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Roland Disability Score.

QUESTIONNAIRE ON LOW BACK PAIN

When your back hurts, you may find it difficult to do some of the things you normally do.

This list contains some sentences that people have used to describe themselves when they have back pain. When you read them, you may find that some stand out because they describe your situation today. As you read the list, think of yourself today. When you read a sentence that describes your situation today, put a tick against it. If the sentence does not describe your situation, then leave the space blank and go on to the next one. Remember, only tick the sentence if you are sure that it describes your situation today.





Personal Information

Name

Date of Birth

Questions

 1. I stay at home most of the day because of the pain in my back. 2. I change position frequently to try and get my back comfortable. 3. I walk more slowly than usual because of the pain in my back. 4. Because of the pain in my back, I am not doing any of the jobs that I usually do around the house. 5. Because of the pain in my back, I use a handrail to climb stairs. 6. Because of the pain in my back, I lie down to rest more often than usual. 7. Because of the pain in my back, I have to hold on to something to get out of a lounge chair. 8. Because of the pain in my back, I ask other people to do things for me. 9. I get dressed more slowly than usual because of the pain in my back. 10. I only stand up for short periods of time because of the pain in my back. 11. Because of the pain in my back, I try not to bend or kneel down. 12. I find it difficult to get out of a dining chair because of the pain in my back. 13. My back is painful most of the time. 14. I find it difficult to turn over in bed because of the pain in my back. 15. I do not feel like eating much because of the pain in my back. 16. I have trouble putting on my socks (or stockings) because of the pain in my back. 17. I only walk short distances because of the pain in my back. 18. I sleep less than usual because of the pain in my back. 19. Because of the pain in my back, I get dressed with help from someone else. 20. I sit down for most of the day because of the pain in my back. 21. I avoid heavy jobs in the house because of the pain in my back. 22. Because of the pain in my back, I am more irritable and bad tempered with people than usual. 23. Because of the pain in my back, I climb stairs more slowly than usual. 24. I stay in bed most of the time because of the pain in my back.