Knee Well Assessment
Welcome to the Knee Wellness Assessment! This tool offers a quick and thorough evaluation of your
Knee health. By examining key aspects of functionality, strength, and mobility, you'll gain
essential insights to help maintain and enhance your Knee wellness. Start now to take the first
step towards optimal Knee health!
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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: Personal Care (Washing, Dressing, etc.)
I can look after myself normally without
causing extra pain
I can look after myself normally but it
causes extra pain
It is painful to look after myself but I am
slow and careful
I need some help but can manage most of my
personal care
I need help every day in most aspects of
self care
I do not get dressed, I wash with difficulty and
stay in bed
Section 3: Swelling
No swelling
Occasional swelling with strenuous sports or heavy
work. Some limitations but minor and tolerable
Occasional swelling with light recreational sports
or moderate work ativities.
Occasional swelling with light recreational sports
or moderate work ativities. Frequently brought on by vigorous activities, running, heavy
labour, and strenuous sport
Swelling limits sports and moderate work. Occurs
infrequently with simple walking activities or light work (approx 3 times a year)
Swelling brought on by simple walking activities and
light work. Relieved by rest
Section 4: Walking
Pain does not prevent me from walking any
distance
Pain prevents me from walking more than 1
mile
Pain prevents me from walking more than 1/2
mile
Pain prevents me from walking more than 1/4
mile
I can walk only with crutches or a cane
I am in bed most of the time and have to crawl
to the toilet
Section 5: Jumping or Twisting
Normal, unlimited, fully competitive,
strenuous
Slight to mild problem; some guarding but port
possible
Moderate problem
Moderate problem; gave up strenuous sports,
recreational sports possible
Severe problem; affects all sports; must constantly
guard
Severe problem; only light activity possible (golf,
swimming)
Section 6: Standing
I can stand as I like
I can only stand as long
as I like
Pain prevents me from Standing more than 1
hour
Pain prevents me from Standing more than 1/2
hour
Pain prevents me from Standing more than 10
minutes
I avoid Standing because it increases pain
immediately
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
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