|
3. SELF CARE
|
|
This refers to activities
which involve personal maintenance and independent daily living (e.g. getting a bath or shower, getting dressed etc)
|
|
PLEASE RATE
|
|
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
not applicable |
|
NO DISABILITY
TOTAL DISABILITY |
|
6. BASIC ACTIVITIES OF LIVING
|
|
This refers to basic matters
such as eating, sleeping and breathing
|
|
PLEASE RATE
|
|
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
not applicable |
|
NO DISABILITY
TOTAL DISABILITY |
|
7. SEXUAL BEHAVIOUR
|
|
This category refers to the
frequency and quality of ones sex life
|
|
PLEASE RATE
|
|
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
not applicable |
|
NO DISABILITY
TOTAL
DISABILITY |
Finally, how many days off
work because of your pain have you had since your last visit to the doctor?.
REFERENCES
Chibnall T.T. Krause S. Tait .C. 1990
The Pain Disability Index:
Psychometric Properties
Pain 40:171-184
Duckro P.N. Krause S.J. Margolis R.B. Pollard C.A. Tait R.C. 1987
The Pain Disability Index:
Psychometric & Validity Data
Archives of Physical Rehabilitation
Medicine 68(7) 438-441
