QuickDASH - Therapy SPOT - Bellaire, Houston TX

Address: 5303 Bissonnet St, Bellaire, TX 77401 | Hours: Mon - Thur: 7:30am - 7:30pm | Fri: 7:00am - 5:00pm

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+1 832-588-3552

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QuickDASH

Please rate your ability to do the following activities in the last week by selecting the number below the appropriate response

Step 1 of 5

20%

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-Unable
2. Do heavy household chores (e.g. wash walls, floors).*
- 1-No Difficulty
- 2-Mild Difficulty
- 3-Moderate Difficulty
- 4-Severe Difficulty
- 5-Unable
3. Carry a shopping bag or briefcase.*
- 1-No Difficulty
- 2-Mild Difficulty
- 3-Moderate Difficulty
- 4-Severe Difficulty
- 5-Unable

4. Wash your back.*
- 1-No Difficulty
- 2-Mild Difficulty
- 3-Moderate Difficulty
- 4-Severe Difficulty
- 5-Unable
5. Use a knife to cut food.*
- 1-No Difficulty
- 2-Mild Difficulty
- 3-Moderate Difficulty
- 4-Severe Difficulty
- 5-Unable
6. 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-Unable

7. 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. Extremely
8. 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. Unable

Please 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. Extreme
10. Tingling (pins and needles) in your arm, shoulder or hand.*
- 1. None
- 2. Mild
- 3. Moderate
- 4. Severe
- 5. Extreme
11. 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 sleep
Total QuickDASH Score

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Therapy SPOT - Bellaire Center is located in the Bellaire neighborhood of Houston TX. Therapy SPOT - Bellaire is your last stop for physical therapy and rehabilitation.

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5303 Bissonnet Street, Bellaire, TX 77401

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Primary #1196CC

Secondary #202c45