Use our readymade template to create your Québec Back Pain Disability Scale (QBPDS) for assessing the severity of disability in patients with back pain
Create your care assessments
| QBPDS score | Disability Severity |
|---|---|
| 0-20 | Minimal |
| 21-40 | Mild |
| 41-60 | Moderate |
| Severe | |
| Very Severe |
- Prebuilt template with QBPDS scoring to assess the presence of back pain and measure its impact on daily activities
- 20-item questionnaire that scores each item from “0” (not difficult at all) to “5” (unable to do)
- Real-time calculation of QBPDS Score based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- Compare the scores from the initial screening with that of the followup to track the progression of back pain related disability
- 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 |
| Select an answer for each statement below | |
| 1. Get out of bed | Somewhat difficult |
| 2. Sleep through the night | Fairly difficult |
| 3. Turn over in bed | Very difficult |
| 4. Ride in a car | Unable to do |
| 5. Stand up for 20-30 minutes | Not difficult at all |
| 6. Sit in a chair for several hours | Minimally difficult |
| 7. Climb one flight of stairs | Somewhat difficult |
| 8. Walk a few blocks (300-400 m) | Fairly difficult |
| 9. Walk several kilometres | Very difficult |
| 10. Reach up to high shelves | Unable to do |
| 11. Throw a ball | Not difficult at all |
| 12. Run one block (about 100m) | Minimally difficult |
| 13. Take food out of the refrigerator | Somewhat difficult |
| 14. Make your bed | Fairly difficult |
| 15. Put on socks (pantyhose) | Very difficult |
| 16. Bend over to clean the bathtub | Unable to do |
| 17. Move a chair | Not difficult at all |
| 18. Pull or push heavy doors | Minimally difficult |
| 19. Carry two bags of groceries | Somewhat difficult |
| 20. Lift and carry a heavy suitcase | Fairly difficult |
| QBPDS score | 75 |
- Pre-populate patient details such as patient id, name, email etc in the QBPDS assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their QBPDS assessment form prior to their visit
- Allow patients to save their progress and complete their QBPDS assessment form at a later time without losing any responses
- Set up an email template for your QBPDS assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their QBPDS score, diagnosis, next steps when they submit their QBPDS assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | 1. Get out of bed | Somewhat difficult | 2 | 75 |
| 3 | John W | 2. Sleep through the night | Fairly difficult | 3 | 75 |
| 4 | John W | 3. Turn over in bed | Very difficult | 4 | 75 |
| 5 | John W | 4. Ride in a car | Unable to do | 5 | 75 |
| 6 | John W | 5. Stand up for 20-30 minutes | Not difficult at all | 0 | 75 |
| 7 | John W | 6. Sit in a chair for several hours | Minimally difficult | 1 | 75 |
| 8 | John W | 7. Climb one flight of stairs | Somewhat difficult | 2 | 75 |
| 9 | John W | 8. Walk a few blocks (300-400 m) | Fairly difficult | 3 | 75 |
| 10 | John W | 9. Walk several kilometres | Very difficult | 4 | 75 |
| 11 | John W | 10. Reach up to high shelves | Unable to do | 5 | 75 |
| 12 | John W | 11. Throw a ball | Not difficult at all | 0 | 75 |
| 13 | John W | 12. Run one block (about 100m) | Minimally difficult | 1 | 75 |
| 14 | John W | 13. Take food out of the refrigerator | Somewhat difficult | 2 | 75 |
| 15 | John W | 14. Make your bed | Fairly difficult | 3 | 75 |
| 16 | John W | 15. Put on socks (pantyhose) | Very difficult | 4 | 75 |
| 17 | John W | 16. Bend over to clean the bathtub | Unable to do | 5 | 75 |
| 18 | John W | 17. Move a chair | Not difficult at all | 0 | 75 |
| 19 | John W | 18. Pull or push heavy doors | Minimally difficult | 1 | 75 |
| 20 | John W | 19. Carry two bags of groceries | Somewhat difficult | 2 | 75 |
| 21 | John W | 20. Lift and carry a heavy suitcase | Fairly difficult | 3 | 75 |
- Export patient responses including the calculated QBPDS score to Google Sheets for easy record-keeping
- Export individual points for 20 items to Google Sheets for data manipulation and analysis for comprehensive insights
- Use pre-built reports to easily keep track of patient progress over time and monitor changes in their back pain related disability
- Receive a copy of the response and the calculated QBPDS score by email whenever a patient submits their QBPDS assessment
- 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 |
| Select an answer for each statement below | |
| 1. Get out of bed: | Somewhat difficult |
| 2. Sleep through the night: | Fairly difficult |
| 3. Turn over in bed: | Very difficult |
| 4. Ride in a car: | Unable to do |
| 5. Stand up for 20-30 minutes: | Not difficult at all |
| 6. Sit in a chair for several hours: | Minimally difficult |
| 7. Climb one flight of stairs: | Somewhat difficult |
| 8. Walk a few blocks (300-400 m): | Fairly difficult |
| 9. Walk several kilometres: | Very difficult |
| 10. Reach up to high shelves: | Unable to do |
| 11. Throw a ball: | Not difficult at all |
| 12. Run one block (about 100m): | Minimally difficult |
| 13. Take food out of the refrigerator: | Somewhat difficult |
| 14. Make your bed: | Fairly difficult |
| 15. Put on socks (pantyhose): | Very difficult |
| 16. Bend over to clean the bathtub: | Unable to do |
| 17. Move a chair: | Not difficult at all |
| 18. Pull or push heavy doors: | Minimally difficult |
| 19. Carry two bags of groceries: | Somewhat difficult |
| 20. Lift and carry a heavy suitcase: | Fairly difficult |
| QBPDS score: | 75 |
| QBPDS score: | 75 |
- Create a HIPAA compliant QBPDS assessment form to safely collect, store and access patient responses
- Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
- Automatically mask PHI fields when exporting QBPDS form responses to Google Sheets and sending them on email
- Prepopulate patient details in QBPDS assessments by creating secure prefill links without exposing PHI
- Limit access to patient data only for authorized personnel and minimize the risk of data breaches
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