Oswestry Disability Index

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Description: This survey is meant to help us obtain information from our patients regarding their current levels of
discomfort and capability.

Name *

Date *

YYYY

Pain Intensity *

0 - I can tolerate the pain I have without having to use pain medication.

1 - The pain is bad, but I can manage without having to take pain medication.

2 - Pain medication provides me with complete relief from pain.

3 - Pain medication provides me with moderate relief from pain.

4 - Pain medication provides me with little relief from pain.

5 - Pain medication has no effect on my pain.

Personal care (washing, dressing, etc.) *

0 - I can take care of myself normally without causing increased pain.

1 - I can take care of myself normally, but it increases my pain.

2 - It is painful to take care of myself, and I am slow and careful.

3 - I need help, but I am able to manage most of my personal care.

4 - I need help every day in most aspects of my care.

5 - I do not get dressed, wash with difficulty, and stay in bed.

Lifting *

0 - I can lift heavy weights without increased pain.

1 - I can lift heavy weights, but it causes increased pain.

2 - Pain prevents me from lifting heavy weights off the floor but I can manage if the weights are conveniently positioned (eg, 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 only very light weights.

5 - I cannot lift or carry anything at all.

Walking *

0 - Pain does not prevent me from walking any distance.

1 - Pain prevents me from walking more than 1 mile.

2 - Pain prevents me from walking more than ½ mile.

3 - Pain prevents me from walking more than ¼ mile.

4 - I can only walk with crutches or a cane.

5 - I am in bed most of the time and have to crawl to the toilet.

Sitting *

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 1 hour.

3 - Pain prevents me from sitting more than ½ hour.

4 - Pain prevents me from sitting more than 10 minutes.

5 - Pain prevents me from sitting at all.

Standing *

0 - I can stand as long as I want without increased pain.

1 - I can stand as long as I want but, it increases my pain.

2 - Pain prevents me from standing more than 1 hour.

3 - Pain prevents me from standing more than 1/2 hour.

4 - Pain prevents me from standing more than 10 minutes.

5 - Pain prevents me from standing at all.

Sleeping *

0 - Pain does not prevent me from sleeping well.

1 - I can sleep well only by using pain medication.

2 - Even when I take pain medication, I sleep less than 6 hours.

3 - Even when I take pain medication, I sleep less than 4 hours.

4 - Even when I take pain medication, I sleep less than 2 hour.

5 - Pain prevents me from sleeping at all.

Social Life *

0 - My social life is normal and does not increase my pain.

1 - My social life is normal, but it increases my level of pain.

2 - Pain prevents me from participating in more energetic activities (eg. sports, dancing).

3 - Pain prevents me from going out very often.

4 - Pain has restricted my social life to my home.

5 - I have hardly any social life because of my pain.

Traveling *

0 - I can travel anywhere without increased pain.

1 - I can travel anywhere, but it increases my pain.

2 - My pain restricts my travel over 2 hours.

3 - My pain restricts my travel over 1 hour.

4 - My pain restricts my travel to short necessary journeys journeys under 1/2 hour.

5 - My pain prevents all travel except for visits to the physician/therapist or hospital.

Employment/Homemaking *

0 - My normal homemaking/job activities do not cause pain.

1 - My normal homemaking/job activities increase my pain, but I can still perform all that is required of me.

2 - I can perform most of my homemaking/job duties, but pain prevents me from performing more physically stressful activities (eg, lifting, vacuuming).

3 - Pain prevents me from doing anything but light duties.

4 - Pain prevents me from doing even light duties.

5 - Pain prevents me from performing any job or homemaking chores.

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