1. During the past 4 weeks - Have you had difficulty lifting things in your home, such as putting out the rubbish, because of your elbow problem?
2. Have you had difficulty carrying bags of shoppin, because of your elbow problem?
3. Have you had any difficulty washing yourself all over, because of your elbow problem?
4. Have you had any difficulty dressing yourself, because of your elbow problem?
5. Have you felt that your elbow problem is "controlling your life"?
6. How much has your elbow problem been "on your mind"?
7. Have you been troubled by pain from your elbow in bed at night?
8. How often has your elbow pain interfered with your sleeping?
9. How much has your elbow problem interfered with your usual work or everyday activities?
10. Has your elbow problem limited your ability to take part in leisure activities that you enjoy doing?
11. How would you describe the worst pain you had from your elbow?
12. How would you describe the pain you usually had from your elbow?
Bibliographic References (copyright belongs to the author/s of this instrument)
1. Dawson J, Doll H, Boller I et al. (2008) The development and validation of a patientreported questionnaire to assess outcomes of elbow surgery. J Bone Joint Surg Br, 90,
466–473.
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