Oswestry Low Back Pain Disability Questionnaire
Instructions This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life.
Nameyour full name
Please answer by checking ONE box in each section for the statement which best applies to you. We realise you may consider that two or more statements in any one section apply but please just shade out the spot that indicates the statement which most clearly describes your problem.
Section 1 – Pain intensityselect one
Section 2 – Personal care (washing, dressing etc)select one
Section 3 – Liftingselect one
Section 4 – Walkingselect one
Section 5 – Sittingselect one
Section 6 – Standingselect one
Section 7 – Sleepingselect one
Section 8 – Sex life (if applicable)select one
Section 9 – Social lifeselect one
Section 10 – Travellingselect one