Oswestry Form

THE OSWESTRY* LOW BACK PAIN DISABILITY QUESTIONNAIRE

Please Read: This questionnaire is designed to enable us to understand how much your low back and/or leg pain has affected your ability to manage everyday activities. Please answer each Section by circling the ONE CHOICE that most applies to you. We realize that you may feel that more than one statement may relate to you, but PLEASE SELECT THE ONE CHOICE WHICH CLOSELY DESCRIBES YOUR PROBLEM RIGHT NOW.

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SECTION 1--Pain Intensity
SECTION 2--Personal Care
SECTION 3--Lifting
SECTION 4 --Walking
SECTION 5--Sitting
SECTION 6 -- Standing
SECTION 7--Sleeping
SECTION 8--Social Life
SECTION 9--Traveling
SECTION 10--Changing Degree of Pain