Pain Intensity (mark only 1) Personal Care (washing, dressing, etc.) Lifting (mark only 1) Walking (mark only 1) Sitting (mark only 1)
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- Ashlee Matthews
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1 Pain Intensity Personal Care (washing, dressing, etc.) Lifting Walking Sitting Standing Sleeping Sex Life OSWESTRY v2 Patient s copy I have no pain at the moment The pain is very mild at the moment The pain is moderate 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 I can look after myself normally, without causing extra pain I can look after myself normally, but it is very painful 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 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, for example, 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 anything at all Pain does not prevent me walking any distance Pain prevents me walking more than 1 mile Pain prevents me walking more than ½ mile Pain prevents me from walking more than 100 yards I can only walk using a stick or crutches I am in bed most of the time and have to crawl to the toilet I can sit in any chair as long as I like I can sit in my favorite chair as long as I like Pain prevents me from sitting for more than 1 hour Pain prevents me from sitting for more than ½ hour Pain prevents me from sitting for more than 10 minutes Pain prevents me from sitting at all 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 more than 1 hour Pain prevents me from standing for more than ½ hour Pain prevents me from standing for more than 10 minutes Pain prevents me from standing at all My sleep is never disturbed by pain My sleep is occasionally disturbed by pain Because of pain I have less than 6 hours of sleep Because of pain I have less than 4 hours of sleep Because of pain I have less than 2 hours of sleep Pain prevents me from sleeping at all 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 it is very painful My sex life is severely restricted by pain My sex life is nearly absent because of pain
2 Social Life Traveling Pain prevents any sex life at all 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 interest e.g. sports, etc. Pain has restricted my social life and I do not go out as often Pain has restricted my social life to home I have no social life because of pain 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 me from traveling except to receive treatment
3 Pain Intensity Personal Care (washing, dressing, etc.) Lifting Walking Sitting Standing Sleeping Sex Life Social Life Traveling OSWESTRY v2 Physician s copy (for scoring purposes) I have no pain at the moment The pain is very mild at the moment The pain is moderate 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 I can look after myself normally, without causing extra pain I can look after myself normally, but it is very painful 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 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, for example, 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 anything at all Pain does not prevent me walking any distance Pain prevents me walking more than 1 mile Pain prevents me walking more than ½ mile Pain prevents me from walking more than 100 yards I can only walk using a stick or crutches I am in bed most of the time and have to crawl to the toilet I can sit in any chair as long as I like I can sit in my favorite chair as long as I like Pain prevents me from sitting for more than 1 hour Pain prevents me from sitting for more than ½ hour Pain prevents me from sitting for more than 10 minutes Pain prevents me from sitting at all 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 more than 1 hour Pain prevents me from standing for more than ½ hour Pain prevents me from standing for more than 10 minutes Pain prevents me from standing at all My sleep is never disturbed by pain My sleep is occasionally disturbed by pain Because of pain I have less than 6 hours of sleep Because of pain I have less than 4 hours of sleep Because of pain I have less than 2 hours of sleep Pain prevents me from sleeping at all 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 it 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 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 interest e.g. sports, etc. Pain has restricted my social life and I do not go out as often Pain has restricted my social life to home I have no social life because of pain 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 me from traveling except to receive treatment
4 Interpretation: For each section of six statements the total score is 5; if the first statement is marked, the score is 0; if the last statement is marked, it is 5. Intervening statements are scored according to rank. If more than one box is marked in each section, take the highest score. If all 10 sections are completed the score is calculated as follows: if 16(total scored) out of 50 (total possible score) x100 = 32%. If one section is missed (or not applicable) the score is calculated: Example: 16 (total scored)/45 (total possible score) x 100 = 35.5% Therefore, the final score may be summarized as: (total score/(5 x number of questions answered)) x 100%. The authors suggest rounding the percentage to a whole number for convenience. Refer to the following timetable for timely scoring.
5
6 References: 1. Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine Dec 15;25(24): Fairbank JC, Pynsent PB, The Oswestry Disability Index. Spine 2000; 25(22): Fairbank JCT, Couper J, Davies JB. The Oswestry low Back Pain Questionnaire. Physiotherapy 1980; 66: Mehra A, Baker D, Disney S, Pynsent PB. Oswestry disability index scoring made easy. Ann R Coll Surg Engl 2008; 90:
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