Sociodemographic factors | Age | What year were you born? (year) |
| Gender | What is your gender? (male/female) |
| Education level | What is the level of the highest qualification you have completed? (school certificate/higher school certificate/trade certificate/diploma/advanced diploma/bachelor degree/postgraduate degree/other) |
Current LBP characteristics | Duration of LBP episode | How long ago did the present episode of low back pain begin? (<2 wk/2–3 wk/3–4 wk/4–6 wk) |
| Sudden onset | Was the onset of low back pain sudden? (yes/no) |
| Leg pain | Do you have leg pain? (yes/no) |
| Pain intensity | How much low back pain have you had during the past week? (none/very mild/mild/moderate/severe/very severe) |
| Interference of symptoms | During the past week, how much did low back pain interfere with your normal work (including both work outside the home and housework)? (not at all/a little bit/moderately/quite a bit/extremely) |
| Medication | Are you currently taking medication for your low back pain? (yes/no) |
Past LBP history | Previous episodes | Have you had a previous episode of low back pain? (yes/no) |
| Surgery | Have you previously had surgery for low back pain? (yes/no) |
Psychological factors | Control of pain | Based on all the things you do to cope, or deal with your pain, on an average day, how much are you able to decrease it? (0–10 scale) |
| Anxiety | How tense or anxious have you felt in the past week? (0–10 scale) |
| Depression | How much have you been bothered by feeling depressed in the past week? (0–10 scale) |
| Perceived risk | In your view, how large is the risk that your current pain may become persistent? (0–10 scale) |
General health | Smoking | Do you currently smoke? (yes/no) |
| Exercise | At the commencement of this back pain episode were you exercising for at least 30 minutes three times per week or more (exercise includes walking briskly, cycling, digging, scrubbing floor on hands and knees, etc.)? (yes/no) |
| Perceived general health | In general how would you say that your health is? (excellent/very good/good/fair/poor) |
Work factors | Sick leave | Have you previously taken sick leave due to low back pain? (yes/no) |
| Disability compensation | Is your back pain compensable, e.g., through worker’s compensation or third party insurance? (yes/no) |