Asian Spine J.  2018 Dec;12(6):1106-1116. 10.31616/asj.2018.12.6.1106.

Development of a Modified Disability Questionnaire for Evaluating Disability Caused by Backache in India and Other Developing Countries

Affiliations
  • 1Department of Orthopedics, Yenepoya Medical College, Mangalore, India.
  • 2Kasturba Medical College, Mangalore, India. samkumar890@gmail.com

Abstract

STUDY DESIGN: Prospective observational study. PURPOSE: To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. OVERVIEW OF LITERATURE: The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI.
METHODS
In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients.
RESULTS
According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach's alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach's alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach's alpha=0.712, p>0.05) and pain (Cronbach's alpha=0.625, p>0.05).
CONCLUSIONS
A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.

Keyword

Spine; Back pain; Oswestry Disability Index; Surveys and questionnaire

MeSH Terms

Activities of Daily Living
Back Pain*
Developing Countries*
Humans
India*
Low Back Pain
Observational Study
Prospective Studies
Sexual Behavior
Spine
Visual Analog Scale
Walking
Weight Lifting
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