Oswestry Survey 1

Chicago Resident,
Do you have back pain?

It may be treatable with No‑Surgery Decompression

Complete the short 10-question Oswestry pain survey to see your score and implications.

1) PAIN INTENSITY
At this moment, the pain is...

2) PERSONAL CARE
Activities like washing, dressing etc

I can look after myself normally without causing extra pain

I can look after myself normally but it causes extra pain

It is painful to look after myself and I am slow and careful

I need some help but manage most of my personal care

I need help every day in most aspects of self-care

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

3) LIFTING

I can lift heavy weights without extra pain

I can lift heavy weights but it gives extra pain

Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently placed eg. on a table

Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

I can lift very light weights

I cannot lift or carry anything at all

4) WALKING

Pain does not prevent me walking any distance

Pain prevents me from walking more than 1 mile

Pain prevents me from walking more than 1/2 mile

Pain prevents me from walking more than 100 yards

I can only walk using a stick or crutches

I am in bed most of the time

5) SITTING

I can sit in any chair as long as I like

I can only sit on my favorite chair/sofa as long as I like

Pain prevents me sitting more than one hour

Pain prevents me from sitting more than 30 minutes

Pain prevents me from sitting more than 10 minutes

Pain prevents me from sitting at all

6) STANDING

I can stand as long as I want without extra pain

I can stand as long as I want but it gives me extra pain

Pain prevents me from standing for more than 1 hour

Pain prevents me from standing for more than 3 minutes

Pain prevents me from standing for more than 10 minutes

Pain prevents me from standing at all

7) SLEEPING

My sleep is never disturbed by pain

My sleep is occasionally disturbed by pain

Because of pain I have less than 6 hours sleep

Because of pain I have less than 4 hours sleep

Because of pain I have less than 2 hours sleep

Pain prevents me from sleeping at all

8) SEX LIFE

My sex life is normal and causes no extra pain

My sex life is normal but causes some extra pain

My sex life is nearly normal but is very painful

My sex life is severely restricted by pain

My sex life is nearly absent because of pain

Pain prevents any sex life at all

9) SOCIAL LIFE

My social life is normal and gives me no extra pain

My social life is normal but increases the degree of pain

Pain has no significant effect on my social life apart from limiting my more energetic interests eg, sports

Pain has restricted my social life and I do not go out as often

Pain has restricted my social life to my home

I have no social life because of pain

10) TRAVELLING

I can travel anywhere without pain

I can travel anywhere but it gives me extra pain

Pain is bad but I manage journeys over two hours

Pain restricts me to journeys of less than one hour

Pain restricts me to short necessary journeys under 30 minutes

Pain prevents me from travelling except to receive treatment

Your Score: 0.0

What does it mean? If you scored between...

0-10: MINIMAL DISABILITY
You can cope with most living activities. Usually no treatment is needed. Proper lifting, sitting and exercise is advised.
11-20: MODERATE DISABILITY
21-30: SEVERE DISABILITY
31-40: CRIPPLED
41-50: BED BOUND

Your Score: 0.0

What does it mean? If you scored between...

0-10: MINIMAL DISABILITY
11-20: MODERATE DISABILITY
You experience more pain and difficulty with sitting, lifting and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected. Quality of life is moderately affected. Conservative treatment is advised.
21-30: SEVERE DISABILITY
31-40: CRIPPLED
41-50: BED BOUND

Your Score: 0.0

What does it mean? If you scored between...

0-10: MINIMAL DISABILITY
11-20: MODERATE DISABILITY
21-30: SEVERE DISABILITY
Back pain is a fundamental part of your life with daily living activities significantly affected. Quality of life fundamentally impacted. Proper medical treatment is needed.
31-40: CRIPPLED
41-50: BED BOUND

Your Score: 0.0

What does it mean? If you scored between...

0-10: MINIMAL DISABILITY
11-20: MODERATE DISABILITY
21-30: SEVERE DISABILITY
31-40: CRIPPLED
Back pain impinges on all aspects of your life. Proper medical treatment is needed.
41-50: BED BOUND

Your Score: 0.0

What does it mean? If you scored between...

0-10: MINIMAL DISABILITY
11-20: MODERATE DISABILITY
21-30: SEVERE DISABILITY
31-40: CRIPPLED
41-50: BED BOUND
You are either bed bound or exaggerating your symptoms.

Would you like to share your responses and score of 0.0 with Dr. Taylor's office to get a FREE consultation on your condition?

Yes, please.

No, thank you.

Please provide your contact information:

First Name :
Last Name :
Phone :
Email Address :

We hope this survey was informative.

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www.DrTaylorRehab.com

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