Oswestry Disability Index

This survey is for patients who have had Lumbar Spinal Surgery with Carle Spine Institute. These are the same surveys you took before surgery. Your surgeon would appreciate it if you would fill these out 3, 6, and 12 months after surgery so we can track your progress.


First

Last

MRN


Today's Date (M/D/Y)

 

If so, was it at the Spine Institute?

These questions pertain to your neck and related symptoms. Please answer each question and mark only ONE answer that best fits your situation.

How would you rate your average daily pain on a 0 to 10 scale?
1

2

3

4

5

6

7

8

9

10

Section 1 - Pain Intensity Section 6 - Standing

The pain comes and goes and is very mild.

I can stand as long as I want without pain.

The pain is mild and does not vary much.

I have some pain on standing but it does not increase with time.

The pain comes and goes and is moderate.

I cannot stand for longer than 1 hour without increasing pain.

The pain is moderate and does not vary much.

I cannot stand for longer than 1/2 hour without increasing pain.

The pain comes and goes and is severe.

I cannot stand for longer than 10 minutes without increasing pain.

The pain is severe and does not vary much.

I avoid standing because it increases the pain immediately.

Section 2 - Personal Care (Washing, Dressing, etc.) Section 7 - Sleeping

I would not have to change my way of washing or dressing in order to avoid pain.

I get no pain in bed.

I do not normally change my way of washing or dressing even though it causes some pain.

I get pain in bed but it does not prevent me from sleeping well.

Washing and dressing increase the pain but I manage not to change my way of doing it.

Because of pain my normal nights sleep is reduced by less than 1/4.

Washing and dressing increase the pain and I find it necessary to change my way of doing it.

Because of pain my normal nights sleep is reduced by less than 1/2.

Because of the pain I am unable to do some washing and dressing without help.

Because of pain my normal nights sleep is reduced by less than 3/4.

Because of the pain I am unable to do any washing and dressing without help.

Pain prevents me from sleeping at all.

Section 3 - Lifting Section 8 - Social Life

I can lift heavy weights without extra gain.

My social life is normal and gives me no pain.

I can lift heavy weights, but it gives extra pain.

My social life is normal but it increases the degree of pain.

Pain prevents me from lifting heavy weights off the floor.

Pain has no significant effect on my social life apart from limiting my more energetic interests, for example, dancing.

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

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

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

Pain has restricted my social life to my home.

I can only lift very light weights at most.

I have hardly any social life because of the pain.

Section 4 - Walking Section 9 - Traveling

I have no pain on walking.

I get no pain when traveling.

I have some pain on walking but it does not increase with distance.

I get some pain when traveling but none of my usual forms of travel make it any worse.

I cannot walk more than 1 mile without increasing pain.

I get extra pain while traveling but it does not compel me to seek alternate forms of travel.

I cannot walk more than 1/2 mile without increasing pain.

I get extra pain while traveling which compels me to seek alternate forms of travel.

I cannot walk more than 1/4 mile without increasing pain.

Pain restricts me to short necessary journeys under 1/2 hour.

I cannot walk at all without increasing pain.

Pain restricts all forms of travel.

Section 5 - Sitting Section 10 - Changing Degree of Pain

I can sit in any chair as long as I like.

My pain is rapidly getting better.

I can sit only in my favorite chair as long as I like.

My pain fluctuates but is definitely getting better.

Pain prevents me from sitting more than 1 hour.

My pain seems to be getting better but improvement is slow.

Pain prevents me from sitting more than 1/2 hour.

My pain is neither getting better or worse.

Pain prevents me from sitting more than 10 minutes.

My pain is gradually worsening.

I avoid sitting because it increases pain immediately.

My pain is rapidly worsening.

These questions pertain to your overall health, not just your Spine Surgery. Please answer each question and mark only ONE answer that best fits your situation.

In general, would you say your health is:

Excellent



Compared to one year ago, how would you rate your health in general now?






Yes, limited a lot
Yes, limited a little
Not limited at all

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.

Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf.

Lifting or carrying groceries.

Climbing several flights of stairs.

Climbing one flight of stairs.

Bending, kneeling, or stooping.

Walking more than a mile.

Walking several hundred yards.

Walking one hundred yards.

Bathing or dressing yourself.

All of the time
Most of the time
Some of the time
A little of the time
None of the time

Cut down on the amount of time you spent on work or other activities.

Accomplished less than you would like.

Were limited in the kind of work or other activities.

Had difficulty performing the work or other activities (for example, it took extra effort).

All of the time
Most of the time
Some of the time
A little of the time
None of the time

Cut down on the amount of time you spent on work or other activities.

Accomplished less than you would like.

Did work or other activities less carefuly than usual.

 
Not at all
Slightly
Moderately
Severe
Extremely
 
 
 
 
None
Very mild
Mild
Moderate
Severe
Very Severe
 
 
 
 
Not at all
A little bit
Moderately
Quite a bit
Extremely
 
 
 
All of the time
Most of the time
Some of the time
A little of the time
None of the time

Did you feel full of life?

Have you been very nervous?

Have you felt so down in the dumps that nothing could cheer you up?

Have you felt calm and peaceful?

Did you have a lot of energy?

Have you felt downhearted and depressed?

Did you feel worn out?

Have you been happy?

Did you feel tired?

 
All of the time
Most of the time
Some of the time
A little of the time
None of the time
 
 
 

How TRUE or FALSE is each of the following statements for you?

Definitely true

Mostly true

Don't know

Mostly false

Definitely false

I seem to get sick a little easier than other people.

I am as healthy as anybody I know.

I expect my health to get worse.

My health is excellent.

Thank you for completing these questions