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Run: Oswestry Disability Index Scoring Sheet

Use this Oswestry Disability Index Scoring Sheet to capture ODI item responses, calculate disability percentage, and document whether change from baseline is...

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Screening Context

Assessment Date (required)

Date the ODI was completed.

Assessment Type (required)

Select whether this is the baseline or discharge administration.

Patient Identifier (required)

Use the minimum necessary identifier used by your organization for record matching. Do not enter SSN.

Completed By

Optional clinician or staff name/initials for audit trail.

ODI Item Responses

Pain Intensity (required)

Personal Care (required)

Lifting (required)

Walking (required)

Sitting (required)

Standing (required)

Sleeping (required)

Social Life (required)

Traveling (required)

Employment Status

Optional context for interpretation. Do not collect more employment detail than needed.

Scoring and Interpretation

ODI Total Score

Sum of the 9 scored items entered above.

ODI Percentage Disability

Calculated percentage disability based on the total score.

Baseline ODI Score

Enter the prior ODI total score if this is a discharge reassessment.

Change From Baseline

Positive values indicate improvement when comparing baseline to discharge.

Minimal Clinically Important Difference Met?

Use the 12.8-point threshold to interpret meaningful change when a baseline score is available.

Clinical Notes

Optional interpretation, limitations, or follow-up actions. Avoid unnecessary PII.

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