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 Disability Index Section 7 – Sleeping Section 1 – Pain Intensity My sleep is never disturbed by pain. My sleep is occasionally disturbed by pain. I have no pain at the moment. Because of pain ...
Name:_________________________________ Date:__________________________________ Oswestry Disability Index This questionnaire has been designed to give the doctor information as to how your pain has affected your ability to manage in every day life. Your pain is rated from 0 (no pain and functional) ...
Shoulder Pain and Disability Index (SPADI) Source: Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991 Dec;4(4):143-9. The Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire ...
Neck Disability Index - 1 - ECK DISABILITY INDEX1 N Name _________________ Age______ Date________ Therapist ______ Occupation _____________ Number of days of pain _____ (this episode) This questionnaire is designed to give your therapist information as to how your neck ...
PATIENT NAME: __________________________________ ID#: _________________ DATE: ____________ Description: This survey is meant to help us obtain information from our patients regarding their current levels of discomfort and capability. Please circle the answers below that best apply. 1. Please rate your ...
Revised Oswestry Disability Index Name : Age: Date: Please complete this questionnaire by circling one answer in each section. It is designed to give us information as to how your back (and/or leg) trouble has affected your ability to manage ...
Neck Disability Index Name: Current Date This questionnaire is designed to help us better understand how your neck pain affects your ability to manage everyday life activities. Please mark in each section the ONE BOX that applies to you. Although ...
Revised Oswestry Disability Index (ODI) Name: Date: This questionnaire is designed to enable us to understand how much your pain has affected your ability to manage everyday activities. Please answer each Section by circling the ONE CHOICE that most applies ...
Pain Disability Index Pain Disability Index: The rating scales below are designed to measure the degree to which aspects of your life are disrupted by chronic pain. In other words, we would like to know how much pain is preventing ...
MODIFIED OSWESTRY LOW BACK PAIN DISABILITY INDEX (ODI) Purpose: The ODI is a disease-specific disability measure is used to establish a level of 1 disability, stage a patient’s acuity status , and monitor change over time. Scoring: 1. The ODI ...
Neck Disability Index This questionnaire is designed to help us better understand how your neck pain affects your ability to manage everyday-life activities. Please mark in each section the ONE box that applies to you. Although you may consider that ...
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 ...
1 Neck Disability Index Name: ____________________________________________ Date: ____________________ This questionnaire has been designed to give your health professional information as to how your neck pain has affected your ability to manage in everyday life2. Please answer every section and mark ...
Neck Disability Index Source: Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991 Sep;14(7):409-15. Neck disorders are a significant source of pain and activity limitation in workers and those ...
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: ...
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 ...
The Revised Oswestry Disability Index (for low back pain/dysfunction) Patient name: File # Date: This questionnaire has been designed to give the doctor information as to how your back pain has affected your ability to manage everyday life. Please answer ...
NECK DISABILITY INDEX Name: _____________________ DOB: _____ / _____ / _____ Date: ____/ ____ / ____ Please read: This questionnaire is designed to enable us to better understand how much your neck pain has affected your ability to manage everyday ...
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