Form C-2 - Oswestry Disability Index 2.0
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1Form C-2
OSWESTRY DISABILITY INDEX 2.0
PLEASE READ: Could you please complete this questionnaire. It is designed to give us information as to how your back (or leg)
trouble has affected your ability to manage in everyday life.
Please answer every section. Mark one box only in each section that most closely describes you today.
SECTION 1 - Pain Intensity
SECTION 6 - Standing
A I have no pain at the moment.
A I can stand as long as I want without extra pain.
B The pain is very mild at the moment.
B I can stand as long as I want but it gives me extra pain.
C The pain is moderate at the moment.
C Pain prevents me from standing for more than 1 hour.
D The pain is fairly severe at the moment.
D Pain prevents me from standing for more than 1/2 hour.
E The pain is very severe at the moment.
E Pain prevents me from standing for more than 10minutes.
F The pain is the worst imaginable at the moment.
F Pain prevents me from standing at all.
SECTION 2 - Personal Care (washing, dressing, etc.)
SECTION 7 - Sleeping
A I can look after myself normally without causing extra pain.
A My sleep is never disturbed by pain.
B I can look after myself normally but it is very painful.
B My sleep is occasionally disturbed by pain.
C It is painful to look after myself and I am slow and careful.
C Because of pain I have less than 6 hours' sleep.
D I need some help but manage most of my personal care.
D Because of pain I have less than 4 hours' sleep.
E I need help every day in most aspects of self care.
E Because of pain I have less than 2 hours' sleep.
F I do not get dressed, wash with difficulty, and stay in bed.
F Pain prevents me from sleeping at all.
SECTION 3 - Lifting
SECTION 8 - Sex Life (if applicable)
A I can lift heavy weights without extra pain.
B I can lift heavy weights, but it causes extra pain.
A My sex life is normal and causes me no extra pain.
C Pain prevents me from lifting heavy weights off the floor, but I
B My sex life is normal, but causes some extra pain.
can manage if they are conveniently positioned, eg. on a table.
C My sex life is nearly normal but is very painful.
D Pain prevents me from lifting heavy weights, but I can manage
D My sex life is severely restricted by pain.
light to medium weights if they are conveniently positioned.
E My sex life is nearly absent because of pain.
E I can only lift very light weights, at the most.
F Pain prevents any sex life at all.
F I cannot lift or carry anything at all.
SECTION 4 - Walking
SECTION 9 - Social Life
A Pain does not prevent me from walking any distance.
A My social life is normal and causes me no extra pain.
B Pain prevents me from walking more than one mile.
B My social life is normal, but increases the degree of pain.
C Pain prevents me from walking more than 1/4 mile.
C Pain has no significant effect on my social life apart from limiting
D Pain prevents me from walking more than 100 yards.
my more energetic interests, e.g., sport, etc.
E I can only walk while using a stick or crutches.
D Pain has restricted my social life and I do not go out as often.
F I am in bed most of the time and have to crawl to the toilet.
E Pain has restricted my social life to my home.
F I have no social life because of the pain.
SECTION 5 - Sitting
SECTION 10 - Traveling
A I can travel anywhere without pain.
A I can sit in any chair as long as I like.
B I can travel anywhere but I gives extra pain.
B I can only sit in my favorite chair as long as I like.
C Pain is bad but I manage journeys over 2 hours.
C Pain prevents me from sitting more than 1 hour.
D Pain restricts me to journeys of less than 1 hour.
D Pain prevents me from sitting more than 1/2 hour.
E Pain restricts me to short necessary journeys under 30 minutes.
E Pain prevents me from sitting more than ten minutes.
F Pain prevents me from traveling except to receive treatment.
F Pain prevents me from sitting at all.
COMMENTS:_____________________________________________________________________________
__________________________________________________________________________________________
NAME: ___________________________________________________ DATE: _______ SCORE: ________
1. What is your pain RIGHT NOW?
X
What is your pain at its worse?
O
worst
no pain
_______________________________________________________________________________
possible
0
1
2
3
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9
10
pain
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