Oswestry Chronic Low Back

REVISED OSWESTRY CHRONIC LOW BACK PAIN DISABILITY QUESTIONNAIRE
Please Read: This questionnaire is designed to enable us to understand how much your low back pain has
affected your ability to manage your everyday activities. Please answer each section by circling the ONE
CHOICE that most applies to you. We realize that you may feel that more than one statement may apply to
you, but PLEASE JUST CIRCLE THEONE CHOICE WHICH MOST CLEARLY DESCRIBES YOUR PROBLEM RIGHT NOW.
Section 1 – Pain Intensity 6. I can only lift very light weights, at the most.
1. The pain comes and goes and is very mild.
Section 4 – Walking
2. The pain is mild and does not vary much.
1. Pain does not prevent me from walking any distance.
3. The pain comes and goes and is moderate.
2. Pain prevents me from walking more than one mile.
4. The pain is moderate and does not vary much.
3. Pain prevents me from walking more than ½ mile.
5. The pain comes and goes and is severe.
4. Pain prevents me from walking more than ¼ mile.
6. The pain is severe and does not vary much.
5. I can only walk while using a cane or on crutches.
Section 2 – Personal Care 6. I am in bed most of the time and have to crawl to the
toilet.
1. I would not have to change my way of washing or dressing
in order to avoid pain.
Section 5 – Sitting
2. I do not normally change my way of washing or dressing
1. I can sit in any chair as long as I like without pain.
even though it causes some pain.
2. I can only sit in my favorite chair as long as I like.
3. Washing and dressing increases the pain,
3. Pain prevents me from sitting more than one hour.
but I manage not to change my way of doing it..
4. Pain prevents me from sitting more than ½ hour.
4. Washing and dressing increases the pain and I find it
5. Pain prevents me from sitting more than ten minutes.
necessary to change my way of doing it.
6. Pain prevents me from sitting at all.
5. Because of the pain, I am unable to do some washing and
dressing without help. Section 6 – Standing
6. Because of the pain, I am unable to do any washing or 1. I can stand as long as I want without pain.
dressing without help. 2. I have some pain while standing,

but it does not increase with time.
Section 3 – Lifting
3. I can not stand for longer than one hour
1. I can lift heavy weights without extra pain.
without increasing pain.
2. I can lift heavy weights, but it causes extra pain.
4. I can not stand for longer than ½ hour,
3. Pain prevents me from lifting heavy weights off the floor.
4. Pain prevents me from lifting heavy weights off the floor, but
5. I can not stand for longer than ten minutes,
I can manage if they are conveniently positioned,
e.g. on a table
6. I avoid standing, because it increases the pain straight away.
5. Pain prevents me from lifting heavy weights,
Section 7 – Sleeping
but I can manage light to medium weights
1. I get no pain in bed.
if they are conveniently positioned.
Comments: ____________________________________________________________________________________
Patient’s Signature: _______________________________________________________ Date: ________________

REVISED OSWESTRY CHRONIC LOW BACK PAIN DISABILITY QUESTIONNAIRE
Please Read: This questionnaire is designed to enable us to understand how much your low back pain has
affected your ability to manage your everyday activities. Please answer each section by circling the ONE
CHOICE that most applies to you. We realize that you may feel that more than one statement may apply to
you, but PLEASE JUST CIRCLE THEONE CHOICE WHICH MOST CLEARLY DESCRIBES YOUR PROBLEM RIGHT NOW.
2. I get pain in bed, but it doesn’t prevent me from sleeping well Section 9 – Traveling
3. Because of my pain, my normal night’s sleep is reduced 1. I get no pain while traveling.
by less than one-quarter. 2. I get some pain while traveling, but none of my usual
4. Because of my pain, my normal night’s sleep is reduced forms of travel make it any worse.
by less than one-half. 3. I get extra pain while traveling, but it does not compel me
5. Because of my pain, my normal night’s sleep is reduced to seek alternate forms of travel.
by less than three-quarters. 4. I get extra pain while traveling which compels me
6. Pain prevents me from sleeping at all. to seek alternative forms of travel.
5. Pain restricts all forms of travel.
Section 8 – Social Life
6. Pain prevents all forms of travel except that done lying down.
1. My social life is normal and gives me no pain.
2. My social life is normal, but increases the degree of my pain. Section 10 – Changing Degree of Pain
3. Pain has no significant effect on my social life apart from 1. My pain is rapidly getting better.
limiting my more energetic interests, e.g. dancing, etc. 2. My pain fluctuates, but overall is definitely getting better.
4. Pain has restricted my social life and 3. My pain seems to be getting better, but improvement is
I do not go out very often. slow at present.
5. Pain has restricted my social life to my home. 4. My pain is neither getting better or worse.
6. I have hardly any social life because of the pain. 5. My pain is gradually getting worse.
6. My pain is rapidly worsening
Comments: ____________________________________________________________________________________
Patient’s Signature: _______________________________________________________ Date: ________________

Oswestry Chronic Low Back

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REVISED OSWESTRY CHRONIC LOW BACK PAIN DISABILITY QUESTIONNAIRE

dressing without help. 2. I have some pain while standing,

Patient’s Signature: _______________________________________ Date:

Patient’s Signature: _______________________________________ Date:

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