Low Back Pain Quiz

1
How bad is your back pain?* This field is required.(0/10 = no pain, 10/10 highest pain you've ever experience)
1-4/10, no pain medication needed
5/10, but still not needing pain medication
6/10, pain medication provides relief
7/10, pain medication provides a moderate relief
8/10, pain medication provides minor relief
10/10, pain medication provides no relief
2
Does your back cope with every day activities?* This field is required.e.g., dressing or house such as vacuuming, washing
Normal function, no extra pain
Normal function, increases my pain a little
I am slow and careful, but able to complete activities independently
I need some assistance to complete daily activities occasionally
I need assistance every day to complete daily taks
I can't complete daily tasks even with assistance
3
How does your back feel when lifting?* This field is required.This may include lifting weights in a gym/studio, or lifting objects around the house.
I can lift heavy weights/objects without increasing my pain
I can lift heavy weights/objects, but it increases my pain
I am unable to lift heavy weights/objects when I have pain
I can lift moderate weights/objects when I have pain
I can only lift light weights/objects
I am unable to lift any weights/objects at all
4
How does your back feel during walking?* This field is required.
I can walk any distance without pain
I can walk any distance although it increases my pain
Pain prevents me from walking more than 1km (approx. 12-15mins)
Pain prevents me from walking more than 500m (approx. 6-8mins)
Pain prevents me from walking more than 100m (approx. 2 mins)
I need a balance aid to walk (such as crutches or a cane)
I am in bed most of the time
5
How does your back feel when sitting?* This field is required.Please answer this question in the context of upright chairs, such as an office chair or couch (not recliner)
I can sit as long as I like, my pain doesn't stop me
I can sit as long as I like, although it increases my pain a little
Pain prevents me from sitting more than 1hr
Pain prevent prevents me from sitting for more than 30mins
Pain prevents me from sitting more than 15mins
Pain prevents me from sitting at all in an upright chair
6
How does your back feel when standing?* This field is required.
I can stand as long as I like without increasing my pain
I can stand as long as I like, although it increases my pain
Pain stops me from standing more than 1hr
Pain stops me from standing more than 30mins
Pain stops me from standing more than 15mins
Pain stops me from standing at all
7
Does your back pain impact your sleep?* This field is required.
Pain does not disturb my sleep
I can sleep without medication, although my sleep is poor (broken sleep or less than 6 hrs)
I can sleep well, but medication is needed to do so
Even when medicating, I sleep less than 6hrs
Even when medicating, I sleep less than 4hrs
Even when medicating, I sleep less than 2hrs
I am lucky to sleep at all (0-1hr)
8
How is your social life impacted by your back pain?* This field is required.
My social life is normal, and my pain does not increase my pain during/following social events
My social life is normal, although my pain increases during/following social events
Pain prevents me from participating how I would like in social settings
Pain prevents me from going out as often as I would like to
Pain restricts my social life to my home
Pain prevents me from having a social life almost entirely
9
How does your back pain affect your job/employment?* This field is required.
My job does not increase my pain and I can complete all my duties without limitation
My job increases my pain, but I can complete all my duties with little limitation
My job does not increase my pain but I can only complete minimal duties with some limitation
Pain prevents me from completing little or minimal duties
Pain stops me from completing any duties
10
How does your back pain impact travelling?* This field is required.
I can travel anywhere without increasing pain
I can travel anywhere, although it increases my pain
I am restricted to travelling 2hrs or less
I am restricted to travelling 1hr or less
I am restricted to travelling 30mins or less
I cannot travel at all, except to the doctor or hospital
11
Name* This field is required.Please enter your details to get your results
First Name
Last Name
12
Email* This field is required.
example@example.com
13
Phone Number* This field is required.
Please enter a valid phone number.
Should be Empty: