Oswestry Low Back Pain Scale - Choice Therapy printable pdf download

SWESTRY

ACK

AIN

CALE

Please rate the severity of your pain by circling a number below:

Unbearable

Pain

Instructions: Please circle the ONE NUMBER in each section which describes your problem best.

Section 1: Pain Intensity

Section 6: Standing

0. The pain comes and goes and is very mild (0pts)

0. I can stand as long as I want without pain (0pts)

1. The pain is mild and does not vary much (1pt)

1. I have some pain with standing but it does not increase with time (1pt)

2.The pain comes and goes and is moderate (2pts)

2. I cannot stand for more than 1 hour without increasing the pain (2pts)

3. The pain is moderate and does not vary much (3pts)

3. I cannot stand for more that 1/2 hour without increasing the pain (3pts)

4. The pain comes and goes and is very severe (4pts)

4. I cannot stand for longer than 10 minutes without increasing the pain (4pts)

5. The pain is severe and does not vary much (5pts)

5. I avoid standing because it increases the pain immediately (5pts)

Section 2: Personal Care

Section 7: Sleeping

0. I would not have to change washing and dressing in order to avoid pain (0pts)

0. I get no pain in bed (0pts)

1. I do not normally change my way of washing or dressing even though it causes

1. I get pain in bed but it does not prevent me from sleeping well (1pt)

some pain (1pt)

2. Washing and dressing increase the pain but I manage not to change the way of

2. Because of pain my normal nights sleep is reduced by less than one quarter

doing it (2pts)

(2pts)

3. Washing and dressing increase the pain and I find it necessary to change my way

3. Because of pain my normal nights sleep is reduced by less than half (3pts)

of doing it (3pts)

4.Because of the pain I am unable to do some of the washing and dressing without

4. Because of pain my normal nights sleep is reduced by less than three quarters

help (4pts)

(4 pts)

5. Because of the pain I am unable to do any of the washing and dressing without

5. Pain prevents me from sleeping at all (5pts)

help (5pts)

Section 3: Lifting

Section 8: Social life

0. I can lift heavy weights without extra pain (0pts)

0. My social life is normal and gives me no pain (0pts)

1. I can lift heavy weights but it gives me extra pain (1pt)

1. My social life is normal but it increases the degree of pain (1pt)

2. Pain prevents me lifting heavy weights off the floor (2pts)

2. Pain has no significant effect on my social life apart from limiting my more

energetic interest (ex dancing) (2pts)

3. Pain prevents me lifting heavy weights off the floor, but I can manage if they are

3.Pain has restricted my social life and I do not go out very often (3pts)

conveniently located (on a table) (3pts)

4. Pain prevents me lifting heavy weights but I can manage light to medium

4. Pain has restricted my social life to my home (4pt)

weights if they are conveniently located (4pts)

5. I can only lift very light weights at most (5pts)

5. I have hardly any social life because of the pain (5pts)

Section: 4 Walking

Section 9: Traveling

0. I have no pain on walking (0pts)

0. I get no pain when traveling (0pts)

1. I have some pain on walking but it does not increase with distance (1pt)

1. I get some pain when traveling but none of my usual forms of travel make it any

worse (1pt)

2. I cannot walk more than 1 mile without increasing pain (2pts)

2. I get extra pain while traveling but it does not compel me t alternative forms of

travel (2pts)

3. I cannot walk more than 1/2 mile without increasing pain (3pts)

3.I get extra pain while traveling which compels me to seek alternative forms of

travel (3pts)

4. I cannot walk more than 1/4 mile without increasing pain (4pts)

4. Pain restricts me to short necessary journeys under 1/2hr (4pts)

5. I cannot walk at all without increasing pain (5pts)

5. Pain restricts all forms of travel (5pts)

Section 5: Sitting

Section 10: Changing degree of pain

0. I can sit in any chair as long as I would like (0pts)

0. My pain is rapidly getting better (0pts)

1. I can sit only in my favorite chair as long as I would like (1pt)

1. My pain fluctuates but is definitely getting better (1pt)

2. Pain prevents me from sitting more than 1 hour (2pts)

2. My pain seems to be getting better but improvement is slow (2pts)

3. Pain prevents me from sitting more than 1/2 hour (3pts)

3. My pain is neither getting better or worse (3pts)

4. Pain prevents me from sitting more than 10 minutes (4pts)

4. The pain is gradually worsening (4pts)

5. I avoid sitting because it increases my pain immediately (5pts)

5. The pain is rapidly worsening (5pts)

Total: _____________________________

2001-2006 JCT, MD, FRCS PB Pynsent, PhD & S Disney, BSc

Oswestry Low Back Pain Scale - Choice Therapy

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