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Upper Extremity Functional Scale (UEFI)
admin
2020-05-20T18:49:20+00:00
Upper Extremity Functional Scale (UEFI)
We are interested in knowing whether you are having difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention. Please provide an answer for each activity.
Name
*
First
Last
Date
*
Date Format: MM slash DD slash YYYY
Any of your usual work, housework, or school activities
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Your usual hobbies, recreational or sporting activities
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Lifting a bag of groceries to waist level
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Lifting a bag of groceries above your head
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Grooming your hair
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Pushing up on your hands (eg from a bathtub or chair)
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Preparing food (eg peeling, cutting)
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Driving
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Vacuuming, sweeping, or raking
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Dressing
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Doing up buttons
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Using tools or appliances
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Opening doors
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Cleaning
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Tying or lacing shoes
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Sleeping
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Laundering clothes (eg washing, ironing, folding)
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Opening a jar
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Throwing a ball
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
Carrying a small suitcase with your affected limb
*
Extreme difficulty or unable to perform activity
Quite a bit of difficulty
Moderate difficulty
A little bit of difficulty
No difficulty
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