The Quebec Back Pain Disability Scale

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The Quebec Back Pain Disability Scale
This questionnaire is about the way your back pain is affecting your daily life. People with back problems may find it difficult to perform some of their daily activities.
Nameyour full name
We would like to know if you find it difficult to perform any of the activities listed below, because of your back. For each activity there is a scale of 0 to 5. Please choose one response option for each activity (do not skip any activities) and circle the corresponding number. Today, do you find it difficult to perform the following activities because of your back?
1. Get out of bedselect just one
2. Sleep through the nightselect just one
3. Turn over in bedselect just one
4. Ride in a carselect just one
5. Stand up for 20-30 minutesselect just one
6. Sit in a chair for several hoursselect just one
7. Climb one flight of stairsselect just one
8. Walk a few blocks (300-400 m)select just one
9. Walk several kilometresselect just one
10. Reach up to high shelvesselect just one
11. Throw a ballselect just one
12. Run one block (about 100m)select just one
13. Take food out of the refrigeratorselect just one
14. Make your bedselect just one
15. Put on socks (pantyhose)select just one
16. Bend over to clean the bathtubselect just one
17. Move a chairselect just one
18. Pull or push heavy doorsselect just one
19. Carry two bags of groceriesselect just one
20. Lift and carry a heavy suitcaseselect just one
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