This questionnaire has been designed to help you see how your back pain is affecting your everyday life. For every question, please select the ONE statement that best describes your back pain. Please note that this quiz is not a substitute for an assessment and diagnosis by a qualified health care provider.
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.
2. Personal Care (washing, dressing, etc.)
I can look after myself normally without causing extra pain.
I can look after myself normally but it is painful.
It is painful to look after myself and I am slow and careful.
I need some help but I 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 I stay in bed.
3. Lifting
I can lift heavy weights without extra pain.
I can lift heavy weights but it causes extra pain.
Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned, for example 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 only very light weights.
I cannot lift or carry anything at all.
4. Walking
Pain does not prevent me walking any distance.
Pain prevents me walking more than 1.6 kilometers (1 mile).
Pain prevents me walking more than 800 meters (1/2 mile).
Pain prevents me walking more than 90 meters (100 yards).
I can only walk using a stick or crutches.
I am in bed most of the time and I have to crawl to the toilet.
5. Sitting
I can sit in any chair as long as I like.
I can sit in my most comfortable chair as long as I like.
Pain prevents me from sitting for more than 1 hour.
Pain prevents me from sitting for more than half an hour (30 minutes).
Pain prevents me from sitting for more than 10 minutes.
Pain prevents me from sitting at all.
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 1 hour.
Pain prevents me from standing for more than half an hour (30 minutes).
Pain prevents me from standing for more than 10 minutes.
Pain prevents me from standing at all.
7. Sleeping
My sleep is never disturbed by pain.
My sleep is occasionally disturbed by pain.
Because of pain I get less than 6 hours sleep per night.
Because of pain I get less than 4 hours sleep per night.
Because of pain I get less than 2 hours sleep per night.
Pain prevents me from sleeping at all.
8. Sex life (if applicable)
My sex life is normal and sex causes no pain.
My sex life is normal but sex causes some extra pain.
My sex life is nearly normal but is very painful.
My sex life is severely restricted by pain.
My sex life is nearly absent because of pain.
Pain prevents any sex life at all.
Not applicable.
9. Social Life
My social life is normal and causes me no extra pain.
My social life is normal but increases the degree of pain.
Pain has no significant effect on my social life apart from limiting my more energetic interests, for example sports.
Pain has restricted my social life and I do not go out as often.
Pain has restricted my social life to home.
I have no social life because of pain.
10. Travelling
I can travel anywhere without pain.
I can travel anywhere but it causes extra pain.
Pain is bad but I manage journeys over 2 hours.
Pain restricts me to journeys of less than 1 hour.
Pain restricts me to short necessary journeys under 30 minutes.
Pain prevents me from travelling except to receive treatment.

             Score Results = %
0% to 20% Minimal disability - If pain does not subside within 48 hours consult your family physician or chiropractor.
21% to 40% Moderate disability - Consult your family physician or chiropractor for advice.
41% to 60% Severe disability - Consult your family physician or chiropractor for a thorough check-up.
61% to 80% Crippling disability - Seek immediate attention from a family physician or chiropractor. Your condition may be best tested and treated by a multi-disciplinary approach.
81% to 100% Bedbound - Seek immediate attention from a family physician or chiropractor. In this case, an ambulance may be warranted. Your condition may be best tested and treated by a multi-disciplinary approach.


† Adapted from Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry Low Back Pain Disability questionnaire. Physiotherapy 1980;66:271-3.


Advertisement