Date of Completion

Oswestry Low Back Pain Disability Questionnaire
Clinician's name (or ref)
Patient's d.o.b
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......

1 - How would you describe the pain you usually have in your hip?
  • None
  • Very mild
  • Mild
  • Moderate
  • Severe
2 - Have you been troubled by pain from your hip in bed at night?
  • No nights
  • Only 1 or 2 nights
  • Some nights
  • Most nights
  • Every night
3 - Have you had any sudden, severe pain - 'shooting', 'stabbing', or 'spasms' from your affected hip?
  • No days
  • Only 1 or 2 days
  • Some days
  • Most days
  • Every day
4 - Have you been limping when walking because of your hip?
  • Rarely/never
  • Sometimes or just at first
  • Often, not just at first
  • Most of the getTime
  • All of the time
5 - For how long have you been able to walk before the pain in your hip becomes severe (with or without a walking aid)?
  • No pain for 30 minutes or more.
  • 16 to 30 minutes
  • 5 to 15 minutes
  • Around the house only
  • Not at all
6 - Have you been able to climb a flight of stairs?
  • Yes, easily
  • With little difficulty
  • With moderate difficulty
  • With extreme difficulty
  • No, impossible
7 - Have you been able to put on a pair of socks, stockings or tights?
  • Yes, easily
  • With little difficulty
  • With moderate difficulty
  • With extreme difficulty
  • No, impossible
8 - After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip?
  • Not at all painful
  • Slightly painful
  • Moderately painful
  • Very painful
  • Unbearable
9 - Have you had any trouble getting in and out of a car or using public transportation because of your hip?
  • No trouble at all
  • Very little trouble
  • Moderate trouble
  • Extreme difficulty
  • Impossible to do
10 - Have you had any trouble with washing and drying yourself (all over) because of your hip?
  • No trouble at all
  • Very little trouble
  • Moderate trouble
  • Extreme difficulty
  • Impossible to do
11 - Could you do the household shopping on your own?
  • Yes, easily
  • With little difficulty
  • With moderate difficulty
  • With extreme difficulty
  • No, impossible
12 - How much has pain from your hip interfered with your usual work, including housework?
  • Not at all
  • A little bit
  • Moderately
  • Greatly
  • Totally
Oxford Hip Score is %

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Reference:

Waddell C, Newton M, Henderson I, et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52:157-168.

Fritz JM, George S.Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs. Phys Ther. 2002; 82(10): 973-983.

Lethem J, Slade PD, Troup JDG, Bendey G. Outline of a fear avoidance model of exaggerated pain perceptions, Behav Res Ther. 1983;21:401-408.

Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.

Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eck H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 36, 272.