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As seen on CBS Minnesota for Prostate Artery Embolization

WOMAC Score Questionnaire for knee pain

Instructions:

Please rate the activities in each category according to the following scale of difficulty:
0 = None, 1 = Slight, 2 = Moderate, 3 = Very, 4 = Extremely.

Pain

1. Walking(Required)
2. Stair climbing(Required)
3. Nocturnal(Required)
4. Rest(Required)
5. Weight bearing(Required)

Stiffness

1. Morning stiffness(Required)
2. Stiffness occurring later in the day(Required)

Physical Function

1. Descending stairs(Required)
2. Ascending stairs(Required)
3. Rise from sitting(Required)
4. Standing(Required)
5. Bending to floor(Required)
6. Walking on flat surface(Required)
7. Getting in/out of car(Required)
8. Going shopping(Required)
9. Putting on socks(Required)
10. Lying in bed(Required)
11. Taking off socks(Required)
12. Rising from bed(Required)
13. Getting in/out of bath(Required)
14. Sitting(Required)
15. Getting on/off toilet(Required)
16. Heavy domestic duties(Required)
17. Light domestic duties(Required)
This field is for validation purposes and should be left unchanged.
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