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Lumbar Disability Assessment Questionnaire

Oswestry Disability Index (ODI)

Follow-up information

Name *

First name *

Phone *

Email *

Self-Care and Daily Living

Pain Intensity

Not applicable
0 I have no pain at the moment
1 The pain is very mild at the moment
2 The pain is moderate at the moment
3 The pain is fairly severe at the moment
4 The pain is very severe at the moment
5 The pain is the worst imaginable at the moment

Personal Care

Not applicable
0 I can look after myself normally without causing extra pain
1 I can look after myself normally but it causes extra pain
2 It is painful to look after myself and I am slow and careful
3 I need some help but manage most of my personal care
4 I need help every day in most aspects of self-care
5 I do not get dressed, wash with difficulty, and stay in bed

Sleeping

Not applicable
0 My sleep is never disturbed by pain
1 My sleep is occasionally disturbed by pain
2 Because of pain I have less than 6 hours sleep
3 Because of pain I have less than 4 hours sleep
4 Because of pain I have less than 2 hours sleep
5 Pain prevents me from sleeping at all

Mobility and Posture

Walking

Not applicable
0 I have no pain on walking.
1 Pain prevents me from walking more than 1 mile (approx. 1.5 km).
2 Pain prevents me from walking more than 1/2 mile (approx. 800 m).
3 Pain prevents me from walking more than 100 yards (approx. 100 meters).
4 I can only walk using a stick or crutches.
5 I am in bed most of the time.

Lifting

Not applicable
0 I can lift heavy weights without extra pain.
1 I can lift heavy weights, but it gives extra pain.
2 Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, e.g., on a table.
3 Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned.
4 I can lift very light weights.
5 I cannot lift or carry anything at all.

Sitting

Not applicable
0 I can sit in any chair as long as I like.
1 I can only sit in my favorite chair as long as I like.
2 Pain prevents me from sitting more than one hour.
3 Pain prevents me from sitting more than 30 minutes.
4 Pain prevents me from sitting more than 10 minutes.
5 Pain prevents me from sitting at all.

Standing

Not applicable
0 I can stand as long as I want without extra pain.
1 I can stand as long as I want but it gives me extra pain.
2 Pain prevents me from standing for more than 1 hour.
3 Pain prevents me from standing for more than 30 minutes.
4 Pain prevents me from standing for more than 10 minutes.
5 Pain prevents me from standing at all.

Social and Sexual Life

Social Life

Not applicable
0 My social life is normal and gives me no pain.
1 My social life is normal but increases the degree of my pain.
2 Pain has no significant effect on my social life apart from limiting my more energetic interests, e.g., sport, etc.
3 Pain has restricted my social life and I do not go out very often.
4 Pain has restricted my social life to my home.
5 I have no social life because of pain.

Sexual Life

Not applicable
0 My sexual life is normal and causes no pain.
1 My sexual life is normal but causes some pain.
2 My sexual life is nearly normal but is very painful.
3 My sexual life is severely restricted by pain.
4 My sexual life is nearly absent because of pain.
5 Pain prevents any sexual life at all.

Traveling

Not applicable
0 I can travel anywhere without pain.
1 I can travel anywhere but it gives me pain.
2 Pain is bad but I manage journeys over two hours.
3 Pain restricts me to journeys of less than one hour.
4 Pain restricts me to short necessary journeys under 30 minutes.
5 Pain prevents me from traveling except to the doctor or hospital.

Your Disability Score (ODI)

This score reflects the current impact of your pain on your daily activities.

%

Pain Intensity

What is your current level of back pain?

(0 = no pain, 10 = worst possible pain / unbearable pain)

What is your current level of leg pain?

(0 = no pain, 10 = worst possible pain / unbearable pain)

I consent to these data being shared with my healthcare provider.

The collected data is processed in accordance with our privacy policy.

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Spécialiste FMH en Chirurgie orthopédique | Chirurgie spinale endoscopique

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