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Oswestry Low Back Pain Disability Questionnaire (Oswestry Disability Index)
This questionnaire has been designed to give clinicians information as to how your back or leg pain is affecting your ability to manage everyday in life. Please answer by choosing ONE option in the dropdown of each section for the statement that best applies to you. I realize you may consider that two or more statements in any one section apply but please just select the statement which most clearly describes your problem.
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Name
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First
Last
Section 1: Pain Intensity
I have no pain at the moment
The pain is very mild at the moment
The pain is moderate at the moment
The pain is fairly severe at the moment
The pain is very severe at the moment
The pain is the worst imaginable at the moment
Section 2: Personal Care (Washing, Dressing, etc.)
I can look after myself normally without causing extra pain
I can look after myself normally but it causes extra pain
It is painful to look after myself and I am slow and careful
I need some help but manage most of my personal care
I need help every day in most aspects of self-care
I do not get dressed, I wash with difficulty and stay in bed
Section 3: Lifting
I can lift heavy weights without extra pain
I can lift heavy weights but it gives extra pain
Pain prevents me from lifting heavy weights of the floor, but I can manage if they are conveniently placed eg. on a table
Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned
I can lift very light weights
I cannot lift or carry anything at all
Section 4: Walking
Pain does not prevent me walking any diistance
Pain prevents me from walking more than 1 mile
Pain prevents me from walking more than 1/2 mile
Pain prevents me from walking more than 100 yards
I can only walk using a cane or walker
I am in bed most of the time
Section 5: Sitting
I can sit in any chair as long as I like
I can only sit in my favorite chair as long as I like
Pain prevents me from sitting more than one hour
Pain prevents me from sitting more than 30 minutes
Pain prevents me from sitting more than 10 minutes
Pain prevents me from sitting at all
Section 6: Standing
I can stand as long as I want without extra pain
I can stand as long as I want but it gives me extra pain
Pain prevents me from standing for more than one hour
Pain prevents me from standing for more than 30 minutes
Pain prevents me from standing for more than 10 minutes
Pain prevents me from standing at all
Section 7: Sleeping
My sleep is never disturbed by pain
My sleep is occasionally disturbed by pain
Because of pain I have less than 6 hours of sleep
Because of pain I have less than 4 hours of sleep
Because of pain I have less than 2 hours of sleep
Pain prevents me from sleeping at all
Section 8: Sex Life (if applicable)
My sex life is normal and causes no extra pain
My sex life is normal but causes some extra pain
My sex life is nearly normal but is very painful
My sex life is restricted by pain
My sex life is nearly absent because of pain
Pain prevents any sex life at all
Section 9: Social Life
My social life is normal and give me no extra pain
My social life is normal but increases the degree of pain
Pain has no significant effect of my social life apart from limiting my more energetic interests, eg. sport
Pain has restricted my social life and I do not go out as often
Pain has restricted my social life to my home
I have no social life because of pain
Section 10: Traveling
I can travel anywhere without pain
I can travel anywhere but it gives me extra pain
Pain is bad but I manage journeys over two hours
Pain restricts me to journeys of less than one hour
Pain restricts me to short necessary journeys under 30 minutes
Pain prevents me from traveling except to receive treatment
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