OSTEOARTHRITIS SELF-ASSESSMENT

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

1. How long have you been experiencing knee pain?

Less than 3 months

3 to 6 months

6 months to 1 year

More than 1 year

More than 3 years

Clear selection

2. Have you recently injured your knee?

Yes

Clear selection

3. How would you rate your knee pain on a scale of 1 (no pain) to 10 (unbearable pain) when resting?

(1 = No pain)

(10 = The worst pain imaginable)

Clear selection

4. How would you rate your knee pain on a scale of 1 (no pain) to 10 (unbearable pain) with activity?

(1 = No pain)

(10 = The worst pain imaginable)

Clear selection

5. What daily activities are more difficult due to your knee pain? Check all that apply.

My knee pain does not affect my daily activities

Walking on level surfaces more than 100 yards

Going up and down stairs

Rising from a chair or getting out of a car

Standing after long periods of sitting

Sleeping through the night

Other:

6. What treatments have you tried to help with your knee pain? Check all that apply.

Exercise or physical therapy

Over-the-counter pain medication (NSAIDs, acetaminophen, etc.)

Prescription pain medication (oral or topical)

Used a knee brace

Steroid injections

Other injections

Surgery

Other:

7. Has your knee ever become swollen or enlarged? If yes, how often?

Yes

Clear selection

8. Have you been diagnosed with osteoarthritis (OA) of the knee by a doctor or other healthcare professional?

Yes

Not sure

Clear selection

What are your goals and expectations from treatment?

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.