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Name: ___ Date: ___The Upper Extremity Functional Index We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem
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Obtain a copy of the Upper Extremity Functional Index-15 form
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Read and understand the instructions for each section of the form
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Fill out each section of the form honestly and accurately
04
Consider any pain or limitations you experience in your upper extremities when answering the questions
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Ask for assistance from a healthcare provider if you have trouble understanding or completing the form

Who needs upper extremity functional index-15?

01
Individuals who have experienced upper extremity injuries
02
Patients undergoing rehabilitation for upper extremity conditions
03
Healthcare providers assessing the functional status of a patient's upper extremities
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The Upper Extremity Functional Index-15 is a self-reported questionnaire used to assess the functional status of the upper extremities.
Patients who have upper extremity injuries or conditions that may affect their daily activities are required to fill out the Upper Extremity Functional Index-15.
To fill out the Upper Extremity Functional Index-15, patients need to answer the questions honestly and to the best of their ability based on their current functional status.
The purpose of the Upper Extremity Functional Index-15 is to assess the patient's functional limitations and monitor their progress throughout the treatment or rehabilitation process.
The Upper Extremity Functional Index-15 requires patients to report their ability to perform various upper extremity activities such as reaching, lifting, and grasping.
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