Questionnaire of Low Back Pain in obese women

Name………………………………. Age ………………………… height ………………………

Weight……………………………… Occupation……………….

Marital status………….. Duration of marriage………….. No of child…………..

Q1. Do you have back Pain?

a) Yes Q7. Tell about working hours?

b) no
a) 4-6 hours
b) 6-8 hours
Q2. If have pain, then in which region?
c) 8-12 hours
a) Upper back d) More than 12 hours
b) Lower back
Q8. Did this pain interfere in your working
Q3. What is the intensity of pain? ability?

a) Mild a) Yes
b) Moderate b) No
c) Severe c) Sometimes

Q4. What is the nature of pain? Q9. Any previous history of back pain?

a) Tingling a) Yes
b) Diffuse b) no
c) Localized
Q10. Do you avoid heavy jobs around the
Q5. In which body position did you work house because of pain?
mostly?
a) Yes
a) Standing b) No
b) Sitting
c) Bending

Q6. In which time did you have back pain?

a) During work
b) Immediately after work
c) At rest
d) Others