WRIST/HAND DISABILITY INDEX
NAME: ________________________________________________________DATE:____________________________________
This questionairre has been designed to give the Physical Therapist information as
Please read:
to how your wrist/hand pain has affected your ability to manage everyday life
.
Section 1 - Pain intensity ____I can do as much work as I want to without symptoms
____I have no pain in my wrist/hand ____I can do all of my usual work, but it increases my symptoms
____The pain in my wrist/hand is intermittent or mild ____I can do most, but not all, of my usual work because of my
____The pain in my wrist/hand is mild but constant symptoms
____The pain in my wrist/hand is constant and moderately limits use of ____I can do about half of my usual work because of my symptoms
the arm ____I can hardly do any work at all because of my wrist/hand symptoms
____The pain in my wrist/hand is constant and severely limits us of that ____I can't do any work at all because of my wrist/hand symptoms
arm
____The pain in my wrist/hand is constant, and I am unable to use that
arm
Section 7 - Driving
Section 2 - Numbness & Tingling ____I can drive my car without any wrist/hand symptoms
____I have no numbness or tingling in my wrist/hand ____I can drive my car as long as I want, but it increases my symptoms
____The numbness or tingling in my wrist/hand is intermittent ____I can drive my car for 31-60 minutes before my wrist/hand
____The numbness or tingling in my wrist/hand is constant but does not symptoms increase
limit use of that arm ____I can drive my car for 11-30 minutes before my wrist/hand
____The numbness or tingling in my wrist/hand is constant and symptoms increase
moderately limits use of that arm ____I can drive my car for only 10 minutes or less before my wrist/hand
____The numbness or tingling in my wrist/hand is constant and severely symptoms increase I am unable to use that arm for
limits use of that arm driving
____Due to constant numbness or tingling in my wrist/hand, I am unable
to use that arm Section 8 - Sleeping
____I have no trouble sleeping
My sleep is slightly disturbed by wrist/hand symptoms (It wakes me 1
Section 3 - Personal Care (Washing, Dressing, etc.) time/night)
____I can look after myself normally without any symptoms My sleep is mildly disturbed by wrist/hand symptoms (It wakes me 2
____I can look after myself normally, but it causes increased symptoms times/night)
____It is uncomfortable to look after myself, and I am slow and careful My sleep is moderately disturbed by wrist/hand symptoms (It wakes me 3-4
____I can only partially use my wrist/hand and sometimes use the other times/night)
side instead My sleep is greatly disturbed by wrist/hand symptoms (It wakes me 5-6
____I can only partially use my wrist/hand and mostly use the other side times/night)
____I am unable to use my wrist/hand for any personal care and always My sleep is completely disturbed by wrist/hand symptoms (It wakes me 7-8
use the other side times/night or more)
Section 9 - House & Yard Work
Section 4 - Strength ____I have no wrist/hand limitations with house or yard work
____I can lift the heaviest weights I need to without symptoms ____I am able to do all house & yard work necessary if I take breaks
____I can lift heavy weights, but it increases my wrist/hand symptoms ____I am to do all house & yard work necessary, but it increases my
My wrist/hand symptoms prevent me from lifting more than wrist/hand symptoms
moderate weights (ex: a gallon of milk) ____I am able to do some, but not all, house & yard work; it increases
My wrist/hand symptoms prevent me from safely lifting more than light my wrist/hand symptoms
weights (ex: a dish or book) ____I am able to do only the minimum of house & yard work because of
____I frequently drop even light objects due to weakness in my my wrist/hand symptoms I am unable to do any house or yard work
wrist/hand because of my symptoms
__ I avoid lifting anything with my involved hand Section 5 - Writing/Typing Section 10 - Recreation/Sports
____I am able to engage in all my recreation/sports activities with no
tolerance wrist/hand symptoms
____I can write or type as long as I need to without symptoms ____I am able to engage in all my recreation/sports activities with some
____I can write or type for as long as I want, but it increases my symptoms in my wrist/hand
symptoms ____I am able to engage in most, but not all, of my usual
____I can write or type for 31-60 minutes before my wrist/hand recreation/sports activities because of my symptoms
symptoms increase ____I am able to engage in a few of my usual recreation/sports activities
____I can write or type for 11-30 minutes before my wrist/hand because of symptoms in my wrist/hand
symptoms increase ____I can hardly do any recreation/sports activities because of
____I can write or type for only 10 minutes or less before my wrist/hand symptoms in my wrist/hand
symptoms increase I am unable to write or type using my involved ____I am unable to do any recreation/sports activities because of
hand/wrist symptoms in my wrist/han
Section 6 - Work
d
Please mark on the line below the pain you have had in the past 24 hours. Use the line as a scale to mark the level of your pain from no pain to the worst
no pain at all worst possible pain _________/50 =______%
