Rate the average amount of pain/difficulty you have had in your wrist over
the past week by choosing the number from 0 (no pain or difficulty) to 10 (the
worst pain you have ever experienced or you could not do the task)
PAIN
At rest
010000012345678910
When doing a task with repeat wrist movement
010000012345678910
When lifting a heavy object
010000012345678910
When it is at its worst
010000012345678910
How often do you have pain?
010000012345678910
FUNCTION-SPECIFIC ACTIVITIES
Turn door knob using my affected hand
010000012345678910
Cut meat using a knife in my affected hand
010000012345678910
Fasten buttons on my shirt
010000012345678910
Use my affected hand to push up from a char
010000012345678910
Carry a 10-lb object in my affected hand
010000012345678910
Use bathroom tissue with my affected hand
010000012345678910
FUNCTION-USUAL ACTIVITIES
Personal care activities (dressing, washing)
010000012345678910
Household work (cleaning)
010000012345678910
Work (your job or everyday work)
010000012345678910
Recreational activities
010000012345678910
Bibliographic References (copyright belongs to the author/s of this instrument)
1. Lewis, C, Wilk, K, Wright, R. The Orthopedic Outcomes toolbox. Virginia:
Learn Publications.
PRINT
EXPORT TO CSV
RESET
Web Design Copyright 2020-2021 Orthopaedic Manipulation