Back index calculator 2026

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  1. Click ‘Get Form’ to open the back index calculator in the editor.
  2. Begin by entering your name and the date at the top of the form. This information is essential for tracking your progress.
  3. Proceed to the 'Pain Intensity' section. Here, select the box that best describes your current pain level. Be honest to ensure accurate assessment.
  4. Move on to 'Standing'. Indicate how long you can stand without increased pain by marking the appropriate box.
  5. In the 'Sleeping' section, choose the statement that reflects how pain affects your sleep quality.
  6. Continue through each section—'Personal Care', 'Social Life', 'Lifting', 'Traveling', 'Walking', 'Sitting', and 'Employment/Homemaking'—marking only one box per question based on your current condition.
  7. Once completed, review your answers for accuracy before submitting. This will help provide a comprehensive overview of your situation.

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This questionnaire will give your provider information about how your back condition affects your everyday life.
The measure categorizes outcome of chronic pain and disability into 5 grades: Grade 0 (pain free), Grade 1 (low disability, low pain intensity), Grade 2 (low disability, high pain intensity), Grade 3 (high disability, pain that is moderately limiting), and Grade 4 (high disability, pain that is highly limiting).
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