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STUDY DESIGN.: A total of 200 patients with low back pain (LBP) completed an English and Marathi Oswestry Disability Index (ODI) questionnaires (100 each), visual analogue scale, and Roland-Morris Disability Questionnaire. OBJECTIVE.: To validate the English and Marathi versions of ODI (version 2.1a). SUMMARY OF BACKGROUND DATA.: Patient-orientated assessment methods are important in the evaluation of treatment outcome. The ODI is one of the condition-specific questionnaires recommended for the use of patients with LBP. METHODS.: An adaptation of the ODI (version 2.1a) for Marathi language was carried out according to established guidelines. RESULTS.: Average age of patients who answered the English ODI was 42 ± 15, whereas that of Marathi-speaking patients was 52 ± 15 years. About 40% were males. The Cronbach [alpha] reliability score was 0.877 for English and 0.943 for Marathi. Forty-seven and 53 of these patients were retested with English and Marathi ODI within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient (ICC) for the test-retest reliability of the questionnaire was 0.877 and 0.943 for English and Marathi respectively. The ODI scores correlated with visual analogue scale pain intensity (r = 0.67, P < 0.0001) and Roland-Morris Disability Questionnaire score (r = 0.71, P < 0.0001) for English and visual analogue scale (r = 0.325, P < 0.001) and Roland-Morris Disability Questionnaire scores (r = 0.503, P < 0.0001) for Marathi. The receiver operating characteristic curve analysis showed comparable performance in discriminating the existence of sign and symptoms (area under curve = 0.947, P < 0.0001, 95% confidence interval: 0.893-0.999 for English and Marathi (area under curve: 0.834, P < 0.0001, 95% confidence interval: 0.735-0.933) for severe compared with nonsevere LBP proving discriminative validity. Results showed that English ODI is valid and reliable. CONCLUSION.: The Marathi version of Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as the English version. It should represent a valuable tool for use in future patient-orientated outcome studies for population with LBP in India. [ABSTRACT FROM AUTHOR]