Please read instructions: When your back hurts, you may find it difficult to do some of the things you normally do. Mark only the sentences that describe you today.
  • Name*full name
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  • Email*a valid email address
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    I stay at home most of the time because of my back.
    I change position frequently to try to get my back comfortable.
    I walk more slowly than usual because of my back.
    Because of my back, I am not doing any jobs that I usually do around the house.
    Because of my back, I use a handrail to get upstairs.
    Because of my back, I lie down to rest more often.
    Because of my back, I have to hold on to something to get out of an easy chair.
    Because of my back, I try to get other people to do things for me.
    I get dressed more slowly than usual because of my back.
    I only stand up for short periods of time because of my back.
    Because of my back, I try not to bend or kneel down.
    I find it difficult to get out of a chair because of my back.
    My back is painful almost all of the time.
    I find it difficult to turn over in bed because of my back.
    My appetite is not very good because of my back.
    I have trouble putting on my socks (or stockings) because of the pain in my back.
    I can only walk short distances because of my back pain.
    I sleep less well because of my back.
    Because of my back pain, I get dressed with the help of someone else.
    I sit down for most of the day because of my back.
    I avoid heavy jobs around the house because of my back.
    Because of back pain, I am more irritable and bad tempered with people than usual.
    Because of my back, I go upstairs more slowly than usual.
    I stay in bed most of the time because of my back.
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