The Upper Extremity Functional Index (UEFI)

Patient Name:*
First Last
Date:
MM slash DD slash YYYY
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.

Today, do you or would you have any difficulty at all with:

Activities

	Extreme Difficulty or Unable to Perform Activity	Quite a Bit of Difficulty	Moderate Difficulty	A Little Bit of Difficulty	No Difficulty
Any of your usual work, housework, or school activities
Your usual hobbies, re creational or sporting activities
Lifting a bag of groceries to waist level
Lifting a bag of groceries above your head
Grooming your hair
Pushing up on your hands (eg. From bathtub or chair)
Preparing food (eg. peeling, cutting)
Driving
Vacuuming, sewing or raking
Dressing
Doing up buttons
Using tools or appliances
Opening doors
Cleaning
Tying or lacing shoes
Sleeping
Laundering clothes (eg. Washing, ironing, folding)
Opening a jar
Throwing a ball
Carrying a small suitcase with your affected limb

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