www.orthopaedicscores.com
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Date of completion
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Oswestry Low Back Pain Disability Questionnaire |
Clinician's name (or ref)
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Patient's name (or ref)
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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 mark in the box that best describes your condition today. |
During the past 4 weeks...... |
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Previous Treatment |
Over the past three months have you received treatment, tablets or medicines of any kind for your back or leg pain? (Please tick the appropriate box. ) |
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......if yes, please state the type of treatment you have received) |
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Nb: This page cannot be saved due to patient data protection so please print the filled in form before closing the window. |
The Oswestry Low back pain Score is:
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Reference for Score: Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire.
Physiotherapy. 1980 Aug;66(8):271-3. link
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