Orebro Form Test | ProRehab Louisville

Rate how much of a burden it is to perform all the things you need to do in a normal day. *

For the last 2-3 days, rate on average how bothersome your pain or problem is. *

For the last 2-3 days, what percentage of the day do you notice your pain or problem? *

During the past 2-3 days, rate how tense or anxious you have felt. *

During the past 2-3 days, rate how “depressed” or “down” you have felt *

What do you think is the risk that your current pain or problem will not improve? *

Think of your life; rate how satisfied you are with your current situation. *

Physical activity makes my pain or problem worse. *

I should not do my normal daily routine or work with my present pain or problem. *

I can walk for an hour or participate in my normal light recreational or sporting activities *

I manage my daily routine and social activities (eg. shopping or transport or see friends) *

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