CAT of the Oswestry and Roland Morris

A Critical Appraisal of the responsiveness of a patient specific outcome measure compared with the Oswestry Disability Index v2.1 and Roland and Morris Disability Questionnaire


P: For patients with at least a six week history of back and/or leg pain

I: is the patient specific outcome measure

C: as compared to the Oswestry Disability Index and Roland and Morris Disability Questionnaire

O: as responsive



Vincent Gutierrez, PT, MPT, cert. MDT



Ovidsp with title term of “Oswestry”. The results were limited to full text.   73 citations were found with no limit to year published.


Date of Search: February 22,2014



Frost H, Lamb S, Stewart-Brown S. Responsiveness of a Patient Specific Outcome Measure Compared With the Oswestry Disability Index v2.1 and Roland and Morris Disability Questionnaire for Patients With Subacute and Chronic Low Back Pain. Spine 2008;33(22):2450-2457.




The purpose of this study is to assess the responsiveness of the Patient Specific Activity Questionnaire compared to the Oswestry Disability Index v2.1 and the Roland and Morris Disability Questionnaire.


The inclusion criteria were subjects at least 18 years old, with at least a 6-week history of low back pain. Subjects with or without leg pain and/or neurological signs were also included. Subjects were excluded for the following: serious pathologies, gynecological problems, ankylosing spondylitis, tumors, infection, past spinal operations, pregnancy, serious spinal pathology, unable or unwilling to complete questionnaires independently, received physical therapy in the previous month or were referred for intensive functional restoration.


The subjects were randomized to either a physiotherapy advice group or an advice with additional physiotherapy intervention group, which was not described. The subjects completed the following measures both prior to intervention and after 12 months: the Patient Specific Activity Questionnaire (PSAQ), the Oswestry Disability Index v2.1 (ODI), the Roland and Morris Disability Questionnaire (RMDQ), and the Global Transition Rating Scale (GTRS).


Subjects were divided into three groups, based on the GTRS, after 12 months: better, same or worse. The change score was calculated by subtracting the baseline scores from the follow-up scores for the ODI, RMDQ and the PSAQ. A relationship was established between the GTRS and each of the latter three outcome measures using 1 way analysis of variance (ANOVA).


Of the 286 subjects randomized initially, 201 completed the follow-up questionnaire. The PSAQ is responsive among subjects noting improvement, but is less sensitive to those reporting no improvement, when compared to the ODI and RMDQ.



The validity of the study is questionable, as there are flaws in the design. The authors do not account for the patient’s lost to follow-up, which may alter the results of the study. The authors fail to note the differences between the two groups at baseline, with regards to demographics. The authors note that a P value of <0.01 was utilized to differentiate among the outcome measures, which provides for a more limited confidence interval to detect true change.


The authors note the area under an operating receiver operator curve as follows: ODI as 0.752, PSAQ as 0.751 and RMDQ as 0.689. This indicates the order of responsiveness to change respectively.


Because the study results indicate that the tested outcome measure (PSAQ) is less sensitive to those patient’s with little change in status pre-post intervention, it would be prudent to utilize an outcome measure than can assess both small and large changes in status, such as the ODI and RMDQ.



With patients presenting to the clinic with complaints of at least a six week history of low back pain, with or without leg symptoms, the ODI would be the most effective to assess change.



Author: Dr. Vince Gutierrez, PT, cert. MDT

After having dedicated 8 years to growing my knowledge regarding the profession of physical therapy, it seems only fitting that I join the social media world in order to spread a little of the knowledge that I have gained over the years. This by no means is meant to act in place of a one-one medical consultation, but only to supplement your baseline knowledge in which to choose a practitioner for your problem. Having completed a Master of Physical Therapy degree, the MDT (Mechanical Diagnosis and Therapy) certification and currently finishing a post-graduate doctorate degree, I have spent the previous 12 years in some sort of post-baccalalaureate study. Hopefully the reader finds the information insightful and uses the information in order to make more informed healthcare decisions. MISSION STATEMENT: My personal mission statement is as follows: As a professional, I will provide a thorough assessment of your clinical presentation and symptoms in order to determine both the provocative and relieving positions and movements. The assessment process and ensuing treatment will be based on current and relevant evidence. Furthermore, I will educate the patients regarding their symptoms and their likelihood of improving with either skilled therapy, an independent exercise program, spontaneous recovery or if the patient should be referred to a separate specialist to possibly provide a more rapid resolution of symptoms. Respecting the patient’s limited resources is important and I will provide an accurate overview of the prognosis within 7 visits, again based on current research. My goal is to empower the patient in order to take charge of both the symptomatic resolution and return to full function with as little dependence on the therapist as possible. Personally, I strive to be an example for family and friends. My goal is to demonstrate that success is not a byproduct of situations, but a series of choices and actions. I will mentor those, in any way possible, that are having difficulty with the choices and actions for success. I will continue to honor my family’s “blue-collar” roots by working to excel at my chosen career and life situations. I choose to be a leader of example, and not words, all the while reducing negativity in my life. I began working towards the professional aspect of the mission statement while still in physical therapy school. By choosing an internship that emphasized patient care and empowering the patient, instead of the internship that was either closest to home or where I knew that I would have the easiest road to graduation, I took the first step towards learning how to utilize the evidence to teach patients how to reduce their symptoms. I continued this process by completing Mechanical Diagnosis and Therapy courses A-D and passing the credentialing exam. I will continue to pursue my clinical education through CEU’s on MDT and my goal is to obtain the status of Diplomat of MDT. Returning back to school for the t-DPT was a major decision for me, as resources (i.e. time and money) are limited. My choice was between saving money for the Dip MDT course (about 15,000 dollars) and continuing on with the Fellowship of American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) (about 5,000 dollars), as these courses are paired through the MDT curriculum or returning to school to work towards a Doctorate of Physical Therapy degree. I initially planned on saving for the Dip MDT and FAAOMPT, but life changes forced me to re-evaluate my situation. The decision then changed to return for the tDPT, as my employer paid for a portion of the DPT program. My goal for applying to and finishing the Dip MDT and FAAOMPT is 10 years. This is how long I anticipate that it will take to finish paying student loans and save for both programs, based on the current rate of payment. I don’t know if I will ever accomplish what I set forth in the mission statement, but I do know that it will be a forever struggle to maintain this standard that I set for myself.

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