Table 1.

Example of an ‘activity form’ completed by a chronic low back pain patient.

Write down movements/activities of which you think they will worsen your complaints or disorder, and/or that are limited due to your pain	Level of conviction 0-------------------------------10
	Unconvinced	Extremely convinced
Vacuuming, mopping the floor, bending forward	9
Bending forward and lifting something heavy	10
Carrying groceries on one side	8
Rotational movements of the back	6
Prolonged sitting or standing	6