Upper Extremity Function Index
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.
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Email *
Your Name *
Your Physical Therapist *
Today, do you or would you have any difficulty at all with: *
0 - Extreme Difficulty
1 - Quite a bit of Difficulty
2 - Moderate Difficulty
3 - A Little bit of Difficulty
4 - No Difficulty
Any of your usual work, housework or school activities
Your usual hobbies, recreational or sporting activities
Lifting a bag of groceries to waist level
Placing an object onto, or removing it from an overhead shelf
Washing your hair or scalp
Pushing up on your hands (e.g., from bathtub or-chair)
Preparing food (e.g., peeling, cutting)
Vacuuming, sweeping, or raking
Doing up buttons
Using tools or appliances
Opening doors
Tying or lacing shoes
Laundering clothes. (e.g., washing, ironing, folding)
Opening a jar
Throwing a ball
Carrying a small suitcase with your affected limb
Total Score (Add all Responses) *
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