SPINE Volume 34, Number 19, pp 2090–2095
©2009, Lippincott Williams & Wilkins
Development of the Italian Version of the Oswestry
Disability Index (ODI-I)
A Cross-Cultural Adaptation, Reliability, and Validity Study
Marco Monticone, MD,* Paola Baiardi, PhD,†‡ Silvano Ferrari, PT,§ Calogero Foti, MD,¶
Raffaele Mugnai, PT,㛳 Paolo Pillastrini, PT,㛳 Carla Vanti, PT,** and Gustavo Zanoli, MD††
Study Design. Evaluation of the psychometric proper-
ties of a translated, culturally adapted questionnaire.
Objective. Translating, culturally adapting, and vali-
dating the Italian version of the Oswestry Disability Index
(ODI-I), allowing its use in Italian-speaking patients with
low back pain inside and outside Italy.
Summary of Background Data. Growing attention is
devoted to standardized outcome measures to improve
interventions for low back pain. A translated form of the
ODI in patients with low back pain has never been vali-
dated within the Italian population.
Methods. The ODI-I questionnaire was developed in-
volving forward-backward translation, final review by an
expert committee and test of the prefinal version to es-
tablish as better as possible proper correspondence with
the original English latest version (2.1a). Psychometric
testing included factor analysis, reliability by internal con-
sistency (Cronbach
␣
) and test-retest repeatability (Intra-
class Coefficient Correlation), concurrent validity by com-
paring the ODI-I to Visual Analogue Scale, (Pearson
correlation), and construct validity by comparing the
ODI-I to Roland Morris Disability Questionnaire, RMDQ,
and to Short Form Health Survey, Short Form Health
Survey-36 (Pearson correlation).
Results. The authors required a 3-month period before
achieving a shared version of the ODI-I. The questionnaire
was administered to 126 subjects, showing satisfying ac-
ceptability. Factor analysis demonstrated a 1-factor struc-
ture (45% of explained variance). The questionnaire
showed high internal consistency (
␣
⫽ 0.855) and good
test-retest reliability (ICC ⫽ 0.961). Concurrent validity
was confirmed by a high correlation with Visual Analogue
Scale (r ⫽ 0.73, P ⬍ 0.001), Construct validity revealed
high correlations with RMDQ (r ⫽ 0.819, P ⬍ 0.001), and
with Short Form Health Survey-36 domains, highly sig-
nificant with the exception of Mental Health (r ⫽⫺0.139,
P ⫽ 0.126).
Conclusion. The ODI outcome measure was success-
fully translated into Italian, showing good factorial struc-
ture and psychometric properties, replicating the results
of existing language versions of the questionnaire. Its use
is recommended in research practice.
Key words: Oswestry Disability Index, Low Back Pain,
Italian validation, outcome measures, psycho-metric prop-
erties. Spine 2009;34:2090–2095
Low back pain (LBP) constitutes a major health burden
among western countries as well as a major cause of
medical expenses, work absenteeism and disability. Life-
time prevalence of LBP is reported as over 70% in indus-
trialized populations; peak prevalence occurs between
ages 35 and 55.
1
Nearly 85% of the patients with a pain in their low
back seen by primary care practitioners are affected by
nonspecific LBP, defined as a pain not attributed to rec-
ognizable specific pathologies such as fractures, nerve
root compressions, infections, tumors, inflammatory or
systemic diseases.
2,3
Nonspecific LBP is often influenced
by heavy physical work, incorrect physical activities
(e.g., frequent bending, twisting, lifting, pulling and
pushing, and repetitive work), wrong postures, and psy-
chosocial factors (e.g., distress, mood alterations, cogni-
tive dysfunction, illness behavior, job dissatisfaction).
2,4
With such a high epidemiological and clinical burden,
it is of great importance to apply evidence-based, vali-
dated and comprehensive outcome measures to help cli-
nicians to quantify and improve interventions for LBP.
5
As supported by most researchers, a number of disease-
specific measures are available for assessing functional
outcomes related to LBP
6
: among back related function
outcome measures Oswestry Disability Index (ODI) and
Roland-Morris Disability Questionnaire (RMDQ) were
recommended.
7
Initially developed by John O’Brien in 1976, ODI 1.0
version was first published in 1980
8
; the questionnaire
was later adapted by the American Academy of Ortho-
pedic Surgeons, omitting sections 1, 8, and 9 and chang-
ing the score of each item from 0 to 5 to 1 to 6.
9
The 2.0
version (1989) was a modification of the original scale
made by a Medical Research Council group in the United
Kingdom.
10
Minor revisions were introduced in ODI ver
-
sion 2.1 (2000) for section 4 (walking)
7
; on September
2006, ODI 2.1a version was introduced, modifying instruc-
From the *Physical Medicine and Rehabilitation Unit, Scientific Insti-
tute of Lissone, Institute of Care and Research, Salvatore Maugeri
Foundation, IRCCS, Lissone, Milan, Italy; †Consorzio Valutazioni
Biologiche e Farmacologiche, Pavia University, Pavia, Italy; ‡Salvatore
Maugeri Foundation, IRCCS, Pavia, Italy; §Manual Therapy Sciences,
Padova University, Padova, Italy; ¶University of Rome Tor Vergata,
Rome, Italy; 㛳Department of Internal Medicine, S. Orsola-Malpighi
Hospital, Bologna University, Bologna, Italy; **School of Physiother-
apy, Bologna University, Bologna, Italy; ††Ferrara University and Casa
di Cura SM Maddalena, Rome, Italy.
Acknowledgment date: December 11, 2008. Acceptance date: March
23, 2009.
The manuscript submitted does not contain information about medical
device(s)/drug(s).
No funds were received in support of this work. No benefits in any
form have been or will be received from a commercial party related
directly or indirectly to the subject of this manuscript.
The Scientific and Technical Committee of the Salvatore Maugeri
Foundation approved this research.
Address correspondence and reprint requests to Marco Monticone,
MD, Via Monsignor Bernasconi, 16-20035 Lissone, Milan, Italy;
E-mail: marco.monticone@fsm.it
2090
tions of the first paragraph to consistently use present tense,
as outlined at the website of the developers.
11
The ODI represents a ten 6-point questionnaire. The
first section rates the intensity of pain and the remaining
ones cover the disabling effect of pain on typical daily
activities: personal care, lifting, walking, sitting, stand-
ing, sleeping, sex life, social life, and traveling. Each item
ranges form 0 to 5 and the sum of the 10 scores is ex-
pressed as a percentage of the maximum scores, varying
from 0 (no disability) to 100 (maximum disability). The
questionnaire is completed in about 5 minutes and
scored in less than 1 minute.
7
The psychometric properties of the original version of
the ODI were tested in a wide variety of clinical condi-
tions demonstrating satisfying degree of internal consis-
tency, reproducibility as well as face, content, concur-
rent, and construct validity.
9
To authors’ knowledge, the ODI was already vali-
dated in Greek,
12
Norwegian,
13
Japanese,
14
Turkish,
15
Korean,
16
Arabic,
17
German,
18,19
Danish,
20
Iranian,
21
and Brazilian.
22
These studies deserved great interest as
they contributed to confirm reliability and validity of the
translated forms of the questionnaire, allowing compar-
ison of results, investigating pain, disability and func-
tional status across different people and countries.
Though the Italian version of NASS/American Acad-
emy of Orthopedic Surgeons questionnaire was pub-
lished,
23
a validation trial of a translated form of the ODI
was never conducted within an Italian population. As
this lack represented a limit for clinicians and researchers
of our country to share validated outcomes, the aim of
this study was to describe translation, cultural adapta-
tion, and validation (internal consistency, reproducibil-
ity, and validity) of the Italian version of the Oswestry
Disability Index (ODI-I), in its latest version named 2.1a.
Materials and Methods
The Institutional Review Board of the Institute approved the
trial, allowing the development of the ODI-I.
Subjects
Outpatients referring to the Physical and Rehabilitation Med-
icine Units of a Research Hospital and a University Hospital of
Italy were included into the study from May to September
2008.
Inclusion criteria were: common low back pain in its sub-
acute (pain lasting more than 4 weeks) and chronic phase (pain
lasting more than 12 weeks), adult age (18 years or older),
ability to read and speak Italian fluently. Exclusion criteria
were: acute common low back pain (included recent thoraco-
lumbar trauma), specific causes of low back pain (disc hernia-
tion, lumbar stenosis, spinal deformity, fracture, spondylolis-
thesis), central or peripheral neurologic signs, systemic illness
(tumor and rheumatologic diseases), psychiatric and mental
deficits. Patients with recent cerebro-vascular accidents and
myocardial infarctions were also excluded.
All the patients included were investigated for demographic
and clinical characteristics. A specific schedule was prepared to
collect main comorbidities. All the patients eligible gave their
written consent to be involved into the study.
Translation and Cross-Cultural Adaptation
This stage followed the Guidelines for the Process of Cross-
Cultural Adaptation of Self-Report Measures.
24,25
Step 1. Forward Translation. ODI 2.1a was initially forward
translated from English into Italian. The purpose was to retain
the concept of the original scale, using culturally and clinically
fitting expressions. Two translations were performed indepen-
dently by translators with Italian as their native tongue; one of
them (naive translator) was not familiar with the measure.
Keeping the language colloquial and compatible with a reading
age level of 14 years, poorer wording choices were outlined and
resolved in a discussion between the 2 translators. With regard
to section 4 (walking), walking distances described in terms of
miles or yards (e.g., “1 mile,” “
1
⁄
2
mile,” “100 yards”) were
judged unfamiliar to the Italians: the distances were changed to
kilometers or meters (respectively, 1 kilometer, 500 m, and
100 m). Step 1 ended when a common adaptation was shared.
None of the items was excluded.
Step 2. Backward Translation. Two bilingual native English-
speaking translators backward translated the initial transla-
tion; the translators were selected because unaware of concepts
explored and without medical background. Taking into ac-
count cultural diversities, conceptual equivalence, or vocabu-
lary differences, the aim was to make sure that the Italian ver-
sion reflected the same item contents of the original version.
Step 3. Expert Committee. The translated versions were sub-
mitted to a bilingual committee composed of clinicians, meth-
odologists, and psychometricians; the 4 translators were in-
cluded. To identify difficulties, inconsistencies or mistakes in
translation, the committee explored semantic, idiomatic, expe-
riential and conceptual equivalence of items and answers op-
tions. Moreover, the committee took into consideration the
Italian version of ODI 2.1, formerly translated by one of the
authors of this work (G.Z.),
11
but neither back warded nor
validated. Step 3 ended when a prefinal version was achieved.
Step 4. Test of the Prefinal Version. The scale was delivered to
30 low back pain sufferers. This field test had the aim to probe
what was meant by each item and the chosen response; the
distribution of responses was also checked for missing items.
All the findings from this step were re-evaluated by the expert
committee, although no adjustment was further required.
Step 5. Submission to the Developer. The final shared version
of the questionnaire (see Appendix, Supplemental Digital Content
1, http://links.lww.com/BRS/A381) was sent to the developer.
Psychometric Scale Properties
Acceptability. Time needed to answer the questionnaire was
registered. Once completed, patients were asked about troubles
encountered; at the same time, examiners checked all data,
included missing or multiple responses.
Factor Analysis. The factor structure of the ODI-I was ana-
lyzed by means of a factor analysis. Cattel Scree Test was used
to determine the number of extracted factors (eigenvalues
greater than 1).
Reliability. This psychometric property was performed by
means of internal consistency and test-retest stability. The first
characteristic was examined with Cronbach
␣
estimated for the
whole questionnaire. The second characteristic was analyzed
asking the patients to complete the Questionnaire 7 days later
2091Italian ODI Version
•
Monticone et al
the first fulfillment; Intraclass Correlation Coefficient (ICC)
was applied for testing agreement between baseline and 7 day
ODI-I scores as well as to evaluate item by item agreement.
Validity. Concurrent validity was achieved comparing (Pear-
son correlations) ODI-I to Visual Analogue Scale (VAS)
26
; con
-
struct validity was achieved comparing (Pearson correlations)
ODI-I to Roland Morris Disability Questionnaire (RMDQ)
27,28
and to Short Form Health Survey (SF-36).
29,30
Statistical Methods
All statistical analyses were performed using SPSS, 15.0
(Italian version, Appendix 1, Supplemental Digital Content 1,
http://links.lww.com/BRS/A381).
Results
Subjects
The trial included a population of 126 subjects, 73 fe-
males (58%) and 53 males (42%), mean age 47 ⫾ 14
years (range: 18–89). Mean low back pain duration was
20.9 ⫾ 19.6 months (range: 1–108).
Additional socio-demographic characteristics of the
enrolled population are described in Table 1.
Translation and Cross-Cultural Adaptation
A forward backward translation was used to translate
the questionnaire into Italian, involving 4 translators. A
2-month period was necessary before a culturally
adapted version was reached. Further revision conducted
by selected experts in spinal and psychometric research
as well as a prefinal version testing (1-month length)
confirmed the work done.
Psychometric Scale Properties
Acceptability. All the questions were well accepted by
the patients. The questionnaire was completed in 6.61 ⫾
2.84 minutes (range: 2–15). Item 8 (sex life) did not re-
ceive an answer in 11.9% of patients; no other missing
responses were recorded and no multiple answers were
found. There were no problems of comprehension with
the questions.
Factor Analysis. Free factor analysis revealed a 1-factor
structure on the basis of the numbers of eigenvalues su-
perior to 1, as obtained by Cattel Scree Test (Figure 1).
This factor explained 45% of variance. Item-factor load-
ings are reported in Table 2.
Reliability. Internal consistency: Cronbach
␣
index for
ODI-I was 0.855. Test-retest stability: correlations be-
tween ODI at day 1 and at day 7 demonstrated highly
significant (ICC ⫽ 0.961; 95% CI: 0.943– 0.972). Low-
est ICC value was achieved for item 3. Repeatability
results are fully reported in Table 3.
Validity. Table 4 presents correlations between ODI-I,
VAS, RMDQ and SF-36 health survey. (1) Concurrent
validity. High correlation was found when ODI-I and
VAS were compared (r ⫽ 0.730, P ⬍ 0.001). (2) Con-
struct validity. High correlation was found when ODI-I
and RMDQ were compared (r ⫽ 0.819, P ⬍ 0.001); high
Table 1. Socio-Demographic Characteristics of
the Population
Variable N %
Married 87 69
Employed 103 81.7
Smoking 27 21.4
Frequency of pain
Sometimes 33 26.2
Often 68 54.0
Persistent 25 19.8
Leg pain 67 53.1
Drugs utilization
Antidepressants 3 2.4
Analgesics 50 39.7
Muscle relaxants 2 1.6
NSAIDs 28 22.2
None 43 34.1
Education level
Elementary 5 4.0
Mid School 17 13.5
Upper school 59 46.8
University 45 35.7
Comorbidities
Hypertension 34 27.0
NIDDM 9 7.1
Heart disease 14 11.1
Lung disease 10 8.0
Enteric disease 11 8.7
Liver disease 6 4.7
Renal failure 7 5.5
Orthopaedic disease 25 19.8
Others 10 8.0
Components
10987654321
Einge
nvalues
5
4
3
2
1
0
Figure 1. Cattel Scree Test.
Table 2. Factor Analysis Loadings
Components 1
Item 9 0.770
Item 10 0.738
Item 4 0.694
Item 5 0.673
Item 6 0.664
Item 1 0.651
Item 3 0.644
Item 8 0.635
Item 2 0.617
Item 7 0.592
2092 Spine
•
Volume 34
•
Number 19
•
2009
correlations were moreover found when ODI-I was con-
fronted to each of the 8 SF-36 domains, with the excep-
tion of Mental Health (r ⫽⫺0.139, P ⫽ 0.121).
Discussion
We performed and described a study of cross-cultural
adaptation, reliability and validity of the Italian version
of the Oswestry Disability Index (ODI-I), 2.1a version,
in a subacute/chronic LBP population.
Cross-cultural adaptation required a process of transla-
tion, backward translation, expert committee revision and
test of the prefinal version to warrant that the meaning of
the original items were adequately captured in idiomatic
translation into the Italian language: steps 1, 2, 3, and 4
indicated that this development was achieved following
recommended methodology and guidelines.
24,25
The questionnaire demonstrated to be highly accept-
able, easily understood, and self-administrable, requir-
ing only few minutes to be completed.
The employment of the factor analysis helped to indi-
viduate the factorial structure of the Italian version. A
1-factor solution for ODI-I was identified, explaining
45% of the variance. It is interesting to note that a factor
analysis was performed in 2 other cross-cultural and val-
idation trials,
17,19
which however, found a 2-factor struc
-
ture. Guermazi et al
17
named their factors as “static phys
-
ical activities” and “dynamic physical activities” while
Osthus et al
19
defined their factors as “pain-related activ
-
ity” and “pain intensity and pain-related participation.”
Internal consistency of ODI-I demonstrated strong cor-
relations (
␣
⫽ 0.855). Our finding was higher than Fisher
and Johnson (0.76)
31
and similar to Kopec et al (0.87)
32
reports in which the original English 2.0 version was imple-
mented. Our results were in agreement to most of the other
cross-cultural and adapted versions, ranging from 0.75
(Iranian version)
21
to 0.94 (Norwegian version).
13
Test-retest reliability of ODI-I assessed at day 1 and at
day 7 demonstrated an highly significant correlation
(ICC ⫽ 0.961); moreover, each item of ODI-I reported
satisfying ICC correlations, ranging from 0.804 to
0.959. Our findings were higher than Gronbland et al
(0.83)
33
and Turkish version (0.938),
15
retested after 1
week; higher results were also found when compared to
Danish version (0.91),
20
retested after 9.1 to 12 days,
while similar results were obtained when compared to
Swiss-German version (0.96),
18
retested after 6 days.
Due to the natural symptom fluctuation associated with
the memory effects, weaker correlations should be con-
sidered when comparing our results to Fairbank (0.99,
1-day retest),
8
Kopec et al (0.91, 4-day retest)
32
as well as
to other non-English ODI versions, such as Norwegian
(0.88, 2-day retest),
13
Japanese (0.93, 1-day retest),
14
Korean (0.916, 2-day retest),
16
Arabic (0.98, 3-day re
-
test),
17
Iranian (0.91, 1-day retest),
21
and Brazilian
(0.99, 1-day retest).
22
In the determination of concurrent validity, we dem-
onstrated a significant correlation between ODI-I and
VAS (r ⫽ 0.730, P ⬍ 0.001). Also Gronbland demon-
strated a positive correlation when ODI was compared
with a VAS (r ⫽ 0.62, chronic LBP).
33
Among translated
versions, moderate to good correlations were achieved in
Greek (
⫽ 0.865, acute/chronic LBP),
12
Norwegian (r ⫽
0.52, chronic LBP),
13
Turkish (r ⫽ 0.367, chronic LBP),
15
Korean (s ⫽ 0.425, chronic LBP),
16
Swiss-German (r ⫽ 0.78,
chronic LBP),
18
Iranian (r ⫽ 0.54, chronic LBP),
21
and Brazil
-
ian (r ⫽ 0.66, mainly chronic LBP)
22
populations.
In the analysis for construct validity, we compared
ODI-I to RMDQ and to SF-36, respectively. Several stud-
ies compared the Oswestry Disability Index with the Ro-
land Morris Disability Questionnaire, showing that the
measures could be related; Boscainos et al
34
and Leclaire et
al
35
found a correlation of r ⫽ 0.73 and r ⫽ 0.72, respec
-
tively. Our results supported this evidence, as the ODI-I
significantly related to the Italian version of the RMDQ
(r ⫽ 0.819, P ⬍ 0.001). Remarkably, our value was higher
than those presented in the other translated forms (Turk-
ish
15
: r ⫽ 0.815; Brazilian
22
: r ⫽ 0.81; Danish
20
: r ⫽ 0.78;
Swiss-German
18
: r ⫽ 0.80; Japanese
14
: r ⫽ 0.785; Greek
12
:
⫽ 0.729; Iranian: r ⫽ 0.71
21
).
The ODI was also expected to reveal correlations with
health-related quality of life scales. Satisfying results
were achieved when ODI-I was compared with each of
the 8 domains of SF-36 questionnaire, highly significant
with the exception of Mental Health (r ⫽⫺0.139, P ⫽
0.121). These findings were in agreement with other ex-
Table 3. Repeatability by Intraclass Coefficient
Correlation (ICC), 1–7 Day
Repeatability ICC 95% CI
Item 1 0.815 0.736–0870
Item 2 0.925 0.895–0.946
Item 3 0.804 0.725–0.861
Item 4 0.944 0.920–0.960
Item 5 0.918 0.885–0.941
Item 6 0.901 0.862–0.929
Item 7 0.831 0.768–0.878
Item 8 0.959 0.942–0.972
Item 9 0.894 0.851–0.924
Item 10 0.930 0.902–0.950
Total 0.961 0.943–0.972
Table 4. Concurrent and Construct Validity. Pearson
Correlations Between ODI-I, VAS, RMDQ, and
SF-36 Domains
Comparison rP
ODI score vs. VAS r ⫽ 0.730 P ⬍ 0.001
ODI score vs. RMDQ r ⫽ 0.819 P ⬍ 0.001
ODI score vs. SF-36 domains
SF-36 physical activity r ⫽⫺0.751 P ⬍ 0.001
SF-36 physical role r ⫽⫺0.607 P ⬍ 0.001
SF-36 physical pain r ⫽⫺0.691 P ⬍ 0.001
SF-36 health in general r ⫽⫺0.300 P ⫽ 0.001
SF-36 vitality r ⫽⫺0.406 P ⬍ 0.001
SF-36 social activities r ⫽⫺0.373 P ⬍ 0.001
SF-36 emotional role r ⫽⫺0.406 P ⬍ 0.001
SF-36 mental health r ⫽⫺0.139 P ⫽ 0.121
2093Italian ODI Version
•
Monticone et al
isting studies
36–38
in which good correlations between
ODI and SF-36 were stated. Our findings were also sup-
ported by the existing non-English ODI versions, achiev-
ing highest correlations when reporting physical func-
tion domains and moderate to low correlations when
psychosocial scales were analyzed. The Norwegian ver-
sion
13
showed better score in Physical Functioning (r ⫽
⫺0.77) and lowest scores in Mental Health (r ⫽⫺0.37),
Emotional Role (r ⫽⫺0.33), and Vitality (r ⫽⫺0.28).
The Japanese version
14
found higher values for Physical
Role (r ⫽⫺0.721) and lower scores for Mental Health
(r ⫽⫺0.603). The German version
19
reported better
scores for Physical Function (r ⫽⫺0.78), lowering when
Mental Health and Emotional Role were considered (r ⫽
⫺0.52 and r ⫽⫺48, respectively). The Danish version
stated a significant correlation when ODI was compared
to Physical Function (r ⫽⫺0.75) and to Bodily Pain (r ⫽
⫺0.65).
20
The Iranian version
21
demonstrated highest
scores in Physical function (r ⫽⫺0.68) and lowest scores
in Emotional Role (r ⫽⫺0.38), Mental Health (r ⫽
⫺0.36), and General Health (r ⫽⫺0.23). The Brazilian
version
22
found highest coefficients when Physical Func
-
tion (r ⫽⫺0.83) and Bodily Pain (r ⫽⫺0.58) were con-
sidered and lowest scores with Vitality (r ⫽⫺0.19) and
Mental Health (r ⫽⫺0.22).
Conclusion
This study described the development of translation, cul-
tural adaptation, reliability and validity of the Italian
version of ODI 2.1a, which is expected to facilitate com-
mon low back pain examination and related disability.
This form is recommended to be used for research
purposes, with special care to subacute and chronic adult
patients, both males and females. Although not exam-
ined in the present study, the authors do not find limita-
tions for the implementation of ODI-I in acute subjects
and in other causes of low back pain.
Further studies using ODI-I are suggested to focus on
minimum detectable change, minimal clinical important
difference, sensitivity with specific spinal conditions and
discrimination among levels of severity, as already re-
ported for the original version.
7,9
Key Points
● The validation of the Italian version of ODI
showed good psychometric properties, in particular
test-rest stability, internal consistency and validity.
● The factor analysis suggested a 1-factor structure.
● The ODI-I showed good correlation with the
VAS as well as the Italian RMDQ and SF-36.
● The ODI-I is recommended to be introduced in
the field of low back pain research in Italy.
Supplemental digital content is available for this article.
Direct URL citations appear in the printed text, and links to
the digital files are provided in the HTML text of this article
on the journal’s Web site (www.spinejournal.com).
Acknowledgments
The authors thank Barbara Rocca and Sergio Parazza for
the assistance provided with the trial.
References
1. Koes B, Van Tulder M. Low back pain (acute). Clin Evid 2006;15:1–3.
2. Van Tulder M, Becker A, Bekkering T, et al. European guidelines for the
management of acute nonspecific low back pain in primary care. Eur Spine J
2006;15(suppl 2):S169–91.
3. Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344:363–70.
4. Hoogendoorn WE, van Poppel MN, Bongers PM, et al. Systematic review of
psychosocial factors at work and private life as risk factors for back pain.
Spine 2000;25:2114 –25.
5. Bombardier C. Outcome assessments in the evaluation of treatment of spinal
disorders: summary and general recommendations. Spine 2000;25:3100 –3.
6. Grotle M, Brox JI, Vollestad NK. Functional status and disability question-
naires: what do they assess? A systematic review of back-specific outcome
questionnaires. Spine 2005;30:130 – 40.
7. Roland M, Fairbank J. The Roland-Morris disability questionnaire and the
Oswestry disability questionnaire. Spine 2000;25:3115–24.
8. Fairbank J, Couper J, Davies J, et al. The Oswestry low back pain question-
naire. Physiotherapy 1980;66:271–3.
9. Fairbank JCT, Pynsent PB. The Oswestry disability index. Spine 2000;25:
2940–53.
10. Baker DJ, Pynsent PB, Fairbank J. The Oswestry disability index revisited: its
reliability, repeatability, and validity, and a comparison with the St. Thomas
disability index. In: Roland M, Jenner JR, eds. Back Pain: New Approaches
to Rehabilitation and Education. Manchester, United Kingdom: Manchester
University Press; 1989:174–86.
11. Oswestry Disability Index homepage. Available at: http://www.
orthosurg.org.uk/odi/.
12. Boscainos PJ, Sapkas G, Stillanessi E, et al. Greek versions of the Oswestry
and Roland-Morris disability questionnaires. Clin Orthop 2003;411:40 –53.
13. Grotle M, Brox JI, Vollestad NK. Cross-cultural adaptation of the Norwe-
gian versions of the Roland-Morris disability questionnaire and the Oswe-
stry disability index. J Rehabil Med 2003;35:241–7.
14. Fujiwara A, Kobayashi N, Saiki K. Association of the Japanese Orthopaedic
Association Score with the Oswestry Disability Index, Roland-Morris Dis-
ability Questionnaire, and Short-Form 36. Spine 2003;28:1601–7.
15. Yakut E, Duger T, Oksuz C, et al. Validation of the Turkish version of the
Oswestry disability index for patients with low back pain. Spine 2004;29:
581–5.
16. Kim DY, Lee SH, Lee HY, et al. Validation of the Korean version of the
Oswestry disability index. Spine 2005;30:E123–7.
17. Guermazi M, Mezghani M, Ghroubi S. The Oswestry index for low back
pain translated into Arabic and validated in an Arab population. Ann Re´-
adapt Me´d Phys 2005;48:1–10.
18. Mannion AF, Junge A, Fairbank JC, et al. Development of a German version
of the Oswestry Disability Index, part 1: cross-cultural adaptation, reliabil-
ity, and validity. Eur Spine J 2005;15:55–65.
19. Osthus H, Cziske R, Jacobi E. Cross-Cultural Adaptation of a German ver-
sion of the Oswestry disability index and evaluation of its measurement
properties. Spine 2006;31:E448 –53.
20. Lauridsen HH, Hartvigsen J, Manniche C, et al. Danish version of the Os-
westry disability index for patients with low back pain, part 1: cross-cultural
adaptation, reliability and validity in two different populations. Eur Spine J
2006 15:1705–16.
21. Mousavi SJ, Parnianpour M, Mehdian H, 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 ver-
sions. Spine 2006;31:E454 –9.
22. Vigatto R, Alexandre NM, Correa Filho HR. Development of a Brazilian
Portuguese Version of the Oswestry Disability Index. Spine 2007;32:481– 6.
23. Padua R, Padua L, Ceccarelli E, et al. Cross-cultural adaptation of the lum-
bar North American Spine Society questionnaire for Italian-speaking pa-
tients with lumbar spinal disease. Spine 2001;26:E344 –7.
24. Beaton D, Bombardier C, Guilleman F, et al. Recommendations for the
Cross-Cultural Adaptation of Health Status Measures. Rosemont, IL; Amer-
ican Academy of Orthopaedic Surgeons, Institute for Work and Health;
1998.
25. Beaton DE, Bombardier C, Guillemin F, et al. Guidelines for the process of
cross-cultural adaptation of self-report measures. Spine 2000;25:3186 –91.
26. Huskinson EC. Measurement of pain. Lancet 1974;2:1127–31.
2094 Spine
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Volume 34
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Number 19
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2009
