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  • Modified Oswestry Questionnaire

Get Modified Oswestry Questionnaire

Modified Oswestry Low Back Pain Disability Questionnaire Patient Name: Date of Birth: / / Date: / / This questionnaire has been designed to give us information as to how your back or leg pain is affecting.

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How to fill out the modified Oswestry questionnaire online

The modified Oswestry questionnaire is an important tool designed to evaluate how back or leg pain impacts your daily activities. This guide will provide you with clear instructions to fill out the questionnaire online effectively.

Follow the steps to complete the modified Oswestry questionnaire online.

  1. Press the ‘Get Form’ button to access the modified Oswestry questionnaire and open it in your document editor.
  2. Begin by entering your personal information in the designated fields, including your name and date of birth. This ensures your responses are accurately linked to your profile.
  3. Carefully read each section’s instructions. In each section, you will find statements that represent different levels of pain or difficulty relating to various activities.
  4. For each section, select the statement that best describes your current condition by checking the corresponding box. It is important to choose only one statement per section to ensure clear communication of your situation.
  5. Continue through each section, including pain intensity, personal care, and various activities, until you have answered all questions. Reflect on your recent experiences to select the most accurate options.
  6. Once you have completed all the sections, review your responses for accuracy and completeness before proceeding.
  7. Finally, save your changes, and use the options available to download, print, or share the completed questionnaire as needed.

Complete your modified Oswestry questionnaire online today to better understand how pain affects your everyday life.

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The Oswestry Disability Index (ODI) is calculated based on each score of the ODQ, which consists of ten items. Each of the ten items is scored from 0 to 5, and the total is added and multiplied by 2. Therefore, the ODI ranges from 0 to 100. A higher score on the ODI indicates a more severe disability caused by LBP.

The index is calculated by dividing the summed score by the total possible score, which is then multiplied by 100 and expressed as a percentage.

It is an adjustment of the Oswestry Disability Index [ODI] (an outcome measure that was designed to assess function in activities of daily living for those with acute or chronic back pain) such that the "Sex Life" question has been replaced with an "Employment/Homemaking" query.

Purpose: The ODI is a disease-specific disability measure is used to establish a level of disability, stage a patient's acuity status1, and monitor change over time.

This questionnaire has been designed to give your therapist information as to how your back pain has affected your ability to manage in every day life. Please answer every question by placing a mark on the line that best describes your condition today.

SCORE DISABILITY LEVEL 0 - 4 No disability 5 - 14 Mild disability 15 - 24 Moderate disability 25 - 34 Severe disability 35 - 50 Completely disabled The Oswestry Disability Index (aka the Oswestry Low Back Pain Disability Questionnaire) is an ex- tremely important tool that researchers and disability evaluators use to ...

A score of 0-20 reflects minimal disability, 21-40 moderate disability, 41-60 severe disability, 61-80 crippled, and 81-100 bed-bound. Minimal clinical difference has been evaluated across numerous types of spinal surgery, and has been shown to vary significantly.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232