Patient Questionnaire
Holsman Physical Therapy & Wellness · 17 NJ & NYC clinics + in-home therapy
holsmanwellness.com · 1-855-465-7626
Holsman Physical Therapy & Wellness · 17 NJ & NYC clinics + in-home therapy
holsmanwellness.com · 1-855-465-7626
20 everyday activities for shoulder, elbow, wrist and hand problems, scored from 0 to 80.
The UEFI is a widely used questionnaire about how an arm problem affects daily life, from grooming your hair to carrying a suitcase. It takes about 3 minutes.
UEFI ©1996 P. Stratford, reprinted with permission
Instructions
We are interested in knowing whether you are having any 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.
Today, do you or would you have any difficulty at all with:
UEFI ©1996 P. Stratford, reprinted with permission
This is a questionnaire, not a diagnosis. The UEFI shows how much your arm problem affects everyday activities. It can’t tell you what is causing it or what treatment you need. Share your result with a physical or occupational therapist, your doctor or another licensed health care provider.
Add the 20 answers for a score from 0 to 80. Higher scores mean better function; 80 means no difficulty with any activity. Percent of maximal function is the score divided by 80.
Sources and permission. UEFI ©1996 P. Stratford, reprinted with permission. Used with the permission of the authors; please do not copy the form from this page. Stratford PW, Binkley JM, Stratford DM. Development and initial validation of the upper extremity functional index. Physiotherapy Canada. 2001;53(4):259-267. Chesworth BM, et al. Reliability and validity of two versions of the Upper Extremity Functional Index. Physiother Can. 2014;66(3):243-253. Holsman Physical Therapy is not affiliated with these organizations, and they do not endorse this website.
Next step: Bring this printout to your next visit. Holsman physical and occupational therapists treat shoulder, elbow, wrist and hand problems at 17 clinics in North Jersey, the Bronx and Brooklyn, plus in-home visits. Request an appointment or call 1-855-465-7626. Some plans require a referral for therapy, and we check yours for free.
The Upper Extremity Functional Index is a 20-question form about everyday activities such as lifting groceries, dressing, opening jars and driving. Therapists use it for shoulder, elbow, wrist and hand problems to track progress.
Each activity is rated from 0 (extreme difficulty or unable to perform) to 4 (no difficulty). The 20 answers are added for a score from 0 to 80. Higher is better.
A change of about 9 points is needed to be confident it is more than measurement error (Stratford et al., 2001; Chesworth et al., 2014).
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Physical therapists at 17 locations across NJ & NYC, plus in-home visits. Same-week appointments available.
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