Upper Extremity Function Index

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We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention. Please provide an answer for each activity.

Email *

Your Name *

Your Clinic *

Today, do you or would you have any difficulty at all with: *

0 - Extreme Difficulty

1 - Quite a bit of Difficulty

2 - Moderate Difficulty

3 - A Little bit of Difficulty

4 - No Difficulty

Any of your usual work, housework or school activities

Your usual hobbies, recreational or sporting activities

Lifting a bag of groceries to waist level

Placing an object onto, or removing it from an overhead shelf

Washing your hair or scalp

Pushing up on your hands (e.g., from bathtub or-chair)

Preparing food (e.g., peeling, cutting)

Driving

Vacuuming, sweeping, or raking

Dressing

Doing up buttons

Using tools or appliances

Opening doors

Cleaning

Tying or lacing shoes

Sleeping

Laundering clothes. (e.g., washing, ironing, folding)

Opening a jar

Throwing a ball

Carrying a small suitcase with your affected limb