Template:SPADI: Difference between revisions

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Revision as of 20:40, 23 March 2023

Pain scale
How severe is your pain?
Circle the number that best describes your experience where: 0 = no difficulty and 10 = so difficult it requires help.
Item Question 0 1 2 3 4 5 6 7 8 9 10
1 At its worst?
2 When lying on the involved side?
3 Reaching for something on a high shelf?
4 Touching the back of your neck?
5 Pushing with the involved arm?
Disability scale
How much difficulty do you have?
Circle the number that best describes your experience where: 0 = no difficulty and 10 = so difficult it requires help.
Item Question 0 1 2 3 4 5 6 7 8 9 10
6 Washing your hair?
7 Washing your back?
8 Putting on an undershirt or jumper?
9 Putting on a shirt that buttons down the front?
10 Putting on your pants?
11 Placing an object on a high shelf?
12 Carrying a heavy object of 4.5 kilograms
13 Removing something from your back pocket?
Pain Score : Score: 0%
Disability Score : Score: 0%
Total Score : Score: 0%