Outcome Measures Questionnaires

Thank you for taking the time to carefully complete each section below and submitting your responses
  • DD slash MM slash YYYY
  • The Brief Pain Inventory (BPI)

  • Intensity

  • Interference

    Select the one number that describes how, during the past 24 hours, pain has interfered with your
    Select the one number that describes how, during the past 24 hours, pain has interfered with your
    Select the one number that describes how, during the past 24 hours, pain has interfered with your
    Select the one number that describes how, during the past 24 hours, pain has interfered with your
    Select the one number that describes how, during the past 24 hours, pain has interfered with your
    Select the one number that describes how, during the past 24 hours, pain has interfered with your
    Select the one number that describes how, during the past 24 hours, pain has interfered with your
  • Pain Self Efficacy Questionnaire (PSEQ)

  • The Patient Specific Functional Scale

    Select three important activities that you are unable to do or are having difficulty with as a result of your problem