During the past 4 weeks......
1. How would you describe the worst pain you had from your shoulder?
2. Have you had any trouble dressing yourself because of your shoulder?
3. Have you had any trouble getting in and out of a car or using public transport because of your shoulder?
4. Have you been able to use a knife and fork at the same time?
5. Could you do the household shopping on your own?
6. Could you carry a tray containing a plate of food across a room?
7. Could you brush/comb your hair with the affected arm?
8. How would you describe the pain you usually had from your shoulder?
9. Could you hang your clothes up in a wardrobe, using the affected arm? (whichever you tend to use)
10. Have you been able to wash and dry yourself under both arms?
11. How much has pain from your shoulder interfered with your usual work (including housework)?
12. Have you been troubled by pain from your shoulder in bed at night?
How did you learn of the screening?
Kettering Health Network Newsletter
Attended a Community Wellness event
Exploring the KHN web site
Learned about it during a Community Wellness Educational Program
DaytonHealthKonnect
Used a Search Engine
Other
If "Other":
