WOMAC Osteoarthritis Index
  • Date of Birth*
     - -
  • Date*
     / /

  • The following questions concern the amount of pain you are currently experiencing in your knees. For each situation, please enter the amount of pain you have experienced in the past 48 hours.

  • 1. Walking on a flat surface*
  • 2. Going up or down stairs*
  • 3. At night while in bed*
  • 4. Sitting or lying down*
  • 5. Standing upright*
  • 6. Level of pain in RIGHT knee*
  • 7. Level of pain in LEFT knee*
  • 8. How severe is your stiffness after first awakening in the morning?*
  • 9. How severe is your stiffness after sitting, lying or resting later in the day?*

  • The following questions concern your physical function. By this we mean your ability to move around and to look after yourself. For each of the following activities, please indicate the degree of difficulty you have experienced in the last 48 hours, in your knees.

  • 1. Descending (going down) stairs*
  • 2. Ascending (going up) stairs*
  • 3. Rising from sitting*
  • 4. Standing*
  • 5. Bending to floor*
  • 6. Walking on a flat surface*
  • 7. Getting in/out of car*
  • 8. Going shopping*
  • 9. Putting on socks/stockings*
  • 10. Rising from bed*
  • 11. Taking off socks/stockings*
  • 12. Lying in bed*
  • 13. Getting in/out of bath*
  • 14. Sitting*
  • 15. Getting on/off toilet*
  • 16. Heavy domestic duties (mowing the lawn, lifting heavy grocery bags)*
  • 17. Light domestic duties (such as tidying a room, dusting, cooking)*
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  • Should be Empty: