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. 2018 Apr 3;19:99. doi: 10.1186/s12891-018-2025-7

Table 1.

Contents of the Scoliosis Japanese Questionnaire-27

Please fill out the following questions about your upper and lower back from the past month. Tick the most appropriate answer for each question. If you wear a brace, answer the questions for the times when you were not wearing the brace.
1. To what extent do you feel pain in your upper or lower back while lying down?
□Not at all □Mild □Moderate □Considerable □Severe
2. To what extent do you feel pain in your upper or lower back after sitting for an hour?
□Not at all □Mild □Moderate □Considerable □Severe
3. To what extent do you feel pain in your upper or lower back after standing for long periods?
□Not at all □Mild □Moderate □Considerable □Severe
4. To what extent do you feel stiffness or soreness in your shoulders or neck?
□Not at all □Mild □Moderate □Considerable □Severe
5. To what extent do you feel uncomfortable when wearing a jacket or coat?
□Not at all □Mild □Moderate □Considerable □Severe
6. To what extent are you concerned about the waistline of a skirt?
□Not at all □Mild □Moderate □Considerable □Severe
7. To what extent do you have difficulty putting on socks or stockings?
□Not at all □Mild □Moderate □Considerable □Severe
8. To what extent are you concerned about the fit of T-shirts?
□Not at all □Mild □Moderate □Considerable □Severe
9. To what extent are you bothered by the slipping of bra or camisole straps from your shoulders?
□Not at all □Mild □Moderate □Considerable □Severe
10. To what extent are you self-conscious about the curve of your back when wearing lighter clothing in warmer weather?
□Not at all □Slightly □Moderately □Strongly □Extremely
11. Do you find yourself wanting to avoid exercise?
□Not at all □Slightly □Moderately □Strongly □Extremely
12. Have parents, friends, or teachers told you that you have a back problem?
□Never □Rarely □Sometimes □Often □Very often
13. Do you feel embarrassed to bathe with your mother or sisters because of the curve of your back?
□Not at all □Slightly □Somewhat □Quite □Very much
14. How self-conscious are you about classmates or colleagues noticing your appearance?
□Not at all □Slightly □Somewhat □Quite □Very much
15. Do you become anxious when standing in front of a group of people?
□Not at all □Slightly □Somewhat □Quite □Very much
16. To what extent are you reluctant to participate in sporting events or performances?
□Not at all □Slightly □Somewhat □Quite □Very much
17. To what extent does your appearance in the mirror make you self-conscious?
□Not at all □Slightly □Somewhat □Quite □Very much
18. To what extent are you self-conscious about the x-ray images on your back?
□Not at all □Slightly □Somewhat □Quite □Very much
19. Do you feel sports or exercise will have a negative effect on your spine?
□Not at all □Slightly □Somewhat □Quite □Very much
20. Do you worry about your future regarding marriage, childbirth, and your children inheriting your condition?
□Not at all □Slightly □Somewhat □Quite □Very much
21. To what extent do you wish you could change the current condition of your spine?
□Not at all □Slightly □Somewhat □Quite □Very much
22. To what extent do you feel shy or reclusive because of the shape of your spine?
□Not at all □Slightly □Somewhat □Quite □Very much
23. To what extent do you feel depressed due to the condition of your spine?
□Not at all □Slightly □Somewhat □Quite □Very much
24. To what extent do you feel an inferiority complex due to the shape of your spine?
□Not at all □Slightly □Somewhat □Quite □Very much
25. To what extent do you feel overly self-conscious about your appearance due to the shape of your spine?
□Not at all □Slightly □Somewhat □Quite □Very much
26. To what extent do you think of yourself as less capable than others because of your spine?
□Not at all □Slightly □Somewhat □Quite □Very much
27. To what extent do you feel self-conscious about how you hold bags?
□Not at all □Slightly □Somewhat □Quite □Very much