Patient Questionnaire
Holsman Physical Therapy & Wellness · 17 NJ & NYC clinics + in-home therapy
holsmanwellness.com · 1-855-465-7626
Holsman Physical Therapy & Wellness · 17 NJ & NYC clinics + in-home therapy
holsmanwellness.com · 1-855-465-7626
Seven quick ratings of how much pain gets in the way of your life, scored from 0 to 70.
The Pain Disability Index is a short, widely used questionnaire about how much pain interferes with everyday life, from chores and work to sleep. Physical therapists use it to track progress. It takes about 2 minutes.
Instructions
The rating scales below are designed to measure the degree to which aspects of your life are disrupted by chronic pain. In other words, we would like to know how much pain is preventing you from doing what you would normally do or from doing it as well as you normally would. Respond to each category indicating the overall impact of pain in your life, not just when pain is at its worst.
For each of the 7 categories of life activity listed, please choose the number on the scale that describes the level of disability you typically experience. A score of 0 means no disability at all, and a score of 10 signifies that all of the activities in which you would normally be involved have been totally disrupted or prevented by your pain.
This is a questionnaire, not a diagnosis. The PDI shows how much pain affects your daily life. It can’t tell you what is causing the pain or what treatment you need. Share your result with a physical therapist, your doctor or another licensed health care provider.
Scores run from 0 to 70; higher means more disability from pain. The PDI has no established severity cut-offs (Cassidy et al., 2026), so it is best used to compare your own scores over time.
Sources. Pain Disability Index, Pollard CA and Tait RC. According to the author, Dr. Raymond Tait, the instrument is in the public domain (Mapi Research Trust ePROVIDE listing). Item wording as printed in the Oregon Health Authority Pain Care Toolbox copy (“circle” changed to “choose” for on-screen use). Tait RC, Chibnall JT, Krause S. The Pain Disability Index: psychometric properties. Pain. 1990;40(2):171-182. Soer R, et al. Responsiveness and minimal clinically important change of the Pain Disability Index in patients with chronic back pain. Spine. 2012;37(8):711-715. Soer R, et al. Extensive validation of the Pain Disability Index in 3 groups of patients with musculoskeletal pain. Spine. 2013;38(9):E562-568. Soer R, et al. Reference values of the Pain Disability Index in patients with painful musculoskeletal and spinal disorders. Spine. 2015;40(9):E545-551. Cassidy L, et al. Development of a Modern Standard Arabic version of the Pain Disability Index. Front Med. 2026;12. Holsman Physical Therapy is not affiliated with these organizations, and they do not endorse this website.
Next step: Bring this printout to your next visit. Holsman physical therapists treat back, neck and joint pain at 17 clinics in North Jersey, the Bronx and Brooklyn, plus in-home visits. Request an appointment or call 1-855-465-7626. No referral needed to start with most plans; we verify your insurance free.
The Pain Disability Index (PDI) is a short questionnaire about how much pain interferes with seven areas of life: family and home, recreation, social activity, work, sex life, self-care and basic activities like eating and sleeping. It was developed by Pollard and Tait at St. Louis University Medical Center and is in the public domain.
Each of the seven areas is rated from 0 (no disability) to 10 (worst disability). The ratings are added for a total from 0 to 70. Higher scores mean pain gets in the way of more of your life.
The PDI has no official severity cut-offs. For comparison, 6,997 patients seen in specialist care for musculoskeletal and spinal pain averaged 37.8 (Soer et al., 2015). Your score is most useful for tracking change over time.
In people with chronic back pain, a drop of 8.5 to 9.5 points was the smallest change patients felt was important (Soer et al., 2012). For one person, a change of about 18 points (17.9) is needed to be confident it is more than day-to-day variation (Soer et al., 2013).
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Physical therapists at 17 locations across NJ & NYC, plus in-home visits. Same-week appointments available.
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