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Questionnaire: Lower Back Pain Assessment Questionnaire with Screenshots
Questionnaire: Lower Back Pain Assessment Questionnaire with Screenshots

Showing the end-to-end flow of the Lower Back Pain Assessment Questionnaire using screenshots

Chris Sartori avatar
Written by Chris Sartori
Updated over a week ago

What does this Questionnaire do?

The Accurx Lower Back Pain questionnaire allows the sending of an online questionnaire to patients to collect information in regard to their lower back pain in order to facilitate their ongoing management.

The questionnaire link is sent via SMS or email. The patient fills in the questionnaire through a browser so can use their phone, tablet, laptop or desktop to complete it.

The responses are returned to the practice and can be saved directly into the clinical record (EMIS, SystmOne or Vision). The responses can have additional notes added, be assigned to other colleagues and be marked as urgent.

What does it look like for the clinician and patient?

Clinician view of sending a questionnaire πŸ‘‡

Accurx green toolbar floating above EMIS

Accurx green toolbar floating above SystmOne

The questionnaire compose screen for clinicians πŸ‘‡

They can edit the SMS message if required.


​Patient's perspective of viewing and completing the Lower Back Pain questionnaire πŸ‘‡

Questions:

1. How long have you had this current episode of lower back pain?

  • Enter Text

2. How severe is the pain?

(0 is no pain; 10 is the worst possible pain)

  • Enter Number

3. Have you experienced back pain similar to this in the past?

  • Yes

  • No

4. Is this episode different to your usual back pain?

  • Yes

  • No

5. Please describe how this current episode is different from your usual back pain?

  • Enter Text

6. Does the pain spread anywhere else?

For example, to your leg or chest

  • Yes

  • No

7. Where does the pain spread to?

  • Enter Text

8. Did your back pain start after an injury?

  • Yes

  • No

9. How did you injure yourself?

  • Enter Text

10. Have you experienced any change in sensation (such as numbness) around your vagina, penis or buttocks?

  • Yes

  • No

11. Have you experienced any weakness, numbness or tingling in your legs?

  • Yes

  • No

12. Have you experienced any problems with passing urine?

For example, being unable to pass urine as you normally would or incontinence (leaking) of urine

  • Yes

  • No

13. Have you experienced any problems with your bowels?

For example, being unable to pass stool (poo) as you normally would or incontinence (leaking) of stool

  • Yes

  • No

14. Have you had any fevers?

  • Yes

  • No

15. Do you have any other symptoms that you relate to your back pain?

  • Enter text

16. Do you have a current or past history of cancer?

  • Yes

  • No

17. Do you have a weakened immune system?

For example, receiving chemotherapy, long-term steroid treatment, or have an underlying condition such as leukaemia or HIV

  • Yes

  • No

  • I'm not sure

18. What is the cause of your weakened immune system?

  • Enter text

19. Have you had any unexplained weight loss?

  • Yes

  • No

20. Does your back pain remain when lying flat?

  • Yes

  • No

21. Do you get pain at night that prevents or disturbs sleep?

  • Yes

  • No

22. Do you have osteoporosis?

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break

  • Yes

  • No

  • I'm not sure

23. Do you currently or frequently need to take oral corticosteroids?

  • Yes

  • No

  • I'm not sure

When they have submitted their answers, they will be thanked for completing the survey and sent a confirmation SMS πŸ‘‡

Clinician view of the Lower Back Pain Questionnaire response

A red notification indicating a patient response has arrived

Inbox view showing a lower back pain response for a patient

Updated entry showing when the response was saved to record and by whom

Users can add internal notes for colleagues relating to the patient response

Users can mark a response as urgent

Users can assign the response to a different team

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