Frage 1 |
How would you describe the worst pain you had
from your shoulder? |
- None
- mild
- Moderate
- Severe
- Unbearable
|
Frage 2 |
Have you had any trouble dressing yourself
because of your shoulder? |
- No trouble at all
- Little trouble
- Moderate trouble
- Extreme difficulty
- Impossible to do
|
Frage 3 |
Have you had any trouble getting in and out of a
car or using public transport because of your shoulder? |
- No trouble at all
- Very little trouble
- Moderate trouble
- Extreme difficulty
- Impossible to do
|
Frage 4 |
Have you been able to use a knife and fork at
the same time? |
- Yes, easily
- With little difficulty
- With moderate difficulty
- With extreme difficulty
- No, impossible
|
Frage 5 |
Could you do the household shopping on your own? |
- Yes, easily
- With little difficulty
- With moderate difficulty
- With extreme difficulty
- No, impossible
|
Frage 6 |
Could you carry a tray containing a plate of
food across a room? |
- Yes, easily
- With little difficulty
- With moderate difficulty
- With extreme difficulty
- No, impossible
|
Frage 7 |
Could you brush/comb your hair with the affected
arm? |
- Yes, easily
- With little difficulty
- With moderate difficulty
- With extreme difficulty
- No, impossible
|
Frage 8 |
How would you describe the pain you usually had
from your shoulder? |
- None
- Very mild
- Mild
- Moderate
- Severe
|
Frage 9 |
Could you hang your clothes up in a wardrobe,
using the affected arm? (whichever you tend to use) |
- Yes, easily
- With little difficulty
- With moderate difficulty
- With great difficulty
- No, impossible
|
Frage 10 |
Have you been able to wash and dry yourself
under both arms? |
- Yes, easily
- With little difficulty
- With moderate difficulty
- With extreme difficulty
- No, impossible
|
Frage 11 |
How much has pain from your shoulder interfered
with your usual work (including housework)? |
- Not at all
- A little bit
- Moderately
- Greatly
- Totally
|
Frage 12 |
Have you been troubled by pain from your
shoulder in bed at night? |
- No nights
- Only 1 or 2 nights
- Some nights
- Most nights
- Every night
|