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

Emaila valid email

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

I have no pain at the momentThe pain is very mild at the momentThe pain is moderate at the momentThe pain is fairly severe at the momentThe pain is very severe at the momentThe pain is the worst imaginable at the moment

Section 2 – Personal care (washing, dressing etc)select one

I can look after myself normally without causing extra painI can look after myself normally but it causes extra painIt is painful to look after myself and I am slow and carefulI need some help but manage most of my personal careI need some help but manage most of my personal careI do not get dressed, I wash with difficulty and stay in bed

Section 3 – Liftingselect one

I can lift heavy weights without extra painI can lift heavy weights but it gives extra painPain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently placed eg. on a tablePain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positionedPain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positionedI can lift very light weightsI cannot lift or carry anything at all

Section 4 – Walkingselect one

Pain does not prevent me walking any distancePain prevents me from walking more than 2 kilometresPain prevents me from walking more than 1 kilometrePain prevents me from walking more than 500 metresI can only walk using a stick or crutchesI am in bed most of the time

Section 5 – Sittingselect one

I can sit in any chair as long as I likeI can only sit in my favourite chair as long as I likePain prevents me sitting more than one hourPain prevents me from sitting more than 30 minutesPain prevents me from sitting more than 10 minutesPain prevents me from sitting at all

Section 6 – Standingselect one

I can stand as long as I want without extra painI can stand as long as I want but it gives me extra painPain prevents me from standing for more than 1 hourPain prevents me from standing for more than 3 minutesPain prevents me from standing for more than 10 minutesPain prevents me from standing at all

Section 7 – Sleepingselect one

My sleep is never disturbed by painMy sleep is occasionally disturbed by painBecause of pain I have less than 6 hours sleepBecause of pain I have less than 4 hours sleepBecause of pain I have less than 2 hours sleepPain prevents me from sleeping at all

Section 8 – Sex life (if applicable)select one

My sex life is normal and causes no extra painMy sex life is normal but causes some extra painMy sex life is nearly normal but is very painfulMy sex life is severely restricted by painMy sex life is nearly absent because of painPain prevents any sex life at all

Section 9 – Social lifeselect one

My social life is normal and gives me no extra painMy social life is normal but increases the degree of painPain has no significant effect on my social life apart from limiting my more energetic interests eg, sportPain has restricted my social life and I do not go out as oftenPain has restricted my social life to my homeI have no social life because of pain

Section 10 – Travellingselect one

I can travel anywhere without painI can travel anywhere but it gives me extra painPain is bad but I manage journeys over two hoursPain restricts me to journeys of less than one hourPain restricts me to short necessary journeys under 30 minutesPain prevents me from travelling except to receive treatment