Sex Life Question on Oswestry Disability Index is Accurately Answered by Most Patients with Chronic Low Back Pain
Anecdotal evidence suggests that the sex life-related question of the Oswestry Disability Index (ODI-8) may need to be altered because it is either inaccurately answered or limits patient participation in the survey. In a new study, researchers found that while nearly half of patients with chronic low back pain did not answer ODI-8, those who did complete this question answered correctly. The authors concluded that section 8 (Figure 1) does not need to be removed or changed in the ODI.
Why ODI-8 is Believed to be Answered Inaccurately
“It is anecdotally believed that patients often complete ODI-8 in regard to psychosocial factors rather than pain-related factors,” explained senior author Laurence A.G. Marshman, MD, FRACS, Consultant Neurosurgeon, Institute of Surgery, The Townsville Hospital, Townsville, Queensland, Australia. “For example, patients may score ODI-8 highly because they abstain from sex because they have had radiotherapy for prostate cancer, do not have a partner, etc. If sex was an option, pain may not have, in fact, actually affected it. Respondents should avoid completing ODI-8 if it is not applicable; however, many believe that respondents do not actually do this. Instead, it is believed that ODI-8 is completed incorrectly.”
“Further, it is believed that ODI-8 may actually cause complete ODI avoidance,” Dr. Marshman explained. “For example, in some cultures, sex is taboo: patients may feel inclined to decline ODI participation altogether when they see ODI-8 as they quickly scan through first. Evidence that ODI-8 is anecdotally believed to cause problems exists in the fact that multiple ODI versions without ODI-8 have been generated,” Dr. Marshman explained.
Based on the study findings, “We hope that only one ODI version will be used, and that we can all be satisfied that ODI-8 is validated. One ODI version would help to standardize all research,” Dr. Marshman said.
Half of Patients With Chronic Low Back Pain Did Not Complete ODI-8
The study was conducted at a multidisciplinary back pain clinic in Australia and included patients age 18 years and older with low back pain for at least 3 months. Of the 88 patients eligible to enroll in the study, 65 patients (age 19 to 80 years) participated.
While 34 of the 66 patients (47.7%) did not complete ODI-8, 100% of the patients completed the rest of the ODI item, suggesting that the ODI-8 does not deter participation in the overall ODI. Nonresponders were significantly older than responders (mean, 60.6 vs 47.8 years; P=0.001) and smoked significantly fewer cigarettes per day (1.9 vs 8.3; P=0.05). No other significant demographic differences were found.
Among responders, ODI-8 was correlated with prospectively identified pain-correlated questionnaire reponses (eg, Short Form-12 version 2, Short-Form McGill Pain Questionnaire–version 2, and the Fear-Avoidance Beliefs Questionnaire), but not non-pain–correlated questionnaires. Thus, ODI-8 is considered an accurate measure of pain-mediated sexual inactivity, according to the authors.
The authors also noted that 85% of the overall group completed the other questionnaires on chronic low back pain, suggesting that the low response to ODI-8 cannot be attributed to a dislike of completing questionnaires on chronic low back pain in this population.
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