Patient Questionnaire
Holsman Physical Therapy & Wellness · NJ & NYC clinics + in-home therapy
holsmanwellness.com · 1-855-465-7626
Holsman Physical Therapy & Wellness · NJ & NYC clinics + in-home therapy
holsmanwellness.com · 1-855-465-7626
24 statements about how low back pain affects your day, scored from 0 to 24.
The Roland-Morris Disability Questionnaire (RMDQ) is a short, widely used checklist that shows how much low back pain is affecting daily life. Physical therapists use it at the first visit and again later to track progress. It takes about 5 minutes.
You can fill this in yourself, but the score is meant to be read by your physical therapist or doctor. Call your doctor promptly for back pain with fever, unexplained weight loss, or new numbness or weakness in the legs. Call 911 for new loss of bladder or bowel control or numbness around the groin.
Instructions
When your back hurts, you may find it difficult to do some of the things you normally do.
This list contains some sentences that people have used to describe themselves when they have back pain. When you read them, you may find that some stand out because they describe you today. As you read the list, think of yourself today. When you read a sentence that describes you today, mark the box next to it. If the sentence does not describe you, then leave the space blank and go on to the next one. Remember, only mark the sentence if you are sure that it describes you today.
This is a questionnaire, not a diagnosis. The RMDQ shows how much back pain affects everyday activities. It can’t tell you what is causing the pain or what treatment you need. Review your result with your physical therapist, your doctor or another licensed health care provider.
The score is the number of statements marked, from 0 to 24. Higher scores mean more disability from back pain; 0 means none of the statements describe you today. A statement that doesn’t apply to you counts as not marked, so the total is always out of 24. The score is most useful for tracking change over time.
Sources. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8(2):141-144. Items and instructions: US English version (Mapi Research Institute, 2005), from the official RMDQ website. Ostelo RW, Deyo RA, Stratford P, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90-94. Stratford PW, Binkley J, Solomon P, et al. Defining the minimum level of detectable change for the Roland-Morris questionnaire. Phys Ther. 1996;76(4):359-365. Guideline: Delitto A, George SZ, Van Dillen L, et al. Low back pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1-A57 (recommends validated self-report questionnaires such as the RMDQ; recommendation based on strong evidence). The 2021 revision (George SZ, et al. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60) uses the RMDQ as a disability outcome throughout.
Permissions. Public domain: the original questionnaire and all translations can be used without permission and for any purpose, per the developer at rmdq.org.
Clinically reviewed by Dr. Richard Holsman, PT, DPT, NCS. Last reviewed: November 12, 2026. Holsman Physical Therapy is not affiliated with these authors or organizations, and they do not endorse this website.
Next step: Bring this printout to your next visit. Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits. Refer a patient or call 1-855-465-7626.
The RMDQ is a list of 24 statements about how low back pain affects everyday life, such as walking, dressing, sleeping and getting out of a chair. It was published by Martin Roland and Richard Morris in 1983 and is one of the most widely used low back pain questionnaires. The APTA low back pain clinical practice guideline names it as a validated self-report questionnaire to use.
Mark each statement that describes you today. The score is the number of statements marked, from 0 to 24. Higher scores mean more disability from back pain. A statement that does not apply to you counts as not marked, so the total is always out of 24.
An international consensus (Ostelo et al., 2008) proposed 5 points, or a 30% improvement from the starting score, as a clinically meaningful improvement. For an individual patient, changes of 4 to 5 points are needed to be beyond measurement error (Stratford et al., 1996).
No. Its developer states that the original questionnaire and all translations are in the public domain and can be used without permission and for any purpose.
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Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.
📞 Call 1-855-465-7626