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 👇
Accurx green toolbar floating above EMIS
Accurx green toolbar floating above SystmOne
The questionnaire compose screen for clinicians 👇
They can edit the SMS message if required.
Patient's perspective of viewing and completing the Lower Back Pain questionnaire 👇
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 👇
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
