Oswestry Low Back Pain Disability Questionnaire Sources: Fairbank JCT & Pynsent, PB (2000) The Oswestry Disability Index. Spine, 25(22):2940-2953. Davidson M & Keating J (2001) A comparison of five low back disability questionnaires: reliability and responsiveness. Physical Therapy ...
Oswestry Low Back Disability Questionnaire Please select the appropriate answer in each section, Oswestry Disability Index Section 7 – Sleeping with respect to your low back. Section 1 – Pain Intensity My sleep is never disturbed by pain. My sleep ...
Oswestry Low Back Disability Questionnaire Name: Current Date This questionnaire has been designed to give your therapist information as to how your back pain has affected your ability to manage in everyday life. Please answer every question by placing a ...
Oswestry Low Back Pain Disability Index Questionnaire Instructions for completion of this questionnaire: Please answer every question, based on your condition today. Answer every question to the best of your ability – missing questions will invalidate the questionnaire. PATIENT NAME: ...
Modified Oswestry Low Back Pain Disability Questionnaire Name:_______________________________________________ Date: _____/_____/______ Please Read: This questionnaire has been designed to give your doctor/therapist We realize you may feel that two of the statements in any one section information as to how your ...
Patient Name:___________________________________________ Date__________________________ a Modified Oswestry Low Back Pain Disability Questionnaire This questionnaire has been designed to give your doctor information as to how your back pain has affected your ability to manage in everyday life. Please answer every section ...
OSWESTRY LOW BACK DISABILITY QUESTIONNAIRE Instructions: this questionnaire has been designed to give us information as to how your back pain has affected your ability to manage everyday life. Please answer every section and mark in each section only the ...
Modified Oswestry Low Back pain Disability Questionnaire Name __________________ DOB ___________ 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 ...
Oswestry Low Back Pain Disability Questionnaire Pain Intensity The pain comes and goes and is very mild. The pain is mild and does not vary much. The pain comes and goes and is moderate. The pain is moderate and does ...
Osvrestry Low Back Disability Ouestionnaire Oswestry Low Back Pain Disability Questionnaire lnstructions This questionnaire has been dBigned to give us information as to ho\fl your back or leg pain is affecting your aulity to manage in everyday lifu. Please answer ...
Appendix D Name: ___________________________________ Date: _____ / _____ / _____ Oswestry Low Back Pain Disability Questionnaire Oswestry Disability Index Please complete this questionnaire. It is designed to tell us how your back pain affects your ability to function in every ...
MODIFIED OSWESTRY LOW BACK PAIN DISABILITY QUESTIONNAIRE Name: Date: Please read: This questionnaire has been designed to give your therapist information as to how your back pack has affected your ability to manage everyday life. Please answer every section, and ...
Name: Date: ______________________ Modified Oswestry Low Back Pain Disability Questionnaire This questionnaire has been designed to give your therapist information as to how your back pain has affected your ability to manage in everyday life. Please answer every question by ...
Griesbaum Family Chiropractic, S.C. 1607 Visa Dr, Ste 1A Modified Oswestry Low & Mid Back Normal, IL 61761 Pain Disability Questionnaire Name______________________________________________________________ Date ________________ Signature __________________________________________________________________________________________________ Please Read: This questionnaire is designed to enable us to understand how ...
REVISED OSWESTRY LOW BACK PAIN DISABILITY QUESTIONNAIRE PLEASE READ: This questionnaire is designed to enable us to understand how much your low back pain has affected your ability to manage your everyday activities. Please answer each section by circling the ...
PHYSICAL THERAPY WELLNESS SERVICES PAIN MANAGEMENT SPORTS ENHANCEMENT INSTRUCTIONS FOR THE: MODIFIED OSWESTRY LOW BACK PAIN DISABILITY INDEX (ODI) This questionnaire has been designed to give your therapist information as to how your back pain has affected your ability to ...
Name:_____________________________________ Date:_________DOB:_________ Modified Oswestry Low Back Pain Disability Questionnaire Please Read: This questionnaire has been designed to give your therapist information as to how your back pain has affected your ability to manage in everyday life. Please answer every question ...
Patient's Name__________________________________________________ Number_____________ Date_____________________ LOW BACK DISABILITY QUESTIONNAIRE (REVISED OSWESTRY) This questionnaire has been designed to give the doctor information as to how your back pain has affected your ability to manage in everyday life. Please answer every section ...
Oswestry Low Back Pain Disability Questionnaire Instructions This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by checking ONE box in ...
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