Örebro Musculoskeletal Pain Screening Questionnaire
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Use our readymade template to create your Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) screening tool for predicting long-term disability and failure to return to work following a soft tissue injury

Create your care assessments

ÖMPQ score Disability Level Proposed treatment
0-104 Low disability May not need treatment
105-130 Moderate disability Consider counseling
131 and above High disability Active treatment
  • navigate_next Prebuilt template with ÖMPQ scoring to assess the risk of long-term disability and failure to return to work
  • navigate_next 25-item questionnaire that scores each item from “0” to “10”
  • navigate_next Real-time calculation of ÖMPQ Score and disability level based on the form responses
  • navigate_next Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
  • navigate_next Compare the scores from the initial screening with that of the followup to track the progression of musculoskeletal pain
  • navigate_next Easily create responsive forms that allow patients to complete their assessments on any device at any time

Collect responses from your patients

Patient ID 1004
Patient Name John W
Patient Email johnw@ymail.com
Patient Phone Number 0987654321
Doctor's Name Dr. Smith
Location New York
Where do you have pain? Neck,Shoulder
How many days of work have you missed because of pain during the past 18 months? 15 - 30 days
How long have you had your current pain problem? 3 - 6 months
Is your work heavy or monotonous? 5
How would you rate the pain that you have had during the past week? 6
In the past three months, on average, how bad was your pain on a 0-10 scale? 7
How often would you say that you have experience pain episodes, on average, during the past three months? 8
Based on all things you do to cope, or deal with your pain, on an average day, how much are you able to decrease it? 3
How tense or anxious have you felt in the past week? 4
How much have you been bothered by feeling depressed in the past week? 5
In your view, how large is the risk that your current pain may become persistent? 6
In your estimation, what are the chances that you will be able to work in six months? 7
If you take into consideration your work routines, management, salary, promotion possibilities and work mates, how satisfied are you with your job? 8
Physical activity makes my pain worse. 9
An increase in pain is an indication that I should stop what I’m doing until the pain decreases. 10
I should not do my normal work with my present pain. 9
I can do light work for an hour. 8
I can walk for an hour. 7
I can do ordinary household chores. 6
I can do the weekly shopping. 5
I can sleep at night. 4
OMPQ Score 105
Disability Level Moderate disability
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the ÖMPQ assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their ÖMPQ assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their ÖMPQ assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your ÖMPQ assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their ÖMPQ score, diagnosis, next steps when they submit their ÖMPQ assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W Where do you have pain? Neck,Shoulder 105
3 John W How many days of work have you missed because of pain during the past 18 months? 15 - 30 days 5 105
4 John W How long have you had your current pain problem? 3 - 6 months 7 105
5 John W Is your work heavy or monotonous? 5 5 105
6 John W How would you rate the pain that you have had during the past week? 6 6 105
7 John W In the past three months, on average, how bad was your pain on a 0-10 scale? 7 7 105
8 John W How often would you say that you have experience pain episodes, on average, during the past three months? 8 8 105
9 John W Based on all things you do to cope, or deal with your pain, on an average day, how much are you able to decrease it? 3 7 105
10 John W How tense or anxious have you felt in the past week? 4 4 105
11 John W How much have you been bothered by feeling depressed in the past week? 5 5 105
12 John W In your view, how large is the risk that your current pain may become persistent? 6 6 105
13 John W In your estimation, what are the chances that you will be able to work in six months? 7 3 105
14 John W If you take into consideration your work routines, management, salary, promotion possibilities and work mates, how satisfied are you with your job? 8 2 105
15 John W Physical activity makes my pain worse. 9 9 105
16 John W An increase in pain is an indication that I should stop what I’m doing until the pain decreases. 10 10 105
17 John W I should not do my normal work with my present pain. 9 9 105
18 John W I can do light work for an hour. 8 2 105
19 John W I can walk for an hour. 7 3 105
20 John W I can do ordinary household chores. 6 4 105
21 John W I can do the weekly shopping. 5 5 105
22 John W I can sleep at night. 4 6 105
  • navigate_next Export patient responses including the calculated ÖMPQ score and disability level to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 25 items to Google Sheets for data manipulation and analysis for comprehensive insights
  • navigate_next Use pre-built reports to easily keep track of patient progress over time and monitor changes in their musculoskeletal pain symptoms
  • navigate_next Receive a copy of the response and the calculated ÖMPQ score by email whenever a patient submits their ÖMPQ assessment
  • navigate_next Use data in Google Sheets to integrate with external EHR systems for seamless data transfer

HIPAA compliance

Patient ID: 1004
Patient Name: ******
Patient Email: ******
Patient Phone Number: ******
Doctor's Name: Dr. Smith
Location: New York
Where do you have pain? : Neck, Shoulder
How many days of work have you missed because of pain during the past 18 months?: 15 - 30 days
How long have you had your current pain problem?: 3 - 6 months
Is your work heavy or monotonous?: 5
How would you rate the pain that you have had during the past week? : 6
In the past three months, on average, how bad was your pain on a 0-10 scale?: 7
How often would you say that you have experience pain episodes, on average, during the past three months?: 8
Based on all things you do to cope, or deal with your pain, on an average day, how much are you able to decrease it?: 3
How tense or anxious have you felt in the past week?: 4
How much have you been bothered by feeling depressed in the past week?: 5
In your view, how large is the risk that your current pain may become persistent?: 6
In your estimation, what are the chances that you will be able to work in six months?: 7
If you take into consideration your work routines, management, salary, promotion possibilities and work mates, how satisfied are you with your job?: 8
Physical activity makes my pain worse.: 9
An increase in pain is an indication that I should stop what I’m doing until the pain decreases.: 10
I should not do my normal work with my present pain.: 9
I can do light work for an hour.: 8
I can walk for an hour.: 7
I can do ordinary household chores.: 6
I can do the weekly shopping.: 5
I can sleep at night.: 4
OMPQ Score: 105
Disability Level: Moderate disability
OMPQ Score: 105
Disability Level: Moderate disability
  • navigate_next Create a HIPAA compliant ÖMPQ assessment form to safely collect, store and access patient responses
  • navigate_next Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
  • navigate_next Automatically mask PHI fields when exporting ÖMPQ form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in ÖMPQ assessments by creating secure prefill links without exposing PHI
  • navigate_next Limit access to patient data only for authorized personnel and minimize the risk of data breaches

These reviews are reproduced without modification from Google Workspace Marketplace.

July 27, 2023

5 stars

I am 100% a fan of this company. We use HIPAA compliant Google Forms and needed a way to collect signatures, the industry standard company is TOO expensive. I started using FormEsign and it worked perfectly. It lacked the ability to provide a pdf copy of the form after signature. This company worked with me help their product evolve into something that could benefit all future clients AND the end user. The team was polite, professional, kind, enthusiastic, and willing to make a change. This earned my loyalty. I will sing their praises. Good work, and thank you!

— Royal Bush

July 23, 2023

5 stars

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— Sol Evans

February 16, 2024

1 stars

Does not work

— Myles Sicuro

October 31, 2023

5 stars

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— Chris Henesy

July 12, 2023

5 stars

It very friendly to used. I love it. For my case multiple signature needed. it's supporting

— Senthil Kumar

November 27, 2023

5 stars

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July 10, 2023

5 stars

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