greatest.
What Are The Questions Asked in the Owestry Disability Index?
- PAIN INTENSITY
I can tolerate the pain I have without having to use pain killers
The pain is bad but I manage without taking pain killers
Pain killers give complete relief from pain
Pain killers give moderate relief from pain
Pain killers give very little relief from pain … Pain killers have no effect on the pain and I do not use them
- PERSONAL CARE (e.g. Washing, Dressing)
I can look after myself normally without causing extra pain
I can look after myself normally but it causes extra pain
It is painful to look after myself and I am slow and careful
I need some help but manage most of my personal care
I need help every day in most aspects of self care
I don’t get dressed, I was with difficulty and stay in bed
I can lift heavy weights without extra pain
I can lift heavy weights but it gives extra pain
Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table
Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned
I can lift very light weights
I cannot lift or carry anything at all
Pain does not prevent me walking any distance
Pain prevents me walking more than one mile
Pain prevents me walking more than ½ mile
Pain prevents me walking more than ¼ mile
I can only walk using a stick or crutches
I am in bed most of the time and have to crawl to the toilet
I can sit in any chair as long as I like
I can only sit in my favorite chair as long as I like
Pain prevents me from sitting more than one hour
Pain prevents me from sitting more than ½ hour
Pain prevents me from sitting more than 10 minutes
Pain prevents me from sitting at all
I can stand as long as I want without extra pain
I can stand as long as I want but it gives me extra pain
Pain prevents me from standing for more than one hour
Pain prevents me from standing for more than 30 minutes
Pain prevents me from standing for more than 10 minutes
Pain prevents me from standing at all
Pain does not prevent me from sleeping well
I can sleep well only by using medication
Even when I take medication, I have less than 6 hrs sleep
Even when I take medication, I have less than 4 hrs sleep
Even when I take medication, I have less than 2 hrs sleep
Pain prevents me from sleeping at all
- SOCIAL LIFE
My social life is normal and gives me no extra pain
My social life is normal but increases the degree of pain
Pain has no significant effect on my social life apart from limiting my more energetic interests, i.e. dancing, etc.
Pain has restricted my social life and I do not go out as often
Pain has restricted my social life to my home
I have no social life because of pain
I can travel anywhere without extra pain
I can travel anywhere but it gives me extra pain
Pain is bad, but I manage journeys over 2 hours
Pain restricts me to journeys of less than 1 hour
Pain restricts me to short necessary journeys under 30 minutes
Pain prevents me from traveling except to the doctor or hospital
- EMPLOYMENT/ HOMEMAKING
My normal homemaking/ job activities do not cause pain.
My normal homemaking/ job activities increase my pain, but I can still perform all that is required of me.
I can perform most of my homemaking/ job duties, but pain prevents me from performing more physically stressful activities (e.g. lifting, vacuuming)
Pain prevents me from doing anything but light duties.
Pain prevents me from doing even light duties.
Pain prevents me from performing any job or homemaking chores.
See Fairbank JC, Pynsent PB. “The Oswestry Disability Index.” Spine 2000: 25(22):2940-2952; Fairbank JCT, Couper J, Davies JB. “The Oswestry Low Back Pain Questionnaire.” Physiotherapy 1980; 66:271-273
How It is Scored? Is There a Problem With Scoring?
“The index is calculated by dividing the summed score by the total possible score, which is then multiplied by 100 and expressed as a percentage. Thus, for every question not answered, the denominator is reduced by 5. If a patient marks more than one statement in a question, the highest scoring statement is recorded as a true indication of disability.” Oswestry Disability Index Scoring Made Easy A Mehra, D Baker, S Disney, and PB Pynsent Ann R Coll Surg Engl. 2008 Sep; 90(6): 497–499. doi: 10.1308/003588408X300984
Scoring of the test can be problematic. First, the individual may not understand the questions asked and answer them incorrectly. There can be language or literacy issues that can come into play. Second, the individuals scoring the test may not use the highest score or may calculate the result appropriately. See Oswestry Disability Index Scoring Made Easy A Mehra, D Baker, S Disney, and PB Pynsent Ann R Coll Surg Engl. 2008 Sep; 90(6): 497–499. doi: 10.1308/003588408X300984 (re: Issues concerning staff scoring tests accurately and their training)
What Does the Score Mean?
The scores of ODI are as follow:
0 – 4 No disability
5 – 14 Mild disability
15 – 24 Moderate disability
25 – 34 Severe disability
35 – 50 Completely disabled
See Fairbank JC, Pynsent PB. “The Oswestry Disability Index.” Spine 2000: 25(22):2940-2952 Fairbank JCT, Couper J, Davies JB. “The Oswestry Low Back Pain Questionnaire.” Physiotherapy 1980; 66:271-273
What Do These Disability Terms Mean?
No disability The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting, sitting and exercise.
Mild disability The patient experiences more pain and difficulty with sitting, lifting and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected and the patient can usually be managed by conservative means.
Moderate disability Pain remains the main problem in this group but activities of daily living are affected. These patients require a detailed investigation.
Severe disability Back pain impinges on all aspects of the patient’s life. Positive intervention is required.
Completely disabled These patients are either bed-bound or are exaggerating their symptoms.
What Does This Mean In Workers’ Compensation?
The Index can help address the credibility of the Injured Worker. Is the scoring commensurate with the pathology? For example, if someone scores “Completely Disabled” but has a minor back sprain, malingering comes into question. If someone post-back surgery scores as “Moderate”, they would most likely be viewed as credible. In sum, an ODI score can either raise a “red flag” concerning an Injured Work or be a confirmatory basis for assigning impairment, disability status or permanent disability.
What If I Need Legal Advice?
If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information. Click Here.