It’s NOT Just About Pain
As clinicians we frequently ask our patients to report their pain level to us. Sometimes we use the visual analogue scale and sometimes we ask for descriptors or ask for drawings on a diagram. In any case, pain is a one-dimensional parameter. Of course, pain is important. It is often one of the primary three reasons people seek medical care. However, it should be taken in context. Sometimes there is concern if a person’s pain level doesn’t decrease with medication or treatment. What if pain doesn’t change but function improves? Isn’t that a win? So how can we merge these two parameters together to assess patient outcomes?
Therapeutic questionnaires can be valuable to provide serial assessments of pain and function. They can even be wonderful outcome measures. Many therapeutic questionnaires have been studied for reliability and validity. Many are very specific to a given pathology and others are more general. In either case, they allow a clinician to track an individual’s progress (or lack of progress) in a quantitative manner.
The purpose of this BLOG is to serve as a resource for a variety of therapeutic questionnaires. Below is a list of questionnaires grouped by pathology and a direct link to the questionnaire with the scoring instructions. Hopefully, this will be helpful for you and your patients to see the big picture.
Shoulder:
- SPADI = Shoulder Pain & Disability Index = The SPADI contains 13 items that assess two domains; a 5-item subscale that measures pain and an 8-item subscale that measures disability. https://denalipt.com/wp-content/uploads/Shoulder-Pain-and-Disability-Index.pdf
- Penn Shoulder Questionnaire = 2 part questionnaire; Part 1 is Pain & Satisfaction; Part 2 is Function. https://www.eliterehabsolutions.com/pdfs/PENN%20SHOULDER%20SCORE.pdf
- DASH = Disabilities of Arm, Shoulder, Hand = a 30-item disability/symptom scale. https://healthcare.msu.edu/_assets/documents/lymphedema/DASH-questionnaire.pdf
Elbow:
- Elbow Evaluation Form = a merger of the SF-36 evaluation & a patient-rated self assessment. https://www.floridaortho.com/wp-content/uploads/2016/07/Form006B_Frankle.pdf
- Patient-Rated Tennis Elbow Evaluation (PRTEE) = 20 question evaluation with 5 questions about pain & 15 about function. https://www.howardhead.org/pdf/HHSM/forms/Elbow.pdf
Wrist & Hand:
- Patient-Rated Wrist Evaluation = a 15 question evaluation with 5 questions about pain & 10 questions about function. https://muscleandspinerehab.com/wp-content/uploads/2019/05/Wrist-Functional-Outcome-Tool.pdf
- Severity of Symptoms & Functional Status of CTS = 2 sets of questions: Severity of Symptoms are 11 questions & Functional Status is 8 questions. http://regis-scholars.wdfiles.com/local–files/upper-extremity/CTSFSS
Hip:
- Harris Hip Score consists of 10 items covering pain, function, functional activities, deformity & hip range of motion https://orthotoolkit.com/harris-hip/
- WOMAC = Western Ontario & McMaster Universities Osteoarthritis Index = evaluate the condition of patients with osteoarthritis of the knee & hip, including pain, stiffness, & physical functioning of the joints. https://www.princetonhcs.org/-/media/files/forms/princeton-rehabilitation/womac.pdf
- Lower Extremity Functional Scale = 20 questions about a person’s ability to perform everyday tasks. https://www.emoryhealthcare.org/-/media/Project/EH/Emory/ui/pdfs/msk-pt-forms/hip-lefs.pdf
- HOOS = Hip Disability & Osteoarthritis Outcome Score (HOOS) consists of 10 items to assess pain, 5 items about stiffness & range of motion, 17 items about activity limitations-daily living, 4 items about sports and recreation function, & 4 items about hip related quality of life. https://orthotoolkit.com/hoos/
Knee:
- WOMAC = Western Ontario & McMaster Universities Osteoarthritis Index = evaluate the condition of patients with osteoarthritis of the knee & hip, including pain, stiffness, & physical functioning of the joints. https://www.princetonhcs.org/-/media/files/forms/princeton-rehabilitation/womac.pdf
- Lysholm Knee Scoring Scale is made up of 8 sections with each section having a scoring value for the answers. https://www.lakarhuset.com/docs/lysholmkneescoringscale.pdf
- Lower Extremity Functional Scale = 20 questions about a person’s ability to perform everyday tasks. https://www.emoryhealthcare.org/-/media/Project/EH/Emory/ui/pdfs/msk-pt-forms/hip-lefs.pdf
- HOOS = Hip Disability & Osteoarthritis Outcome Score (HOOS) consists of 10 items to assess pain, 5 items about stiffness & range of motion, 17 items about activity limitations-daily living, 4 items about sports and recreation function, & 4 items about hip related quality of life. https://orthotoolkit.com/hoos/
Ankle & Foot:
- Cumberland Ankle Instability Tool assesses chronic ankle instability via a 9-question survey with scores ranging from 0 to 30 (the higher the score the more instability). https://orthotoolkit.com/cait/
- University of Kansas Functional Ankle Testing Protocol is a compilation of several functional tests such as Y-balance, Leg Press, Cross-over hop, Figure-8 hop, Square hop, Side hop, etc tests https://www.kansashealthsystem.com/-/media/Project/Website/PDFs-for-Download/PT-protocols/Functio nal-Testing-ProtocolAnkle.pdf
Cervical Spine:
- Neck Disability Index (AKA Oswestry Cervical Pain Questionnaire) includes 10 items about pain, sleep, work, & recreation. https://www.smcnd.org/assets/docs/pt/neck_disability_index.pdf
Lumbar Spine:
- Oswestry Low Back Disability Questionnaire is composed of 10 sets of questions ranging from pain to function. https://www.aaos.org/globalassets/quality-and-practice-resources/patient-reported-outcome-measures/spine/oswestry-2.pdf
- Quebec Back Pain Disability Questionnaire is composed of 20 questions scored from 0 – 5. https://www.tac.vic.gov.au/files-to-move/media/upload/quebec_scale.pdf
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