Thinking about the last 2 weeks tick your response to the following questions:
Disagree= 0 Agree = 1
1 My back pain has spread down my leg(s) at some time in the last 2 weeks
2 I have had pain in the shoulder or neck at some time in the last 2 weeks
3 I have only walked short distances because of my back pain
4 In the last 2 weeks, I have dressed more slowly than usual because of back pain
5 It’s not really safe for a person with a condition like mine to be physically active
6 Worrying thoughts have been going through my mind a lot of the time
7 I feel that my back pain is terrible and it’s never going to get any better
8 In general I have not enjoyed all the things I used to enjoy
- Overall, how bothersome has your back pain been in the last 2 weeks?
Not at all = 0, Slightly = 0, Moderately = 0, Very much = 1, Extremely =
Total score (all 9): ______ Sub Score (Q5-9):__
Total 3 or less – GP MANAGEMENT
Total 4 or more (sub score Q5-9 is 3 or less) – MEDIUM RISK, PHYSIO REFERRAL
Total 4 or more (sub score Q5-9 is 4 or more) – HIGH RISK – MSK CLINICAL ASSESSMENT AND TRIAGE REFERRAL
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