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Upper Extremity Functional Index
Today, do you or would you have any difficulty at all with:
1. Any of your usual work, housework, or school activities
11. Doing up buttons
2. Your usual hobbies, re creational or sporting activities
12. Using tools or appliances
3. Lifting a bag of groceries to waist level
13. Opening doors
4. Lifting a bag of groceries above your head
14. Cleaning
5. Grooming your hair
15. Tying or lacing shoes
6. Pushing up on your hands (eg from bathtub or chair)
16 Sleeping
7. Preparing food (eg peeling, cutting)
17 Laundering clothes (eg washing, ironing, folding)
8. Driving
18. Opening a jar
9. Vacuuming, sweeping or raking
19. Throwing a ball
10. Dressing
20. Carrying a small suitcase with your affected limb
Subtotal (1 through 10):
Subtotal (11 through 20)
Minimum Level of Detectable Change (90% Confidence): 9 points
UEFI Score
Higher scores correlate with better function (Best = 80)

DrChrono Physical Therapy | FOS Upper Extremity Functional Index (UEFI) Medical Form

Physical Therapist

DrChrono's FOS upper extremity functional index form, customizable for your Physical Therapy practice.

There are 3 copies in use.
Published: Dec. 11, 2018, 6:21 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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Sunnyvale, CA 94089

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