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Juvenile Rheumatoid Arthritis | Childhood Health Assessment Questionnaire (CHAQ)

Purpose: To evaluate a pediatric patient with juvenile rheumatoid arthritis using the Childhood Health Assessment Questionnaire (CHAQ) of Singh et al.

Evaluation

Are you evaluating a pediatric patient with juvenile rheumatoid arthritis?

Indicate the ability to perform each activity during the past week

Dress self

Shampoo hair

Remove socks

Cut fingernails

Stand up from a low chair or the floor

Get in and out of bed, or stand up in crib

Cut food

Lift a full cup or glass to mouth

Open a new cereal box

Walk outdoors on flat ground

Climb up 5 steps

Wash and dry entire body

Take a tub bath

Get on and off the toilet or potty chair

Brush teeth

Comb or brush hair

Reach and get down a heavy game or book from just above the head

Bend down to pick up clothing or piece of paper off the floor

Pull on a sweater over head

Turn neck to look back over shoulder

Write or scribble with a pen or pencil

Open car doors

Open a jar that has been previously opened

Turn a water faucet on or off

Open a door after turning a door knob

Run errands and shop

Get in and out of a car, toy car or bus

Do household chores

Ride a bike or tricycle

Run and play

Pain during past week as indicated by the number of centimeters along a 10 cm line ranging from no pain to very severe

How well the child has been doing during the past week as indicated by the number of centimeters along a 10 cm line ranging from very well to very poor

Does the patient regularly use?

• a cane?

• a walker?

• crutches?

• a wheelchair?

• devices for dressing?

• built up pencil or special utensils?

• built up or special chair?

• a raised toilet seat?

• a bathtub seat?

• a jar opener?

• a bathtub bar?

• a long-handled appliance for reach?

• a long-handled appliance for bathroom?

• other aid or device?

Does the patient need help from someone?

• to dress or groom?

• rise up?

• to eat?

• to walk?

• to perform personal hygiene?

• to reach for things?

• to grip things?

• to perform daily activities?

Results

Please fill out required fields.

Specialty

Objective

ICD-10