How Are You Doing?

Difficulty *
How difficult were your exercises?
Please explain
Symptoms *
How is your pain or dysfunction?
Please explain
How many days did you complete your exercises?
Satisfaction *
How has your experience been?
Name *
Name

Oswestry Disability Index

Instructions

This questionnaire has been designed to give us information as to how your back or leg pain is affecting your ability to manage in everyday life. Please answer by checking ONE box in each section for the statement which best applies to you. We realise you may consider that two or more statements in any one section apply but please just shade out the spot that indicates the statement which most clearly describes your problem. 

Name *
Name

Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000 Nov 15;25(22):2940-52; discussion 52.