Oxford Score - Shoulder
Please answer the questions as they relate to the past four (4) weeks
Shoulder
*
Left
Right
Name
*
First Name
Last Name
How would you describe the worst pain you had from your shoulder?
*
None
Mild
Moderate
Severe
Unbearable
Have you had any trouble dressing yourself because of your shoulder?
*
No trouble at all
A little bit of trouble
Moderate trouble
Extreme difficulty
Impossible to do
Have you had any trouble getting in and out of a car or using public transport because of your shoulder?
*
No trouble at all
A little bit of trouble
Moderate trouble
Extreme difficulty
Impossible to do
Have you been able to use a knife and fork at the same time?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
Could you do household shopping on your own?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
Could you carry a tray containing a plate of food across a room?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
Could you comb/brush your hair with the affected arm?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
How would you describe the pain you usually had from your shoulder?
*
None
Very mild
Mild
Moderate
Severe
Could you hang your clothes up in a wardrobe using your affected arm?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
Have you been able to wash and dry yourself under both arms?
*
Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible
How much has pain from your shoulder interfered with your usual work? Including housework
*
Not at all
A little bit
Moderately
Greatly
Totally
Have you been troubled by pain from your shoulder in bed at night?
*
No nights
Only 1 - 2 nights
Some nights
Most nights
Every night
Submit
Should be Empty: