Pain Intensity (45 points) | None Mild Moderate Severe | 45 pts 30 pts 15 pts 0 point |
Motion (20 points): Arc of motion | Arc of motion greater than 100˚ Arc between 50˚ to 100˚ Arc less than 50˚ | 20 pts 15 pts 5 points |
Stability (10 points) | Stable Moderate stability Grossly unstable | 10 pts 5 pts 0 points |
Function (tick as many as able) (25 pts) | Can comb hair Can eat Can perform hygiene Can don shirt Can don shoe | 5 pts 5 pts 5 pts 5 pts 5 points |
Total Score | Excellent Good Fair Poor | 90 - 100 pts 75 - 89 pts 60 - 74 pts 0 - 59 pts |