Adapted Owestry Low Back Disability Questionnaire

Back Pain Questionnaire

How serious is your lower back pain?

This questionnaire has been designed to find out how your back pain affects your ability to manage everyday life.

This questionnaire has been designed provide information as to how your back or leg pain is affecting your ability to manage in everyday life.

Please answer by checking one box in each section for the statement which best applies to you.
We understand that two or more statements in any one section may apply to you but please select the statement which most clearly describes your problem.

Source: Fairbank JCT & Pynsent, PB (2000) The Oswestry Disability Index. Spine, 25(22):2940-2953.

By completing this questionnaire you consent to us contacting you to discuss your condition.
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