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UEFI
Upper Extremity Functional Index
1.
Please type your name. Surname, First Name
*
2.
We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention. Please provide an answer for each activity.
(Required.)
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Any of your usual work, housework, or school activities
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Your usual hobbies, re creational or sporting activities
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Lifting a bag of groceries to waist level
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Lifting a bag of groceries above your head
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Grooming your hair
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Pushing up on your hands (eg from bathtub or chair)
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Preparing food (eg peeling, cutting)
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Driving
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Vacuuming, sweeping or raking
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Dressing
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Doing up buttoms
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Using tools or appliances
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Opening doors
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Cleaning
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Tying or lacing shoes
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Sleeping
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Laundering clothes (eg washing, ironing, folding)
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Opening a jar
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Throwing a ball
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
Carrying a small suitcase with your affected limb
0 Extreme Difficulty
or Unable to
Perform Activity
1 Quite a Bit of
Difficulty
2 Moderate
Difficulty
3 A Little Bit
of Difficulty
4 No
Difficulty
3.
I
nterp
retation of scores (for office use only)
Total score: add up the total scores = _______/80 MCID = Dominant arm = 7, Non-dominant arm = 10 SCORE RANGE = 80(no disability) to 0 (max disability)
This questionnaire is taken from: Stratford PW, Binkley, JM, Stratford DM (2001): Development and initial validation of the upper extremity functional index. Physiotherapy Canada. 53(4):259-267.
