QuickDASH Please rate your ability to do the following activities in the last week by selecting the number below the appropriate responseStep 1 of 520%Name First Last Date MM slash DD slash YYYY 1. Open a tight or new jar* 1-No Difficulty 2-Mild Difficulty 3-Moderate Difficulty 4-Severe Difficulty 5-Unable2. Do heavy household chores (e.g. wash walls, floors).* 1-No Difficulty 2-Mild Difficulty 3-Moderate Difficulty 4-Severe Difficulty 5-Unable3. Carry a shopping bag or briefcase.* 1-No Difficulty 2-Mild Difficulty 3-Moderate Difficulty 4-Severe Difficulty 5-Unable4. Wash your back.* 1-No Difficulty 2-Mild Difficulty 3-Moderate Difficulty 4-Severe Difficulty 5-Unable5. Use a knife to cut food.* 1-No Difficulty 2-Mild Difficulty 3-Moderate Difficulty 4-Severe Difficulty 5-Unable6. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis,etc).* 1-No Difficulty 2-Mild Difficulty 3-Moderate Difficulty 4-Severe Difficulty 5-Unable7. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups?* 1. Not at all 2. Slightly 3. Moderately 4. Quite a bit 5. Extremely8. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem?* 1. Not limited at all 2. Slightly limited 3. Moderately limited 4. Very limited 5. UnablePlease rate the severity of the following symptoms in the last week.9. Arm, soulder, or hand pain.* 1. None 2. Mild 3. Moderate 4. Severe 5. Extreme10. Tingling (pins and needles) in your arm, shoulder or hand.* 1. None 2. Mild 3. Moderate 4. Severe 5. Extreme11. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand?* 1-No Difficulty 2-Mild Difficulty 3-Moderate Difficulty 4-Severe Difficulty 5-So Much Difficulty that I can't sleepTotal QuickDASH ScoreΔ
