Hand Well Assessment

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Score: 0 / 50 or 0%

Patient Identifier:

Date completed:

Section 1: Pain Intensity

I have no pain at the moment The pain is very mild at the moment The pain is moderate at the moment The pain is fairly severe at the moment The pain is very severe at the moment The pain is the worst imaginable at the moment

Section 2: Heavy household chores (eg wash walls, wash floors)

No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable to do Severe Pain

Section 3: Lifting

I can lift heavy weights without extra pain I can lift heavy weights but it gives extra pain Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned (e.g. on a table) Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned I can lift very light weights I cannot lift or carry anything at all

Section 4: Garden or do yard work

No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable to do Severe Pain

Section 5: Stiffness in your arm, shoulder or hand

No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable to do Severe Pain

Section 6: Put on a pullover sweater

No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable to do Severe Pain

Section 7: Sleeping

I can sleep as I like I can only sleep as long as I like Pain prevents me from Sleeping more than 1 hour Pain prevents me from Sleeping more than 1/2 hour Pain prevents me from Sleeping more than 10 minutes I avoid Sleeping because it increases pain immediately

Section 8: Stairs

Normally without using a railing Normally using a railing In any manner Unable to do stairs Pain prevents me from doing I avoid because it increases pain immediately

Section 9: Social Life

I can involve as I like I can only involve as long as I like Pain prevents me from involving more peoples Pain prevents me from involving more peoples comfort Pain prevents me from involving more peoples Severe I avoid involving because it increases pain immediately

Section 10: Travelling

I can travel as I like I can only travel as long as I like Pain prevents me from Travelling more than 1 hour Pain prevents me from Travelling more than 2 day Pain prevents me from Travelling more than 10 days I avoid Travelling because it increases pain immediately

Progress Report

Hand Score

Hand Well Assessment

Patient Identifier:

Date completed:

Section 1: Pain Intensity

Section 2: Heavy household chores (eg wash walls, wash floors)

Section 3: Lifting

Section 4: Garden or do yard work

Section 5: Stiffness in your arm, shoulder or hand

Section 6: Put on a pullover sweater

Section 7: Sleeping

Section 8: Stairs

Section 9: Social Life

Section 10: Travelling

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Hand Score

Hand Well Assessment

Patient Identifier:

Date completed:

Section 1: Pain Intensity

Section 2: Heavy household chores (eg wash walls, wash floors)

Section 3: Lifting

Section 4: Garden or do yard work

Section 5: Stiffness in your arm, shoulder or hand

Section 6: Put on a pullover sweater

Section 7: Sleeping

Section 8: Stairs

Section 9: Social Life

Section 10: Travelling

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