NSR — Low Back Pain — Oswestry Disability Index (ODI)
Fields marked * are required. All information is kept strictly confidential and protected under HIPAA.

Patient Information

Oswestry Disability Index (ODI) — Low Back Pain

Instructions: This questionnaire has been designed to assess how your back pain affects your ability to manage everyday activities. Please mark ONE answer in each section that most closely describes your situation TODAY.
1. Pain Intensity
2. Personal Care (Washing / Dressing)
3. Lifting
4. Walking
5. Sitting
6. Standing
7. Sleeping
8. Social Life
9. Traveling
10. Employment / Homemaking

✓   End of Patient Questionnaire

Thank you for completing this questionnaire. Please return this form to your therapist.
The scoring section below is for clinician use only.

🔒   CLINICIAN USE ONLY — Complete the score fields below after the patient finishes this questionnaire.
Score Range Classification Typical Clinical Presentation
0 – 20% Minimal disability Patient can manage most activities. Treatment focuses on lifting, posture, and fitness.
21 – 40% Moderate disability Pain limits sitting, lifting, and standing. Employment possible. Conservative treatment appropriate.
41 – 60% Severe disability Pain is the primary problem. Detailed investigation needed.
61 – 80% Crippling Pain impacts all aspects of daily life. Positive intervention is required.
81 – 100% Bed-bound / Exaggerating Patient is bed-bound or symptoms may be exaggerated. Evaluation warranted.

Form 6 of 11  ·  Next Step Rehab Patient Intake Suite  ·  www.nextstep-rehab.com