Oswestry Disability Index Step 1 of 11 9% Start Information Summary Back Pain Questionnaire (Oswestry Disability Index) If you have experienced these symptoms, don’t wait for them to get worse! Taking the Oswestry Disability Index (ODI) assessment is a simple way to help you understand how severe your symptoms are and whether you should see a doctor. ✅ Just answer 10 questions about your daily life activities ✅ Get instant results with interpretation ✅ Help decide how you should start treatment Name(Required)Date of Birth(Required) MM slash DD slash YYYY Gender(Required)MaleFemaleOtherNot SpecifiedContact Phone Number Start Information Summary Assessment Instructions Instructions: This questionnaire is designed to help doctors understand information about your back pain and its impact on your daily life activities. Please answer all questions by marking ✓ in only one ❑ box that best describes your symptoms. 1. Pain Intensity(Required) My pain is tolerable without medication My pain is very bad, but I can manage without medication Pain medication completely relieves my pain Pain medication partially relieves my pain (about half) Pain medication provides slight relief from my pain Pain medication does not help my pain and I don’t use pain medication 2. Personal Care in Daily Life (bathing, dressing, etc.)(Required) I can bathe and dress normally without increasing my pain I can bathe and dress normally but it causes pain I can bathe and dress but must do so slowly and carefully because it causes pain I can bathe and dress but need some assistance I can bathe and dress but need assistance with most activities I can bathe and dress myself but must stay in bed 3. Lifting(Required) I can lift heavy objects without increasing my pain I can lift heavy objects but it increases my pain I cannot lift heavy objects from the floor, but I can lift heavy objects if they are at table height I cannot lift heavy objects from the floor, but I can lift objects at table height if they are not too heavy I can only lift very light objects I cannot lift anything at all 4. Walking(Required) I can walk normal distances without pain Pain limits my walking to no more than 1.6 kilometers (about 5 bus stops) Pain limits my walking to no more than 800 meters (about 2 bus stops) Pain limits my walking to no more than 400 meters (about 1 bus stop) I can walk but need walking aids such as a cane or crutches I must stay in bed but crawl when going to the bathroom 5. Sitting(Required) I can sit as long as normal without pain I can sit as long as normal without pain only in my regular comfortable chair Pain limits my sitting to no more than 1 hour Pain limits my sitting to no more than 30 minutes Pain limits my sitting to no more than 10 minutes Pain prevents me from sitting at all 6. Standing(Required) I can stand as long as normal without increasing my pain I can stand as long as normal but it increases my pain Pain limits my standing to no more than 1 hour Pain limits my standing to no more than 30 minutes Pain limits my standing to no more than 10 minutes Pain prevents me from standing at all 7. Sleeping(Required) I can sleep normally without pain I can sleep normally but need medication Even with medication, I can sleep less than 6 hours Even with medication, I can sleep less than 4 hours Even with medication, I can sleep less than 2 hours Pain prevents me from sleeping at all 8. Sexual Activity(Required) I can have sexual relations normally without increasing my pain I can have sexual relations normally but it increases my pain I can have sexual relations almost normally but with significant pain I have very limited sexual relations because of pain I can barely have sexual relations because of severe pain Pain prevents me from having sexual relations at all 9. Social Life(Required) I can participate in social activities normally without increasing my pain I can participate in social activities normally but with increased pain Pain doesn’t significantly affect my social activities except for high-movement activities like dancing or sports Pain prevents me from frequently participating in social activities outside the home Pain prevents me from participating in social activities outside the home but I can participate in social activities at home Pain prevents me from participating in any social activities 10. Travelling(Required) I can travel anywhere without increasing my pain I can travel anywhere but with increased pain My pain is severe, but I can manage it and travel for more than 1 hour Pain limits my travel to less than 1 hour Pain limits my travel to nearby places that take less than 30 minutes I cannot travel anywhere except to see a doctor or go to the hospital This field is hidden when viewing the formSummary
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