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Is It Time to Replace the Oswestry Index With PROMIS Physical Function Computer Adaptive Test?

Léon Rijk1, Joost T P Kortlever1, George W Tipton2

  • 1Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas.

Archives of Physical Medicine and Rehabilitation
|May 8, 2020
PubMed
Summary

Psychological factors significantly influence low back pain outcomes. The Oswestry Low Back Pain Disability Index (ODI) and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) Computer Adaptive Test (CAT) show comparable sensitivity to these factors.

Keywords:
CatastrophizationDepressionLow back painPatient reported outcome measuresRehabilitation

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Area of Science:

  • Orthopedics
  • Rehabilitation Medicine
  • Psychology

Background:

  • Persistent low back pain significantly impacts patient function and quality of life.
  • Psychological factors, such as pain catastrophizing, depression, and self-efficacy, are increasingly recognized as crucial in managing chronic pain conditions.
  • Understanding the interplay between psychological status and functional outcomes is vital for effective treatment strategies.

Purpose of the Study:

  • To determine the relative influence of psychological factors on scores from the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) Computer Adaptive Test (CAT) and the Oswestry Low Back Pain Disability Index (ODI).
  • To compare the sensitivity of PROMIS PF CAT and ODI to psychological variables in patients with low back pain.

Main Methods:

  • A cross-sectional study involving 116 new and returning patients with low back pain attending specialist spine clinics.
  • Participants completed validated questionnaires assessing pain catastrophizing, depression symptoms (PHQ-2), self-efficacy (PSEQ-2), PROMIS PF CAT, and ODI via secure tablet.
  • Statistical analyses were performed to assess the variation in PROMIS PF CAT and ODI scores explained by psychological measures.

Main Results:

  • Psychological measures explained a larger proportion of variation in ODI (semipartial R²=0.48) compared to PROMIS PF CAT (semipartial R²=0.17).
  • The Oswestry Low Back Pain Disability Index (ODI) scores were independently associated with higher pain catastrophizing and lower self-efficacy.
  • PROMIS PF CAT scores were independently associated with fewer symptoms of depression. Both measures showed strong correlation (r=-0.69; P<.001).

Conclusions:

  • Both the Oswestry Low Back Pain Disability Index (ODI) and PROMIS Physical Function (PF) Computer Adaptive Test (CAT) are comparably sensitive to psychological factors in patients with persistent low back pain.
  • Given its greater administrative efficiency, clinicians may consider utilizing PROMIS PF CAT for assessing physical limitations in this patient population.
  • These findings underscore the importance of addressing psychological well-being in the comprehensive management of low back pain.