Developing the Total Disability Index Based on an Analysis of the Interrelationships and Limitations of Oswestry and Neck Disability Index.
METHODS
Retrospective.


OBJECTIVE
This study assessed the feasibility of combining Oswestry and Neck Disability Index (ODI and NDI) into 1 shorter "Total Disability Index" (TDI) from which reconstructed scores could be computed.


BACKGROUND
ODI and NDI are not pure assessments of disability related to back and neck, respectively. Because of similarities/redundancies of questions, ODI scores may be elevated in neck-pain patients and the converse is true for NDI in back-pain patients.


METHODS
Spine patients completed ODI and NDI, and complaints were recorded as back pain (BP), neck pain (NP), or both (BNP). Questionnaire scores were compared across cohorts via descriptives and Spearman (ρ) correlations. In exploring the feasibility of merging ODI/NDI, TDI was constructed from 9 ODI and 5 NDI items. Extracting questions from TDI, reconstructed 9-item rODI and 10-item rNDI indices were formed and compared with true ODI/NDI.


RESULTS
There were a total of 1207 patients: 741 BP, 134 NP, and 268 BNP. Mean ODI was 37 ± 21 and mean NDI was 32 ± 21. Patients with concurrent BP and NP had significantly more disability. Seventy-eight patients of 134 (58%) patients with NP only had at least "moderate disability" by ODI and 297 of 741 (40%) patients with back pain only, had at least "moderate disability" by NDI. ODI versus NDI correlation was ρ = 0.755; ODI versus reconstructed rODI correlated at ρ = 0.985, and NDI versus reconstructed rNDI correlated at ρ = 0.967 (P < 0.01).


CONCLUSIONS
Elevated ODI/NDI scores in patients with isolated complaints show that disability in 1 region affects scores on both surveys. This study constructed a 14-item TDI that represents every domain of ODI/NDI with exception of ODI "Sex Life." From this TDI, reconstructed scores correlated near perfectly with true scores. TDI provides a more global assessment of spinal disability and is a questionnaire that reduces the time burden to patients. The TDI allows for simultaneous assessment of back, neck, and global spinal disability.
*NYULMC Hospital for Joint Diseases, Department of Orthopaedic Surgery, Spine Division, New York City, NY †UCSF Medical Center, Department of Neurological Surgery, San Francisco, CA.
Matthew A
MA
Spiegel
Renaud
R
Lafage
Virginie
V
Lafage
Devon
D
Ryan
Bryan
B
Marascalchi
Yuriy
Y
Trimba
Christopher
C
Ames
Bradley
B
Harris
Elizabeth
E
Tanzi
Jonathan
J
Oren
Shaleen
S
Vira
Thomas
T
Errico
Frank
F
Schwab
Themistocles S
TS
Protopsaltis
D001416:Back Pain / Q000453:epidemiology* / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000453:epidemiology* / Q000503:physiopathology; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index