Neck Disability Index Questionnaire Template

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Modified Oswestry Neck Pain Disability Questionnaire
This questionnaire has been designed to give your therapist information as to how your neck pain has affected
your ability to manage in everyday life. Please answer every question by placing a mark in the one box that
best describes your condition today. We realize you may feel that two of the statements may describe your
condition, but please mark only the box that most closely describes your current condition.
Pain Intensity
Headaches
I can tolerate the pain I have without having to use
I have no headaches at all.
pain medication.
I have slight headaches which come infrequently.
The pain is very mild at the moment.
I have moderate headaches which come
The pain is moderate at the moment.
infrequently.
The pain is fairly severe at the moment.
I have moderate headaches which come frequently.
The pain is very severe at the moment.
I have severe headaches which come frequently.
The pain is the worst imaginable at the moment.
I have headaches almost all the time.
Personal Care (e.g., Washing, Dressing)
Concentration
I can take care of myself normally without causing
I can concentrate fully when I want with no
increased pain.
difficulty.
I can take care of myself normally, but it increases
I can concentrate fully when I want with slight
my pain.
difficulty.
It is painful to take care of myself, and I am slow
I have a fair degree of difficulty in concentrating
and careful.
when I want.
I need help, but I am able to manage most of my
I have a lot of difficulty in concentrating when
personal care.
I want.
I need help every day in most aspects of my care.
I have a great deal of difficulty in concentrating
I do not get dressed, I wash with difficulty, and I
when I want.
stay in bed.
I cannot concentrate at all.
Lifting
Work
I can lift heavy weights without increased pain.
I can do as much work as I want.
I can lift heavy weights, but it causes increased pain.
I can only do my usual work, but no more.
Pain prevents me from lifting heavy weights off
I can do most of my usual work, but no more.
the floor, but I can manage if the weights are
I cannot do my usual work.
conveniently positioned (e.g., on a table).
I can hardly do any work at all.
Pain prevents me from lifting heavy weights, but
I cannot do any work at all.
I can manage light to medium weights if they are
conveniently positioned.
Driving
I can lift only very light weights.
I can drive my car without any neck pain.
I cannot lift or carry anything at all.
I can drive my car as long as I want with slight pain
in my neck.
Reading
I can drive my car as long as I want with moderate
I can read as much as I want with no pain in
pain in my neck.
my neck.
I cannot drive my car as long as I want because of
I can read as much as I want with slight pain in
moderate pain in my neck.
my neck.
I can hardly drive at all because of severe pain in
I can read as much as I want with moderate pain in
my neck.
my neck.
I cannot drive my car at all.
I cannot read as much as I want because of moderate
pain in my neck.
I can hardly read at all because of moderate pain in
my neck.
I cannot read at all.
Please complete questionnaire on other side.

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