The Quebec Back Pain Disability Scale

This questionnaire inquires about the way your back pain is affecting your daily life. People with back problems may find it difficult to perform some of their daily activities. We would like to know if you find it difficult to perform any of the activities listed below, because of your back. For each activity there is a scale of 0 to 5. Please choose one response option for each activity (do not skip any activities).

NameEmail
1) Because of your back pain, do you find it difficult to get out of bed?
2) Because of your back pain, do you find it difficult to sleep through the night?
3) Because of your back pain, do you find it difficult to turn over in bed?
4) Because of your back pain, do you find it difficult to ride in a car?
5) Because of your back pain, do you find it difficult to stand up for 20-30minutes?
6) Because of your back pain, do you find it difficult to sit in a chair for several hours?
7) Because of your back pain, do you find it difficult to climb one flight of stairs?
8) Because of your back pain, do you find it difficult to walk a few blocks (300-400 metres)?
9) Because of your back pain, do you find it difficult to walk several kilometres?
10) Because of your back pain, do you find it difficult to reach up to high shelves?
11) Because of your back pain, do you find it difficult to throw a ball?
12) Because of your back pain, do you find it difficult to run one block (about 100 metres?
13) Because of your back pain, do you find it difficult to take food out of the refrigerator?
14) Because of your back pain, do you find it difficult to make your bed?
15) Because of your back pain, do you find it difficult to bend over to clean the bathtub?
16) Because of your back pain, do you find it difficult to move a chair?
17) Because of your back pain, do you find it difficult to pull or push heavy doors?
18) Because of your back pain, do you find it difficult to carry two bags of groceries?
19) Because of your back pain, do you find it difficult to lift and carry a heavy suitcase?

Thank you for your submission. it will form a valuable part of our ongoing assessment of your functional capacity as it relates to your back pain



Sources:

  1. Kopec, JA, Esdaile, JM, Abrahamowicz, M., Abenhaim, L, Wood-Dauphinee, S, Lamping, DL & Williams JI. (1995). The Quebec Back Pain Disability Scale. Spine, 20(3): 341-352.
  2. Davidson, M. & Keating, J.L. (2002). A comparison of five low back disability questionnaires: Reliability and responsiveness. Physical Therapy, 82(1): 8- 24.

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