"The Quebec Back Pain Disability Scale Questionnaire Sheet"

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Download "The Quebec Back Pain Disability Scale Questionnaire Sheet"

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The Quebec Back Pain Disability Scale:
This questionnaire is about the way your back pain is affecting your daily life. People with back problems may find it
difficult to perform some of their daily activities. We would like to know if you find it difficult to perform any of the
activities listed below, because of your back. For each activity there is a scale of 0 to 5. Please choose one
response option for each activity (do not skip any activities) and circle the corresponding number.
Today, do you find it difficult to perform the following activities because of your back?
0.
1.
2.
3.
4.
5.
Not
Minimally
Somewhat
Fairly
Very
Unable to
difficult at
difficult
difficult
difficult
difficult
do
all
1.
Get out of bed
0
1
2
3
4
5
2.
Sleep through the night
3.
Turn over in bed
4.
Ride in a car
5.
Stand up for 20-30 minutes
6.
Sit in a chair for several hours
7.
Climb one flight of stairs
8.
Walk a few blocks (300-400 m)
9.
Walk several kilometres
10.
Reach up to high shelves
11.
Throw a ball
12.
Run one block (about 100m)
13.
Take food out of the refrigerator
14.
Make your bed
15.
Put on socks (pantyhose)
16.
Bend over to clean the bathtub
17.
Move a chair
18.
Pull or push heavy doors
19.
Carry two bags of groceries
20.
Lift and carry a heavy suitcase
Add the numbers for a total score: ___________
Minimum detectable change (90% confidence) 15 points
Sources:
Kopec, JA, Esdaile, JM, Abrahamowicz, M., Abenhaim, L, Wood-Dauphinee, S, Lamping, DL & Williams JI. (1995). The
Quebec Back Pain Disability Scale. Spine, 20(3): 341-352.
Davidson, M. & Keating, J.L. (2002). A comparison of five low back disability questionnaires: Reliability and responsiveness.
Physical Therapy, 82(1): 8- 24.
The Quebec Back Pain Disability Scale:
This questionnaire is about the way your back pain is affecting your daily life. People with back problems may find it
difficult to perform some of their daily activities. We would like to know if you find it difficult to perform any of the
activities listed below, because of your back. For each activity there is a scale of 0 to 5. Please choose one
response option for each activity (do not skip any activities) and circle the corresponding number.
Today, do you find it difficult to perform the following activities because of your back?
0.
1.
2.
3.
4.
5.
Not
Minimally
Somewhat
Fairly
Very
Unable to
difficult at
difficult
difficult
difficult
difficult
do
all
1.
Get out of bed
0
1
2
3
4
5
2.
Sleep through the night
3.
Turn over in bed
4.
Ride in a car
5.
Stand up for 20-30 minutes
6.
Sit in a chair for several hours
7.
Climb one flight of stairs
8.
Walk a few blocks (300-400 m)
9.
Walk several kilometres
10.
Reach up to high shelves
11.
Throw a ball
12.
Run one block (about 100m)
13.
Take food out of the refrigerator
14.
Make your bed
15.
Put on socks (pantyhose)
16.
Bend over to clean the bathtub
17.
Move a chair
18.
Pull or push heavy doors
19.
Carry two bags of groceries
20.
Lift and carry a heavy suitcase
Add the numbers for a total score: ___________
Minimum detectable change (90% confidence) 15 points
Sources:
Kopec, JA, Esdaile, JM, Abrahamowicz, M., Abenhaim, L, Wood-Dauphinee, S, Lamping, DL & Williams JI. (1995). The
Quebec Back Pain Disability Scale. Spine, 20(3): 341-352.
Davidson, M. & Keating, J.L. (2002). A comparison of five low back disability questionnaires: Reliability and responsiveness.
Physical Therapy, 82(1): 8- 24.