Psychometric properties of the Roland-Morris Disability Questionnaire compared to the Oswestry Disability Index: a systematic review

Objectives: To compare the psychometric properties of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index used to measure physical ability in people with low back pain. Methods: A literature search of computerised databases from 1980 through June 2009 was performed using search terms: clinical assessment tools, Roland-Morris, questionnaires, back, spine, back pain, Oswestry Disability Index, psychometrics, reliability, validity, specificity and sensitivity. Twenty-three articles were reviewed using an adult population over 18 years old with acute, sub-acute and chronic low back pain. Results: The Roland-Morris Disability Questionnaire and the Oswestry Disability Index demonstrate good reliability in test-retest performance clinically at initial evaluation and up to 6 weeks following interventions. Two studies described the construct validity of the two measures as highly correlated with each other. Overall, it appears that both questionnaires have similar responsiveness rates of 0.76-0.78 but two studies report a responsiveness rate of 0.94 for the Oswestry. Discussion/Conclusion: The Roland-Morris Disability Questionnaire is most sensitive for patients with mild to moderate disability while the Oswestry Disability Index is most effective for persistent severe disability. Clinically, both questionnaires should be considered depending on the patient's objective presentation of disability. The clinician needs to determine either 'mild to moderate' or 'severe persistent disability' after a thorough history and physical exam is completed so that the appropriate questionnaire can be administered. This helps support the clinician's assessment of function, determine a patient's level of disability and provide outcome information.