แบบประเมินภาวะข้อเข่าเสื่อม

1

utm_campaign

2

utm_source

3

1. How would you characterize your knee pain?* This field is required.

You do not experience knee pain.

You experience mild pain deep in the knee only while shifting weight or in certain positions.

Knee pain aggravates with prolonged use, improves with rest, or is intermittent.

The knee pain is more severe and lasts longer.

The knee pain intensifies even during periods of inactivity and becomes locked.

4

2. Do you have knee trouble with daily tasks, such as showering or dressing?* This field is required.

Never.

Seldomly experience mild knee pain/stiffness.

Frequently experience mild knee pain/stiffness.

Your knee problems begin to cause difficulty performing activities.

Your knee problems prevent you from performing daily tasks.

5

3. Do you have problems getting in and out of a car or a transit bus?* This field is required.

No symptoms.

Seldomly experience mild knee pain/stiffness.

Knee pain/stiffness slowing you down while getting in and out of a car.

Your knee pain/stiffness is severe, causing difficulty getting in and out of a car.

Unable to get in or out of a car.

6

4. How long can you walk before feeling knee pain?* This field is required.

You can walk for over an hour without symptoms.

Knee pain develops after 6-60 minutes of walking.

You begin having knee pain after walking for 5 minutes.

Walking around the house is sufficient to cause knee pain.

You could not walk at all.

7

5. How is your knee when standing up after having a meal?* This field is required.

No symptoms.

Your knee is mildly painful/stiff.

Your knee is moderately painful/stiff.

Your knee is severely painful and stiff; standing up is a challenge.

Unable to stand up due to extreme knee pain.

8

6. How often do your knee problems force you to limp?* This field is required.

Never

Only in the first few steps

Sometimes

Most of the time

Always

9

7. Are you able to stand up from the kneeling position?* This field is required.

Yes, it is easy.

You can stand up but with some difficulty.

You can stand up but with more difficulty.

You can stand up but with extreme difficulty.

You cannot stand up from a kneeling position.

10

8. How often do you experience knee pain at night?* This field is required.

Never

1-2 times a month

1-3 times a week

4-6 times a week

Every night

11

9. How often does knee pain develop at work or doing housework?* This field is required.

Never

Rarely

Sometimes

Most of the time

All the time

12

10. Have you ever felt your knee suddenly give out or weak to the point you slump down?* This field is required.

Never

Only in the first few steps

Sometimes

Most of the time

Always

13

11. Are you able to go shopping by yourself?* This field is required.

Yes, with no limitation.

Yes, but with slight knee pain/stiffness.

Yes, but with more knee pain/stiffness.

Yes, with extreme difficulty.

You find it impossible to go shopping.

14

12. Are you able to walk down the stairs?* This field is required.

Yes, as usual.

Yes, but with slight knee pain/stiffness.

Yes, but with more knee pain/stiffness.

Yes, with extreme difficulty.

You cannot walk down the stairs.

15

Full name* This field is required.

Prefix

First name

Last name

16

Gender* This field is required.

Male

Female

17

Date of birth* This field is required.

18

Email* This field is required.

example@example.com

Confirm Email

19

Phone number* This field is required.

20

* This field is required.

21

22

Total