WOMAC Form

WOMAC

The Western Ontario and McMaster Universities Osteoarthritis Index

MM slash DD slash YYYY
Instructions: Please rate the activities in each category according to the following scale of difficulty. Select the number of "E's" that corresponds with your answer to each question.
0 = None, 1 = Slight, 2 = Moderate, 3 = Very, 4 = Extremely

Pain

Stiffness

Physical Function
______ / 96 = _______%