"The Oswestry Disability Index for Back Pain - Whiplash and Oswestry Questionnaire Form"

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The Oswestry Disability Index for Back Pain
This questionnaire has been designed to give us information as to how your back pain has affected your ability to manage everyday life
activities. Please answer every section, and mark in each section the one box that applies to you. We realize you may consider that two
of the statements in any one section relate to you, but please just mark the box that most closely describes your present day situation.
Section 1. Pain Intensity:
Section 6. Standing:
A. My pain is mild to moderate. I do not need pain killers.
A. I can stand as long as I want without extra pain.
B. The pain is bad, but I manage without taking pain killers.
B. I can stand as long as I want, but it gives me extra pain.
C. Pain killers give complete relief from pain.
C. Pain prevents me from standing for more than 1 hour.
D. Pain killers give moderate relief from pain.
D. Pain prevents me from standing for more than 1/2 hour.
E. Pain killers give very little relief from pain.
E. Pain prevents me from standing for more than 10
minutes.
F. Pain killers have no effect on the pain.
F. Pain prevents me from standing at all.
Section 2. Personal Care:
Section 7. Sleeping:
A. I can look after myself normally without causing extra pain.
A. Pain does not prevent me from sleeping well.
B. I can look after myself normally but it causes extra pain.
B. I sleep well but only when taking medicine.
C. It is painful to look after myself and I am slow and careful.
C. Even when I take medication, I sleep less than 6 hours.
D. I need some help but manage most of my personal care.
D. Even when I take medication, I sleep less than 4 hours.
E. I need help every day in most aspects of self-care.
E. Even when I take medication, I sleep less than 2 hours.
F. I do not get dressed, I wash with difficulty and stay in bed.
F. Pain prevents me from sleeping at all.
Section 3. Lifting:
Section 8. Social Life:
A. I can lift heavy weights without causing extra pain.
A. My social life is normal and causes me no extra pain.
B. I can lift heavy weights but it gives me extra pain.
B. My social life is normal, but increases the degree of
C. Pain prevents me from lifting heavy weights off the floor, but I
pain.
can manage if they are conveniently positioned, for example on a
C. Pain affects my social life by limiting only my more
table.
energetic interests, such as dancing, sports, etc.
D. Pain prevents me from lifting heavy weights, but I can manage
D. Pain has restricted my social life and I do not go out as
light to medium weights if they are conveniently positioned.
often.
E. I can lift very light weights.
E. Pain has restricted my social life to my home.
F. I cannot lift or carry anything at all.
F. I have no social life because of pain.
Section 4. Walking:
Section 9. Sexual Activity:
A. I can walk as far as I wish.
A. My sexual activity is normal and causes no extra pain.
B. Pain prevents me from walking more than 1 mile.
B. My sexual activity is normal, but causes some extra
pain.
C. Pain prevents me from walking more than 1/2 mile.
C. My sexual activity is nearly normal, but it very painful.
D. Pain prevents me from walking more than 1/4 mile.
D. My sexual activity is severely restricted by pain.
E. I can walk only if I use a cane or crutches.
E. My sexual activity is nearly absent because of pain.
F. I am in bed or in a chair for most of every day.
F. Pain prevents any sexual activity at all.
Section 5. Sitting:
Section 10. Traveling:
A. I can sit in any chair for as long as I like.
A. I can travel anywhere without extra pain.
B. I can sit in my favorite chair only, but for as long as I like.
B. I can travel anywhere, but it gives me extra pain.
C. Pain prevents me from sitting for more than 1 hour.
C. Pain is bad, but I manage journeys over 2 hours.
D. Pain prevents me from sitting for more than 1/2 hour.
D. Pain restricts me to journeys of less than 1 hour.
E. Pain prevents me from sitting for more than 10 minutes.
E. Pain restricts me to necessary journeys under 1/2 hour.
F. Pain prevents me from sitting at all.
F. Pain prevents traveling except to the doctor/hospital.
Patient Name: _________________________
Date:_________ Score:________/________
The Oswestry Disability Index for Back Pain
This questionnaire has been designed to give us information as to how your back pain has affected your ability to manage everyday life
activities. Please answer every section, and mark in each section the one box that applies to you. We realize you may consider that two
of the statements in any one section relate to you, but please just mark the box that most closely describes your present day situation.
Section 1. Pain Intensity:
Section 6. Standing:
A. My pain is mild to moderate. I do not need pain killers.
A. I can stand as long as I want without extra pain.
B. The pain is bad, but I manage without taking pain killers.
B. I can stand as long as I want, but it gives me extra pain.
C. Pain killers give complete relief from pain.
C. Pain prevents me from standing for more than 1 hour.
D. Pain killers give moderate relief from pain.
D. Pain prevents me from standing for more than 1/2 hour.
E. Pain killers give very little relief from pain.
E. Pain prevents me from standing for more than 10
minutes.
F. Pain killers have no effect on the pain.
F. Pain prevents me from standing at all.
Section 2. Personal Care:
Section 7. Sleeping:
A. I can look after myself normally without causing extra pain.
A. Pain does not prevent me from sleeping well.
B. I can look after myself normally but it causes extra pain.
B. I sleep well but only when taking medicine.
C. It is painful to look after myself and I am slow and careful.
C. Even when I take medication, I sleep less than 6 hours.
D. I need some help but manage most of my personal care.
D. Even when I take medication, I sleep less than 4 hours.
E. I need help every day in most aspects of self-care.
E. Even when I take medication, I sleep less than 2 hours.
F. I do not get dressed, I wash with difficulty and stay in bed.
F. Pain prevents me from sleeping at all.
Section 3. Lifting:
Section 8. Social Life:
A. I can lift heavy weights without causing extra pain.
A. My social life is normal and causes me no extra pain.
B. I can lift heavy weights but it gives me extra pain.
B. My social life is normal, but increases the degree of
C. Pain prevents me from lifting heavy weights off the floor, but I
pain.
can manage if they are conveniently positioned, for example on a
C. Pain affects my social life by limiting only my more
table.
energetic interests, such as dancing, sports, etc.
D. Pain prevents me from lifting heavy weights, but I can manage
D. Pain has restricted my social life and I do not go out as
light to medium weights if they are conveniently positioned.
often.
E. I can lift very light weights.
E. Pain has restricted my social life to my home.
F. I cannot lift or carry anything at all.
F. I have no social life because of pain.
Section 4. Walking:
Section 9. Sexual Activity:
A. I can walk as far as I wish.
A. My sexual activity is normal and causes no extra pain.
B. Pain prevents me from walking more than 1 mile.
B. My sexual activity is normal, but causes some extra
pain.
C. Pain prevents me from walking more than 1/2 mile.
C. My sexual activity is nearly normal, but it very painful.
D. Pain prevents me from walking more than 1/4 mile.
D. My sexual activity is severely restricted by pain.
E. I can walk only if I use a cane or crutches.
E. My sexual activity is nearly absent because of pain.
F. I am in bed or in a chair for most of every day.
F. Pain prevents any sexual activity at all.
Section 5. Sitting:
Section 10. Traveling:
A. I can sit in any chair for as long as I like.
A. I can travel anywhere without extra pain.
B. I can sit in my favorite chair only, but for as long as I like.
B. I can travel anywhere, but it gives me extra pain.
C. Pain prevents me from sitting for more than 1 hour.
C. Pain is bad, but I manage journeys over 2 hours.
D. Pain prevents me from sitting for more than 1/2 hour.
D. Pain restricts me to journeys of less than 1 hour.
E. Pain prevents me from sitting for more than 10 minutes.
E. Pain restricts me to necessary journeys under 1/2 hour.
F. Pain prevents me from sitting at all.
F. Pain prevents traveling except to the doctor/hospital.
Patient Name: _________________________
Date:_________ Score:________/________
How to Score the
Whiplash and Oswestry Questionnaires
Each Section contains six possible answers A to F
Each letter is assigned a number A=0, B=1, C=2, D=3, E=4 and F=5
*Only one possible answer per section!
How to Score:
Minimal Disability = 0 - 20%
1)Assign the corresponding number
Moderate Disability = 21 - 40%
to each letter
Severe Disability = 41 - 60%
2)Total the scores from each section
Crippling = 61 - 80%
3)Multiply the total X 2 = % Disability
Confined to Bed/Exaggerated = 81 - 100%
Please take a moment to review the Questionnaire forms.
1.
Checklist form for easy scoring. This has been turned into "Checklist" form, making it easy for clients and
patients to answer, and even easier for you to determine the extent of your client's injuries following a motor
vehicle collision or personal injury.
2.
Ten major categories: It may interest you to know that whiplash affects a patient in multiple areas of life,
causing much anxiety and discomfort. Most attorneys only focus on one "injury source", usually neck pain.
But in fact there are 10 possible areas of activities of daily living that are directly affected from an injury.
1 = Pain Intensity - This immediately will let you know if your client is experiencing mild, moderate
or severe pain right now.
2 = Personal Care - This question addresses your client's "lifestyle" and how the accident has
affected his/her ability to take care of himself/herself, on a daily basis.
3 = Lifting - One of the most common problems associated with whiplash and back injury is lifting
heavy or even lightweight objects.
4 = Reading, 5 = Headache & 6 = Concentration - These three categories address possible
concussion injuries sustained as a result of whiplash.
7 = Work - The client indicates how his/her pain is affecting job productivity.
8 = Driving, 9 = Sleeping & 10 = Recreation - These questions provide you with information as to
how whiplash pain has affected your client's ability to manage everyday routine tasks and recreational
activities.
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