Back4life

The back pain specialists

Oswestry Disability Index

Please answer each Section by selecting the ONE CHOICE that most applies to you. We realise that you may feel that more than one statement may relate to you, but Please just circle the one choice which closely describes your problem right now.

Pain Intensity

I have no pain at the moment
The pain is very mild at the moment.
The pain is fairly severe at the moment.
The pain is very severe at the moment.
The pain is the worst imaginable at the moment.

Personal Care

I can look after myself normally but it is very painful.
I can look after myself normally but it causes extra pain.
It is painful to look after myself and I am slow and careful.
I need some help but manage most of my personal care.
I need help every day in most aspects of self-care.
I do not get dressed, wash with difficulty and stay in bed.

Lifting

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

Walking

Pain does not prevent my walking any distance.
Pain prevents me walking more than 1 mile.
Pain prevents me walking more than 1/2 mile.
Pain prevents me walking more than 1/4 mile.
I can only walk using a stick or crutches.
I am in bed most of the time and have to crawl to the toilet.

Sitting

I can sit in any chair as long as I like.
I can sit in my favourite chair as long as I like.
Pain prevents me sitting more than 1 hour.
Pain prevents me from sitting more than 1/2 an hour.
Pain prevents me from sitting more than 10 minutes.
Pain prevents me from sitting at all.

Standing

I can stand as long as I want without extra pain.
I can stand as long as I want but it gives me extra pain.
Pain prevents me from standing for more than 1 hour.
Pain prevents me from standing for more than 30 minutes.
Pain prevents me from standing for more than 10 minutes.
Pain prevents me from standing at all.

Sleeping

Pain does not prevent me from sleeping well.
I can sleep well only by using tablets.
Even when I take tablets I have less than 6 hours sleep.
Even when I take tablets I have less than 4 hours sleep.
Even when I take tablets I have less than 2 hours sleep.
Pain prevents me from sleeping at all.

Sex Life

My sex life is normal and causes no extra pain.
My sex life is normal but causes some extra pain.
My sex life is nearly normal but is very painful.
My sex life is severely restricted by pain.
My sex life is nearly absent because of pain.
Pain prevents any sex life at all.

Social Life

My social life is normal and gives me no extra pain.
My social life is normal but increases the degree of pain.
Pain has no significant effect on my social life apart from limiting my more energetic interests, eg dancing, etc.
Pain has restricted my social life and I do not go out as often.
Pain has restricted social life to my home.
I have no social life because of pain.

Travelling

I can travel anywhere without extra pain.
I can travel anywhere but it gives me extra pain.
Pain is bad but I manage journeys over two hours.
Pain restricts me to journeys of less than one hour.
Pain restricts me to short necessary journeys under 30 minutes.
Pain prevents travel except to the doctor or hospital.

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 (See below)
Treatment DetailsPlease click here and add details of the treatment you received.

Your Details

Name
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About
- We are a team of medical professionals specialising in the treatment of spinal conditions. Based in London, we work together employing the latest evidence-based non-surgical, surgical treatments and rehabilitation. Our goal is to restore function and improve quality of life by up-to-date, safe and effective therapy.
Telephone: 0207 060 4362

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- July 2009

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Back4life

Oswestry Disability Index

Telephone: 0207 060 4362