Oswestry Low Back Questionnaire

0 of 10 sections answered

Total so far: 0/50

Please allow 5 minutes to complete this.

Patient Name

Email Address

Date of Birth

Gender

MaleFemale

Date

This is my first time filling out this questionnaire.

Instructions

The following questionnaire has been designed to tell us about your ability to function, and how your back or leg pain affects your ability to function in everyday life. Please answer by checking ONE box in each section for the statement which best applies to you. We realize you may consider that two or more statements in any one section apply to you, but please check / shade out only the box that indicates the statement which most clearly describes your problem. Please complete this questionnaire.

Please mark the box which most closely describes your current condition.

I have “Chronic Pain” or pain that has bothered me for 3 months or more:

YesNo

Please answer each section below by checking the One Choice that applies the most to you at this time. (You may feel that more than one of the statements relates to you at this time, but it is very important that you check only one choice that best describes your problem at this time.)

Scoring instructions

Each section lists six statements, from least to most difficulty: the first statement scores 0 points, the second 1 point, the third 2 points, the fourth 3 points, the fifth 4 points and the last 5 points. The points are shown next to each statement.

The points of the ten sections are added up for a point total out of 50.

Section 8 (Sex life) may be left blank if it does not apply; the point total is then out of 45.

Pain diagram

Mark where you are experiencing pain right now. Choose the type of sensation, then tap the body where you feel it. Tap a mark again to remove it.

Choose Male or Female at the top to see the matching body.

Nothing to Mark

Nothing marked yet.

Total so far

0 out of 50

0 of 10 sections answered · each section scores 0–5