Smart Health Assessment | Bangkok Hospital Pattaya

ODI : Oswestry Disability Index

แบบประเมินระดับความรุนแรงของอาการปวดหลัง

Bangkok Hospital Pattaya

*First name

*Last name

*Gender

Male Female

*Date of birth

HN (if known)

*Height (cm.)

*Weight (kg.)

*Contact number

E-mail

Please section with most describes your problems during the past 4 weeks.

1. Pain Intensity

I have no pain at the moment
The pain is very mild at the moment
The pain is moderate at the moment
The pain is fairly severe at the moment
The pain is very severe at the moment
The pain is the worst imaginable at the moment

2. Personal Care (eg. washing, dressing)

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 can manage most of my personal care
I need help every day in most aspects of self-care
I do not get dressed, 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 me extra pain
Pain prevents me lifting heavy weights off the floor but I can manage if they are conveniently placed eg.on a table
Pain prevents me lifting heavy weights but I can manage light to medium weights if they are conveniently positioned
I can only lift very light weights
I cannot lift or carry anything

4. Walking

Pain does not prevent me walking any distance
Pain prevents me from walking more than 2 kilometres
Pain prevents me from walking more than 1 kilometre
Pain prevents me from walking more than 500 metres
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 in my favourite chair 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 30 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 (if applicable)

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 e.g. sport
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

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