Middleburg Physical Therapy
Del Wilson, P.T., O.C.S. ∎ Mary Wilson, P.T., O.C.S.
WRIST/HAND DISABILITY INDEX
NAME: DATE:
Please read: This questionairre has been designed to give the Physical Therapist information as to how your wrist/hand pain has affected your
ability to manage everyday life
Section 1 – Pain intensity Section 6 – Work
___I have no pain in my wrist/hand ___I can do as much work as I want to without symptoms
___The pain in my wrist/hand is intermittent or mild ___I can do all of my usual work, but it increases my symptoms
___The pain in my wrist/hand is mild but constant ___I can do most, but not all, of my usual work because of
___The pain in my wrist/hand is constant and moderately limits use of my symptoms
the arm ___I can do about half of my usual work because of my symptoms
___The pain in my wrist/hand is constant and severely limits us of that ___I can hardly do any work at all because of my wrist/hand symptoms
arm ___I can’t do any work at all because of my wrist/hand symptoms
___The pain in my wrist/hand is constant, and I am unable to use
that arm
Section 7 – Driving
Section 2 – Numbness & Tingling ___I can drive my car without any wrist/hand symptoms
___I have no numbness or tingling in my wrist/hand ___I can drive my car as long as I want, but it increases my symptoms
___The numbness or tingling in my wrist/hand is intermittent ___I can drive my car for 31-60 minutes before my
___The numbness or tingling in my wrist/hand is constant but does not wrist/hand symptoms increase
limit use of that arm ___I can drive my car for 11-30 minutes before my
___The numbness or tingling in my wrist/hand is constant and wrist/hand symptoms increase
moderately limits use of that arm ___I can drive my car for only 10 minutes or less before my
___The numbness or tingling in my wrist/hand is constant and severely wrist/hand symptoms increase
limits use of that arm ___I am unable to use that arm for driving
___Due to constant numbness or tingling in my wrist/hand, I am
unable to use that arm Section 8 – Sleeping
___I have no trouble sleeping
Section 3 – Personal Care (Washing, Dressing, etc.) ___My sleep is slightly disturbed by wrist/hand symptoms (It
___I can look after myself normally without any symptoms wakes me 1 time/night)
___I can look after myself normally, but it causes increased symptoms ___My sleep is mildly disturbed by wrist/hand symptoms (It wakes
___It is uncomfortable to look after myself, and I am slow and careful me 2 times/night)
___I can only partially use my wrist/hand and sometimes use the other ___My sleep is moderately disturbed by wrist/hand symptoms
side instead (It wakes me 3-4 times/night)
___I can only partially use my wrist/hand and mostly use the other side ___My sleep is greatly disturbed by wrist/hand symptoms (It wakes
___I am unable to use my wrist/hand for any personal care and always me 5-6 times/night)
use the other side ___My sleep is completely disturbed by wrist/hand symptoms
(It wakes me 7-8 times/night or more)
Section 4 – Strength
___I can lift the heaviest weights I need to without symptoms Section 9 – House & Yard Work
___I have no wrist/hand limitations with house or yard work
___I can lift heavy weights, but it increases my wrist/hand symptoms
___I am able to do all house & yard work necessary if I take breaks
___My wrist/hand symptoms prevent me from lifting more
than moderate weights (ex: a gallon of milk) ___I am to do all house & yard work necessary, but it increases
my wrist/hand symptoms
___My wrist/hand symptoms prevent me from safely lifting more than
light weights (ex: a dish or book) ___I am able to do some, but not all, house & yard work; it
increases my wrist/hand symptoms
___I frequently drop even light objects due to weakness in
my wrist/hand ___I am able to do only the minimum of house & yard work because
of my wrist/hand symptoms
__I avoid lifting anything with my involved hand ___I am unable to do any house or yard work because of my symptoms
Section 5 – Writing/Typing tolerance
___I can write or type as long as I need to without symptoms Section 10 - Recreation/Sports
___I can write or type for as long as I want, but it increases my ___I am able to engage in all my recreation/sports activities with
symptoms no wrist/hand symptoms
___I am able to engage in all my recreation/sports activities with
___I can write or type for 31-60 minutes before my
wrist/hand symptoms increase some symptoms in my wrist/hand
___I am able to engage in most, but not all, of my usual
___I can write or type for 11-30 minutes before my
recreation/sports activities because of my symptoms
wrist/hand symptoms increase
___I can write or type for only 10 minutes or less before my wrist/hand ___I am able to engage in a few of my usual recreation/sports
symptoms increase activities because of symptoms in my wrist/hand
___I am unable to write or type using my involved hand/wrist ___I can hardly do any recreation/sports activities because
of symptoms in my wrist/hand
___I am unable to do any recreation/sports activities because
of symptoms in my wrist/hand
Please mark on the line below the pain you have had in the past 24 hours. Use the line as a scale to mark the level of your pain from no pain to
the worst
no pain at all ___________________________________________________________worst possible pain ____/50 ____%
