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Modified Health Assessment Questionnaire | Spondyloarthropathy (HAQ-S)

Purpose: To evaluate a patient for clinical features of Down syndrome using the diagnostic index of Preus.

Evaluation

Are you evaluating a patient with a spondyloarthropathy?

Select the appropriate answer to indicate the ability to perform each activity during the past week

Dress self

Shampoo hair

Stand up from an armless straight chair

Get in and out of bed

Cut food

Lift a full cup or glass to mouth

Open a new milk carton

Walk outdoors on flat ground

Climb up 5 steps

Wash and dry entire body

Take a tub bath

Get on and off the toilet

Reach and get down a 5 pound (2.3 kg) object from just above head

Bend down to pick up clothing off the floor

Open a car door

Open a jar that has been previously opened

Turn a water faucet on or off

Run errands and shop

Get in and out of a car

Do chores around the house

Carry heavy packages

Sit for a long period of time

Sit and work at a flat topped table or desk

Look into rear view mirror while driving

Turn head around and drive in reverse

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

Stiffness during past week as indicated by the number of centimeters along a 10 cm line ranging from none to very severe

Does the patient regularly use?

• a cane?

• a walker?

• crutches?

• a wheelchair?

• devices for dressing?

• built up 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

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Specialty

Objective

ICD-10