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In the following questionnaire, I am going to ask you a variety of questions.

Some are concerned with you and some are general. There are Five (5) options

for every single question, Agree strongly Agree Neither Agree Nor disagree

Disagree Disagree strongly. Please tick () mark only to the answer to

which you feel to. Tick () mark to only one answer of each question.

I am simply interested in knowing your interest and perception of your life.

Please complete all the questions carefully as possible.

All your answers in the questionnaire will be treated in strict confidence.

May I thank you very much for your co-operation.

Sabiha Hakeem(Research Investigator)

PGDRP Student

Name: .

Age: Sex: (Male / Female)

Education: . (Illiterate/ Literate)

If Literate, mention qualification:

Occupation:

Monthly Income:

Family Status: (Nuclear/Joint) ..

Address:

Rural / Urban:

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6. My back pain is such an achey feeling?Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

7. There are activities that can temporarily or permanently to ease back pain?Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

8. Is medication or doing special exercise essential for back pain?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

9. Do you usually feel low back pain?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

10. Do you usually have over weight? Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

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11. The medication is usually effective for treatment of back pain?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

12. I am not getting time to look after5 my child because of back pain?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

13.I think eating fatty and oily things create back ache trouble among women?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

14.I think that the heavy activities might be a cause of back trouble?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

15.I feel vertigo?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

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16.Ifeel over confident in my work?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

17. I do not take a proper concentration on my job?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

18.I often do not sleep properly?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

19.The back agony always creates a problem on my way?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

20.I feel helpless ?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

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21. I prefer to make cook by taking help of others?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

22.I cannot sit properly?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

23.I cannot walk properly?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

24.I stand with support?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

25.I usually feel weakness in my legs?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

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26.I usually have a problem of headache?

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly

27.I often have a feeling of depression? Agree strongly

Agree strongly

Agree

Neither Agree Nor Disagree

Disagree

Disagree Strongly