Questionnaire - ÖMPSQ (Short Version) Questionnaire - ÖMPSQ (Short Version) CompanyThis field is for validation purposes and should be left unchanged.First Name*Last Name*Tick One* 0-1 weeks 1-2 weeks 3-4 weeks 4-5 weeks 6-8 weeks 9-11 weeks 3-6 months 6-9 months 9-12 months Over 1 year 2. How would you rate the pain that you have had during the past week? Select one.*0123456789100 being no pain and 10 pain as bad as it could be.3. I can do light work for an hour? Select one.*0123456789100 can't do it because of the pain being a problem. 10 can do it without pain being a problem. 4. I can sleep at night? Select one.*0123456789100 can't do it because of the pain being a problem. 10 can do it without pain being a problem. 5. How tense or anxious have you felt in the past week? Select one.*0123456789100 absolutely calm and relaxed. 10 as tense and anxious as I've ever felt. 6. How much have you been bothered by feeling depressed in the past week? Select one.*0123456789100 not at all. 10 extremely. 7. In your view how large is the risk that your current pain may become persistent? Select one.*0123456789100 no risk. 10 very large risk. 8. In your estimation, what are the chances you will be working your normal duties in 3 months? Select one.*0123456789100 no risk. 10 very large risk. Here are some of the things which other people have told us about their pain. For each statement please circle one number from 0-10 to say how much physical activities, such as bending, lifting, walking, or driving affect your pain.9. An increase in pain is an indication that I should stop what I am doing until the pain decreases? Select one.*0123456789100 completely disagree. 10 completely agree. 10. I should not do my normal work with my present pain? Select one.*0123456789100 completely disagree. 10 completely agree.
