PRECISION PHYSIO

Örebro Musculoskeletal Pain Screening Questionnaire (SHORT-FORM)

Description of Image

Please follow the questions and the rating you believe applies to you. You are not required to complete the ‘Enter Score ‘ boxes. These will be completed by your Clinician once submitted.

Name:(Required)
MM slash DD slash YYYY
1. How long have you had your current pain problem? Tick one.(Required)
0
No pain
12345678910
Pain as bad as it could be
0
Not at all
12345678910
Without any difficulty
0
Not at all
12345678910
Without any difficulty
0
Absolutely calm and relaxed
12345678910
As tense and anxious as I’ve ever felt
0
Not at all
12345678910
Extremely
0
No risk
12345678910
Very large risk
0
Not chance
12345678910
Very large chance
0
Completely disagree
12345678910
Completely agree
0
Completely disagree
12345678910
Completely agree



Scoring the short version of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ)

The items are scored 0-10, where 0 refers to absence of impairment and 10 to severe impairment. However, three items need to be reversed in order for all the questions to be oriented in the same direction.

The scoring method has been built into the questionnaire and scoring boxes are provided to the right of each item:

  • Item 1: On pain duration, the categories 1-10 represent periods of time ranging from “0-1 week” (first box on the left) to “over 1 year” (last box to the right). For example, “6-8 weeks” would be scored as “5.”
  • Items 2, 5, 6, 7, 9, and 10: The score is the number circled.
  • Items 3, 4, and 8: The score is 10 minus the number circled. These items are marked with “10-x” next to the scoring box. For example, if the patient circles 7 for question 3 (“I can sleep at night”), the score will be 10-7 = 3.
  • Write the score for each item in the shaded scoring box.
  • Score total:
    • If using the tool online, the score total in the last shaded box will be calculated as the score for each item is entered.
    • If using a printed version of the tool, add all the scores to obtain the total score and write it in the last shaded box.

The total score will range between 1 and 100, with a score >50 indicating higher estimated risk for future work disability (Linton, Nicholas & MacDonald, 2011).

Thank you for completing this questionnaire. It will be sent to your Clinician at Precision Physio.