Rheumatoid Arthritis Survey
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1. Default Section
1
. How long have you been living with Rheumatoid Arthritis (RA)?
How long have you been living with Rheumatoid Arthritis (RA)?
less then 5 years
5-10 years
10-20 years
20 years or more
2
. Gender
Gender
Male
Female
3
. Where does RA effect you the most?
Where does RA effect you the most?
4
. Which do you find the most difficult to use?
Which do you find the most difficult to use?
Switches
Knobs
Levers
Handles
Other (please specify)
5
. Which motion do you find the most painful?
Which motion do you find the most painful?
Picking up objects
Pinching objects
Pulling objects
Twisting objects
Other (please specify)
6
. What daily task do you find the most difficult to do?
What daily task do you find the most difficult to do?
7
. Do you find yourself improvising to do simple tasks?
Do you find yourself improvising to do simple tasks?
Yes
No
If Yes please specify
8
. Any comments or suggestions are helpful.
Any comments or suggestions are helpful.
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