SRS 22r Summary

1. Which describes the pain you have experienced during the past 6 months? (2 points)
Moderate to severe pain during past 6 months

2. Which describes the pain you have experienced over the last month? (3 points)
Moderate pain during past month

3. During the past 6 months have you been a very nervous person? (3 points)
Some of the time a very nervous person during past 6 months

4. If you had to spend rest of life with current back shape, how would you feel? (2 points)
Somewhat happy if rest of life spent with current back shape

5. What is your current level of activity? (3 points)

Activity level: Light labor and light sports

6. How do you look in clothes? (3 points)

Feels appearance is fair in clothes

7. In past 6 months have you felt so down in dumps that nothing could cheer you? (3 points)
Sometimes felt so down in the dumps that nothing could cheer up in past 6 months

8. Do you experience back pain when at rest? (2 points)

Often feels back pain at rest

9. What is your current level of work/school activity? (3 points)

50% of normal work/school activity level

10. Which of the following best describes the appearance of your trunk? (3 points)
Describes appearance of trunk as fair

11. Which of following best describes your pain medication use for back pain? (4 points)
Non-narcotics weekly or less (e.g., aspirin, Tylenol, Ibuprofen)

12. Does your back limit your ability to do things around the house? (2 points)
Back often limits ability to do things around the house

13. Have you felt calm and peaceful during the past 6 months? (3 points)
Felt calm some of the time during past 6 months

14. Do you feel that your back condition affects your personal relationships? (2 points)
Feels that back condition moderately affects personal relationships

15. You and/or family experiencing financial difficulties because of back? (3 points)
Mild financial difficulties because of back

16. In the past 6 months have you felt down hearted and blue? (2 points)
Often in the past 6 months felt down hearted and blue

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SRS 22r Summary
17. In the last 3 months have you taken any days off because of back pain? (2 points)
3 days taken off work/school because of back pain in last 3 months

18. Does your back condition limit your going out with friends/family? (2 points)
Back pain often limits going out with friends/family

19. Do you feel attractive with your current back condition? (2 points)
No, does not feel very attractive with current back condition

20. Have you been a happy person during the past 6 months? (3 points)
Some of the time a happy person during past 6 months

21. Are you satisfied with the results of your back management? (3 points)
Neither satisified nor unsatisfied with the results of back management

22. Would you have the same management again if you had the same condition? (4 points)
Probably yes, would have the same management again

Pertinent Negative Pertinent Positive Pertinent Positive

Total SRS22 Score:

2.7/5=54.0 percent.
Graphical Total SRS22 Score:

Function:
2.6/5

Pain:
2.6/5

Self image:
2.4/5

Mental health:
2.8/5

Satisfaction/dissatisfaction with management:

3.5/5

The tools listed on this website do not substitute for the informed opinion of a licensed physician or other health care provider.
All scores should be re-checked. Please see our full Terms of Use.