Osteoarthritis - Follow-up Form
These scales are used to assess osteoarthritis-related symptoms in the lower limbs. This assessment may help the physician better target the problem that is affecting you. By completing the questionnaire at regular intervals, it can also determine whether the recommended treatments are effective. To take the test, rate your level of pain, stiffness or difficulty, for each of the statements.
| I. | Pain | Pain assessment | ||
|---|---|---|---|---|
| Do I have any pain when sitting or lying? | No pain | 0 1 2 3 4 5 6 7 8 9 10 | Extreme pain | |
| Do I have any pain when standing? | No pain | 0 1 2 3 4 5 6 7 8 9 10 | Extreme pain | |
| Do I have any pain at night while in bed? | No pain | 0 1 2 3 4 5 6 7 8 9 10 | Extreme pain | |
| Do I have any pain when walking on a flat surface? | No pain | 0 1 2 3 4 5 6 7 8 9 10 | Extreme pain | |
| Do I have any pain when going up or coming down stairs? | No pain | 0 1 2 3 4 5 6 7 8 9 10 | Extreme pain | |
| II. | Stiffness | Stiffness assessment | ||
| Do I have any stiffness after first waking up in the morning? | No stiffness | 0 1 2 3 4 5 6 7 8 9 10 | Extreme stiffness | |
| Do I have any stiffness after sitting, lying or resting later in the day? | No stiffness | 0 1 2 3 4 5 6 7 8 9 10 | Extreme stiffness | |
| III. | Function | Physical function assessment | ||
| Do I have difficulty sitting? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty rising after having been seated? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty standing? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty bending forward? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty walking on a flat surface? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty going up or coming down stairs? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty getting in or out of a car? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty running my errands? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty lying in bed? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty getting out of bed? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty putting on or taking off my socks? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty getting on or off the toilet (sitting or getting up)? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty doing light housework? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
| Do I have difficulty doing heavy housework? | No difficulty | 0 1 2 3 4 5 6 7 8 9 10 | Extreme difficulty | |
* The questions on this form were inspired by the WOMAC scale (Western Ontario and McMaster Universities Osteoarthritis Index).
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The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.