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 |
- Prebuilt template with ÖMPQ scoring to assess the risk of long-term disability and failure to return to work
- 25-item questionnaire that scores each item from “0” to “10”
- Real-time calculation of ÖMPQ Score and disability level 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 musculoskeletal pain
- 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 |
- Pre-populate patient details such as patient id, name, email etc in the ÖMPQ assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their ÖMPQ assessment form prior to their visit
- Allow patients to save their progress and complete their ÖMPQ assessment form at a later time without losing any responses
- Set up an email template for your ÖMPQ assessment and automatically send invitation emails to multiple patients with ease
- 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 |
- Export patient responses including the calculated ÖMPQ score and disability level to Google Sheets for easy record-keeping
- Export individual points for 25 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 musculoskeletal pain symptoms
- Receive a copy of the response and the calculated ÖMPQ score by email whenever a patient submits their ÖMPQ 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 |
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 |
- Create a HIPAA compliant ÖMPQ 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 ÖMPQ form responses to Google Sheets and sending them on email
- Prepopulate patient details in ÖMPQ 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
These reviews are reproduced without modification from Google Workspace Marketplace.
July 27, 2023
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
I am not tech savvy. I chose formesign to help create registration links for clients. Vipid has been great in assisting me. He goes above and beyond. My company now has moved from the stone age to modern age through the ability to use this feature. Of the many features I am impressed with, the ability to update a form without needing to regenerate a link is amazing. I often make mistakes and that ability allows me to fix mistakes without needing to change everything. Thank you!!!
— Sol Evans
October 31, 2023
We needed a way to create forms with e-signatures and this app made it very easy. Support is also very quick and always helpful. Cannot recommend enough!
— Chris Henesy
February 16, 2024
Does not work
— Myles Sicuro
July 12, 2023
It very friendly to used. I love it. For my case multiple signature needed. it's supporting
— Senthil Kumar
November 27, 2023
Yeah this is good for all
— luqman Khan
July 10, 2023
We were looking for a way to have a signature option in our form. Formesign addon allowed us to collect signatures for the acknowledgment and consent forms. It was simple and easy to setup. Very useful addon for google forms.
— Joan S