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Phone: (02) 4923 8900

Fax: (02) 4947 8991

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Patient Forms

Roland-Morris Disability Questionnaire (RMDQ)

Please allow 20 minutes to complete this questionnaire below in its entirety.

If you have any questions, please phone our rooms on (02) 4923 8900.

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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Contact NIPM

Enquiries - All Locations

Phone: (02) 4923 8900

Roland-Morris Disability Questionnaire (RMDQ)

Roland-Morris Disability Questionnaire (RMDQ)

EnquiriesAll Locations

Phone: (02) 4923 8900

Fax: (02) 4947 8991

Email: Click Here

Enquiries
All Locations