ND - Roland-Morris Disability Questionnaire

Roland-Morris Low Back Pain Disability Questionnaire

When your back hurts, you may find it difficult to do some of the things you usually do. Does this apply to you today (Yes/No)?

1. I stay at home most of the time because of my back. * Required

YesNo

2. I change position frequently to try and get my back comfortable. * Required

YesNo

3. I walk more slowly than usual because of my back. * Required

YesNo

4. Because of my back, I am not doing any of the jobs that I usually do around the house. * Required

YesNo

5. Because of my back, I use a handrail to get upstairs. * Required

YesNo

6. Because of my back, I have to lie down to rest more often. * Required

YesNo

7. Because of my back, I have to hold on to something to get out of an easy chair. * Required

YesNo

8. Because of my back, I try to get other people to do things for me. * Required

YesNo

9. I get dressed more slowly than usual because of my back. * Required

YesNo

10. I only stand up for short periods of time because of my back. * Required

YesNo

11. Because of my back, I try not to bend or kneel down. * Required

YesNo

12. I find it difficult to get out of a chair because of my back. * Required

YesNo

13. My back is painful almost all of the time. * Required

YesNo

14. I find it difficult to turn over in bed because of my back. * Required

YesNo

15. My appetite is not very good because of my back pain. * Required

YesNo

16. I have trouble putting on my socks because of the pain in my back. * Required

YesNo

17. I only walk short distances because of my back pain. * Required

YesNo

18. I sleep less well because of my back. * Required

YesNo

19. Because of my back pain, I get dressed with help from someone else. * Required

YesNo

20. I sit down for most of the time because of my back. * Required

YesNo

21. I avoid heavy jobs around the house because of my back. * Required

YesNo

22. Because of my back pain, I am more irritable and bad tempered than usual. * Required

YesNo

23. Because of my back, I go upstairs more slowly than usual. * Required

YesNo

24. I stay in bed most of the time because of my back. * Required

YesNo

ND - Roland-Morris Disability Questionnaire

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