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Self Assessment - Lower Back and neck disability
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Lower Back and neck disability self assessment:
For each statement below, choose the answer that most closely matches how you feel, and click the orange calculate button:
Q1
Pain intensity
Select intensity level...
Pain comes and goes and is very mild.
Pain is mild and does not vary much.
Pain comes and goes and is moderate.
Pain is moderate and does not vary.
Pain comes and goes and is severe.
Pain is severe and does not vary much.
Q2
Personal care
Select care level...
I would not have to change my way of washing or dressing in order to avoid pain.
I don't normally change my way of washing or dressing even though it's painful.
Washing & dressing increases the pain but I manage not to change my way of doing it.
Washing & dressing increases the pain and I find it necessary to change my way of doing it.
Because of the pain, I'm unable to do some washing and dressing without help.
Because of the pain, I'm unable to do any washing and dressing without help.
Q3
Pain intensity
Select intensity level...
I can lift heavy weights without extra pain.
I can lift heavy weights, but it causes extra pain.
Pain prevents me from lifting heavy weights off the floor.
I can manage heavy weights, if they are conveniently positioned eg table height.
I can manage light to medium weights, if they are conveniently positioned.
I can only life very light weights, at the most.
Q4
Walking
Select intensity level...
Pain does not prevent me from walking any distance.
Pain prevents me from walking more than one kilometer.
Pain prevents me from walking more than a quarter of a kilometer
Pain prevents me from walking more than a quarter of a kilometer
I can only walk while using a cane or on crutches.
I am in bed most of the time and have to crawl to the toilet.
Q5
Sitting
Select intensity level...
I can sit in any chair as long as I like without pain..
I can only sit in my favourite chair as long as I like.
Pain prevents me from sitting more than one hour.
Pain prevents me from sitting more than half an hour.
Pain prevents me from sitting more than ten minutes.
Pain prevents me from sitting at all.
Q6
Standing
Select intensity level...
I can stand as long as I want without pain.
I have some pain while standing, but it doesnt increase with time.
I cannot stand for longer than one hour without increasing pain.
I cannot stand for longer than half an hour without increasing pain.
I cannot stand for longer than ten minuites without increasing pain.
I avoid standing, because it increases the pain striaght away.
Q7
Sleeping
Select intensity level...
I get no pain in bed.
I get pain in bed, but it does not prevent me from sleeping well.
Beacuse of pain, my normal night's sleep is reduced by less than one-quarter.
Beacuse of pain, my normal night's sleep is reduced by less than half.
Beacuse of pain, my normal night's sleep is reduced by less than three-quarters.
Pain prevents me from sleeping.
Q8
Social Life
Select intensity level...
My social life is normal and gives me no pain.
My social life is normal, but increases the degree of my pain.
Pain has no significant effect on my social life apart from limiting my energetice interests.
Pain has restricted my social life and I do not go out very often.
Pain has restricted my social life to my home.
I have hardly any social life because of the pain.
Q9
Traveling
Select intensity level...
I get no pain while traveling.
I get some pain while traveling, but none of my usual forms make it worse.
I get extra pain while traveling, but it does not compel me to seek alternative forms.
I get extra pain while traveling which compels me to seek alternative forms.
Pain restricts all forms of travel.
Pain restricts all forms of travel except that done lying down.
Q10
Changing Degree of Pain
Select intensity level...
My pain is repidly getting better.
My pain fluctuates, but overall is definitely getting better.
My pain seems to be getting better, but inprovement is slow at present.
My pain is neither getting better or worse.
My pain is gradually worsening.
My pain is rapidly worsening.
Back & Neck Assessments and Treatment
|
What is MedX?
|
MedX Assessments
|
MedX Treatment
Who can benefit from MedX
|
Self Assessment
|
Frequently Treated Diagnosis
|
Special Features
|
Search Reports
Sports Injuries and Fitness
|
Common Diagnosis Treated
|
Golf Fitness Progam
Wellness Centre
|
Frequently Asked Questions
|
Find Us
|
Contact Us
Web sites with additional info on MedX
www.medxonline.com
|
www.spineworks.com
|
www.dynamicrehab.com
