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Phone: (02) 4923 8900

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RMDQ 2011

When your pain hurts, you may find it difficult to do some of the things you normally do. This list contains some sentences that people have used to describe themselves when they have pain. When you read them, you may find that some stand out because they describe you today. As you read the list, think of yourself today. When you read a sentence that describes you today, check the box. If the sentence does not describe you, then leave the box blank and go to the next one.

Remember, only tick the sentence if you are sure that it describes you today.

Roland-Morris Disability Questionnaire (RMDQ)

Full Name(Required)

First

Date of birth(Required)

DD slash MM slash YYYY

Tick the sentence if you are sure that it describes you today.

I stay at home most of the time because of my pain.

I change position frequently to try and get my pain comfortable.

I walk more slowly than usual because of my pain.

Because of my pain, I am not doing any of the jobs that I usually do around the house.

Because of my pain, I use a handrail to get up the stairs.

Because of my pain, I lie down to rest more often.

Because of my pain, I have to hold on to something to get out of an easy chair.

Because of my pain, I try to get other people to do things for me.

I get dressed more slowly than usual because of my pain.

I only stand for short periods of time because of my pain

Because of my pain, I try not to bend or kneel down.

I find it difficult to get out of a chair because of my pain.

I am in pain almost all of the time

I find it difficult to turn over in bed because of my pain

My appetite is not very good because of my pain.

I have trouble putting on my socks (or stockings) because of my pain.

I only walk short distances because of my pain

I sleep less well because of my pain.

Because of my pain, I get dressed with help from someone else.

I sit down for most of the day because of my pain.

I avoid heavy jobs around the house because of my pain.

Because of my pain, I am more irritable and bad tempered with people than usual.

Because of my pain, I go up stairs more slowly than usual.

I stay in bed most of the time because of my pain.

Enquiries
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Phone: (02) 4923 8900

Fax: (02) 4947 8991

Email: Click Here

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