Please read instructions: When your back hurts, you may find it difficult to do some of the things you normally do. Mark only the sentences that describe you today.
1. I stay at home most of the time because of my back
2. I change position frequently to try to get my back comfortable
3. I walk more slowly than usual because of my back
4. Because of my back, I am not doing any jobs that I usually do around the house
5. Because of my back, I use a handrail to get upstairs
6. Because of my back, I lie down to rest more often
7. Because of my back, I have to hold on to something to get out of an easy chair
8. Because of my back, I try to get other people to do things for me
9. I get dressed more slowly than usual because of my back
10. I only stand up for short periods of time because of my back
11. Because of my back, I try not to bend or kneel down
12. I find it difficult to get out of a chair because of my back
13. My back is painful almost all of the time
14. I find it difficult to turn over in bed because of my back
15. My appetite is not very good because of my back
16. I have trouble putting on my sock (or stockings) because of the pain in my back
17. I can only walk short distances because of my back pain
18. I sleep less well because of my back
19. Because of my back pain, I get dressed with the help of someone else
20. I sit down for most of the day because of my back
21. I avoid heavy jobs around the house because of my back
22. Because of back pain, I am more irritable and bad tempered with people than usual
23. Because of my back, I go upstairs more slowly than usual
24. I stay in bed most of the time because of my back
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