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Date of completion
Modified Oswestry Low Back Pain Disability Questionnaire
Clinician's name (or ref)
Patient's name (or ref)
 
This questionnaire has been designed to give your therapist information as to how your back pain has affected your ability to manage in everyday life.  Please answer every question by placing a mark in the box that best describes your condition today.
During the past 4 weeks......  
Section 1 - Pain Intensity   Section 6 - Standing
I can tolerate the pain I have without having to use pain medication.   I can stand as long as I want without increased pain.
The pain is bad, but I can manage without having to take pain medication.   I can stand as long as I want but it increases my pain.
Pain medication provides me with complete relief from pain.   Pain prevents me from standing for more than 1 hour.
Pain medication provides me with moderate relief from pain   Pain prevents me from standing for more than ½ an hour.
Pain medication provides me with little relief from pain   Pain prevents me from standing for more than 10 minutes.
Pain medication has no effect on my pain   Pain prevents me from standing at all.
     
Section 2 - Personal Care (e.g., Washing, Dressing)   Section 7 - Sleeping
I can take care of myself normally without causing increased pain.   My sleep is never disturbed by pain.
I can take care of myself normally, but it increases my pain.   I can sleep well only using pain medication.
It is painful to take care of myself, and I am slow and careful.   Even when I take medication, I sleep less than 6 hours.
I need help, but I am able to manage most of my personal care.   Even when I take medication, I sleep less than 4 hours.
I need help every day in most aspects of my care.   Even when I take medication, I sleep less than 2 hours.
I do not get dressed, I wash with difficulty, and stay in bed.   Pain prevents me from sleeping at all.
     
Section 3 - Lifting   Section 8 - Social Life
I can lift heavy weights without increased pain.   My social life is normal and does not increase my pain.
I can lift heavy weights, but it causes increased pain.   My social life is normal, but it increases my level of pain.
Pain prevents me from lifting heavy weights off the floor, but I can manage if the weights are conveniently positioned (e.g., on a table).   Pain prevents me from participating in more energetic activities (e.g., sports, dancing).
Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned.   Pain prevents me from going out very often.
I can lift only very light weights.   Pain has restricted my social life to my home.
I cannot lift or carry anything at all.   I have hardly any social life because of my pain.
     
Section 4 - Walking   Section 9 - Traveling
Pain does not prevent me from walking any distance.   I can travel anywhere without increased pain.
Pain prevents me from walking more than 1 mile.  (1 mile = 1.6 km)   I can travel anywhere, but it increases my pain..
Pain prevents me from walking more than 1/2 mile.   My pain restricts my travel over 2 hours.
Pain prevents me from walking more than 1/4 mile.   My pain restricts my travel over 1 hour.
I can walk only with crutches or a cane.   My pain restricts my travel to short necessary journeys under 1/2 hour.
I am in bed most of the time and have to crawl to the toilet.   My pain prevents all travel except for visits to the physician/therapist or hospital.
     
Section 5 - Sitting   Section 10 - Employment/Homemaking
I can sit in any chair as long as I like   My normal homemaking/job activities do not cause pain.
I can sit in my favourite chair for as long as I like   My normal homemaking/job activities increase my pain, but I can still perform all that is required of me..
Pain prevents me from sitting for more than 1 hour.   I can perform most of my homemaking/job duties, but pain prevents me from performing more physically stressful activities (eg., lifting, vacuuming).
Pain prevents me from sitting for more than ½ an hour   Pain prevents me from doing anything but light duties
Pain prevents me from sitting for more that 10 minutes   Pain prevents me from doing even light duties.
Pain prevents me from sitting at all.   Pain prevents me from performing any job or homemaking chores.
     

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The Oswestry Low back pain Score is: %

Reference for Score: Source: Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Physical Therapy . 2001;81:776-788.

*Modified by Fritz & Irrgang with permission of The Chartered Society of Physiotherapy, from Fairbanks JCT, Couper J, Davies JB, et al. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy . 1980;66:271-273.