Oswestry Disability Index

Oswestry Disability Index (Low Back)

Name

Date

Section 1 – Pain Intensity

I have no pain at the moment. (0) The pain is very mild at the moment. (1) The pain is moderate at the moment. (2) The pain is fairly severe at the moment.(3) The pain is very severe at the moment.(4) The pain is the worst imaginable at the moment.(5)

Section 2 – Personal Care (washing, dressing, etc.)

I can look after myself normally (0) I can look after myself normally but it is very painful. (1) It is painful to look after myself and I am slow and careful. (2) I need some help but manage most of my personal care. (3) I need help every day in most aspects of my personal care. (4) I need help every day in most aspects of self-care. (5) I do not get dressed, wash with difficulty, and stay in bed. (6)

Section 3 - Lifting

I can lift heavy weights without extra pain. (0) I can lift heavy weights but it gives extra pain. (1) Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned (i.e. on a table). (2) Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned. (3) I can lift only very light weights. (4) I cannot lift or carry anything at all. (5)

Section 4 – Walking

Pain does not prevent me walking any distance. (0) Pain prevents me walking more than 1 mile. (1) Pain prevents me walking more than ¼ of a mile. (2) Pain prevents me walking more than 100 yards. (3) I can only walk using a stick or crutches. (4) I am in bed most of the time and have to crawl to the toilet. (5)

Section 5 – Sitting

I can sit in any chair as long as I like. (0) I can sit in my favorite chair as long as I like. (1) Pain prevents me from sitting for more than 1 hour. (2) Pain prevents me from sitting for more than ½ hour. (3) Pain prevents me from sitting for more than 10 minutes. (4) Pain prevents me from sitting at all. (5)

Section 6 – Standing

I can stand as long as I want without extra pain. (0) I can stand as long as I want but it gives me extra pain. (1) Pain prevents me from standing more than 1 hour. (2) Pain prevents me from standing for more than ½ an hour. (3) Pain prevents me from standing for more than 10 minutes. (4) Pain prevents me from standing at all. (5)

Section 7 – Sleeping

My sleep is never disturbed by pain. (0) My sleep is occasionally disturbed by pain. (1) Because of pain, I have less than 6 hours sleep. (2) Because of pain, I have less than 4 hours sleep. (3) Because of pain, I have less than 2 hours sleep. (4) Pain prevents me from sleeping at all. (5)

Section 8 – Sex life (if applicable)

My sex life is normal and causes no extra pain. (0) My sex life is normal but causes some extra pain. (1) My sex life is nearly normal but is very painful. (2) My sex life is severely restricted by pain. (3) My sex life is nearly absent because of pain. (4) Pain prevents any sex life at all. (5)

Section 9 – Social Life

My social life is normal and causes me no extra pain. (0) My social life is normal but increases the degree of pain. (1) Pain has no significant effect on my social life apart from limiting my more energetic interests, i.e. sports. (2) Pain has restricted my social life and I do not go out as often. (3) Pain has restricted social life to my home. (4) I have no social life because of pain. (5)

Section 10 – Traveling

I can travel anywhere without pain. (0) I can travel anywhere but it gives extra pain. (1) Pain is bad but I manage journeys of over two hours. (2) Pain restricts me to short necessary journeys under 30 minutes. (3) Pain prevents me from traveling except to receive treatment. (4)

Section 11 - Previous Treatment Over the past three months have you received treatment, tablets or medicines of any kind for your back or leg pain? Please check the appropriate box.

No Yes (if yes, please state the type of treatment you have received)

Type of treatment

What was your final score for your low back?

Neck Disability Index

This questionnaire has been designed to give the doctor information as to how your neck pain has affected your ability to manage in everyday life. Please answer every section and mark in each section only the ONE box which applies to you. We realize you may consider that two of the statements in any one section relate to you, but please just mark the box which most closely describes your problem.

Section 1 – Pain Intensity

I have no pain at the moment. (0) The pain is very mild at the moment. (1) The pain is moderate at the moment. (2) The pain is fairly severe at the moment. (3) The pain is very severe at the moment. (4) The pain is the worst imaginable at the moment. (5)

Section 2 – Personal Care (Washing, Dressing, etc.)

I can look after myself normally without causing extra pain. (0) I can look after myself normally but it causes extra pain. (1) It is painful to look after myself and I am slow and careful. (2) I need some help but manage most of my personal care. (3) I need help every day in most aspects of self care. (4) I do not get dressed, I wash with difficulty and stay in bed. (5)

Section 3 – Lifting

I can lift heavy weights without extra pain. (0) I can lift heavy weights but it gives extra pain. (1) Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, for example on a table. (2) Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned. (3) I can lift very light weights. (4) I cannot lift or carry anything at all. (5)

Section 4 – Reading

I can read as much as I want to with no pain in my neck. (0) I can read as much as I want to with slight pain in my neck. (1) I can read as much as I want with moderate pain in my neck. (2) I cannot read as much as I want because of moderate pain in my neck. (3) I can hardly read at all because of severe pain in my neck. (4)

Section 5 – Headaches

I have no headaches at all. (0) I have slight headaches that come infrequently. (1) I have moderate headaches which come infrequently. (2) I have moderate headaches which come frequently. (3) I have severe headaches which come frequently. (4) I have headaches almost all the time. (5)

Section 6 – Concentration

I can concentrate fully when I want to with no difficulty. (0) I can concentrate fully when I want to with slight difficulty. (1) I have a fair degree of difficulty in concentrating when I want to. (2) I have a lot of difficulty in concentrating when I want to. (3) I have a great deal of difficulty in concentrating when I want to. (4) I cannot concentrate at all. (5)

Section 7 – Work

I can do as much work as I want to. (0) I can do my usual work, but no more. (1) I can do most of my usual work, but no more. (2) I cannot do my usual work. (3) I can hardly do any work at all. (4) I cannot do any work at all. (5)

Section 8 – Driving

I can drive my car without any neck pain. (0) I can drive my car as long as I want with slight pain in my neck. (1) I can drive my car as long as I want with moderate pain in my neck. (2) I cannot drive my car as long as I want because of moderate pain in my neck. (3) I can hardly drive at all because of severe pain in my neck. (4) I cannot drive my car at all. (5)

Section 9 – Sleeping

I have no trouble sleeping. (0) My sleep is slightly disturbed (less than 1 hour sleepless). (1) My sleep is mildly disturbed (1-2 hours sleepless). (2) My sleep is moderately disturbed (2-3 hours sleepless). (3) My sleep is greatly disturbed (3-5 hours sleepless). (4) My sleep is completely disturbed (5-7 hours sleepless). (5)

Section 10 – Recreation

I am able to engage in all my recreation activities with no neck pain at all. (0) I am able to engage in all my recreation activities, with some pain in my neck. (1) I am able to engage in most, but not all, of my usual recreation activities because of pain in my neck. (2) I am able to engage in a few of my usual recreation activities because of pain in my neck. (3) I can hardly do any recreation activities because of pain in my neck. (4) I cannot do any recreation activities at all. (5)

Section 11 - Previous Treatment Over the past three months have you received treatment, tablets or medicines of any kind for your neck, head or arm pain? Please check the appropriate box.

no Yes (if yes, please state the type of treatment you have received)

Type of treatment received

What is your final score for the neck?

0-4 No disability
5-14 Mild disability
15-24 Moderate disability
25-34 Severe disability
> 35 Complete disability

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