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WOMAC
Western Ontario and McMaster Universities Osteoarthritis Index
*
1.
Please type your name. Surname, First Name
(Required.)
*
2.
Who is your Physiotherapist?
(Required.)
Mandi Hayes
Jennifer Duke
Anthony Giorgianni
Jeanine Stott
Beata Sadowska
Heather Clegg
Chris Cosby
I cannot remember
Instructions: In Sections 2, 3, and 4, questions will be asked about your hip or knee pain. Please select the most appropriate response. If you are unsure about how to answer a question, please give the best answer you can.
*
3.
Think about the pain you felt in your hip/knee during the last 48 hours. How much pain do you have?
(Required.)
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Walking on a flat surface
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Going up and down stairs
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
At night while in bed, pain disturbs your sleep
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Sitting or lying
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Standing upright
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
*
4.
Think about the stiffness (not pain) you have in your hip/knee during the last 48 hours. Stiffness is a sensation of decreased
ease in moving your joint.
(Required.)
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
How severe is your stiffness after first awakening in the morning?
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
How severe is your stiffness after sitting, lying, or resting in the day?
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
*
5.
Think about the difficulty you had in doing the following daily physical activities due to your hip/knee during the last 48 hours.
By this we mean your ability to move around and look after yourself. What degree of difficulty do you have?
(Required.)
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Descending stairs
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Ascending stairs
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Rising from sitting
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Standing
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Bending to the floor
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Walking on flat surfaces
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Getting in and out of a car, or on or off a bus
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Going shopping
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Putting on your socks or stockings
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Rising from the bed
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Taking off your socks or stockings
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Lying in bed
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Getting in or out of the bath
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Sitting
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Getting on or off the toilet
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Performance heavy domestic duties
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
Performing light domestic duties
0 None
1 Mild
2 Moderate
3 Severe
4 Extreme
6.
SCORING - for office use only
PAIN SCORE = add up all scores ______/20 = _______ STIFFNESS SCORE = add up all scores______/8 = ______ PHYSICAL FUNCTION SCORE = add up all scores ______/68 = ______
This questionnaire is taken from: McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2001 Oct;45(5):453-61.
