Template:SPADI
From WikiMSK
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% |
