GRIP o. Open car doors? p. Open jars which have been previously opened? q. Turn faucets on and off? Without Any With Some With Much Unable Difculty Difculty Difculty To Do ACTIVITIES r. Run errands and shop? s. Get in and out of a car? t. Do chores such as vacuuming, yard work? Please check any AIDS OR DEVICES that you usually use for any of these activities: Please check any categories for which you need HELP FROM ANOTHER PERSON Raised toilet seat Long-handled appliances for reach Bathtub seat Long-handled appliances in bathroom Jar opener Bathtub bar Other (specify): Hygience Gripping and opening things Reach Errands and chores 2. How much PAIN have you had because of your illness in the PAST WEEK? Please indicate on the scale below how severe your pain has been: Very severe No pain pain 3. How much of a problem has UNUSUAL fatigue or tiredness been for you OVER THE PAST WEEK? 4. How much of a problem has sleeping been for you OVER THE PAST WEEK? 5. How active has your arthritis been in the LAST 24 HOURS? 6. When you get up in the morning do you feel stif? YES NO 7. How do you feel today compared to ONE MONTH AGO? Please check only one: 012345678910 Fatigue is no problem 012345678910 Fatigue is a major problem Sleep is no problem 012345678910 Sleep is a major problem Very well 012345678910 Very poorly If you answer NO please go to item number 7. If you answer YES, please write the number of minutes: , OR number of hours: until you are as limber as you will be for the day? MUCH BETTER(1) BETTER(2) THE SAME(3) WORSE(4) MUCH WORSE(5) ref: Wolfe F. A brief clinical health assessment instrument: CLINHAQ. Arthritis Rheum. 1989; 32 (suppl): S9 Wolfe F. Data collection and utilization: a methodology for clinical practice and clinical research. In: Wolfe F, Pincus T, Dekker M, eds. Rheumatoid arthritis: pathogenesis, assessment, outcome and treatment. New York: Marcel Dekker, 1994: 463-514. 42
RkJQdWJsaXNoZXIy MjgzNzA=