Fiona Stanley Fremantle Hospitals Group

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Upper Limb Burn

BSHS-B, Itch, SF-36, SIP, BFI, Posas, QuickDASH

BSHS

How much difficulty do you have:

Bathing independently? Extreme Quite a bit Moderate A little bit None/Not at all Dressing yourself? Extreme Quite a bit Moderate A little bit None/Not at all Getting in and out of a chair? Extreme Quite a bit Moderate A little bit None/Not at all Signing your name? Extreme Quite a bit Moderate A little bit None/Not at all Eating with utensils? Extreme Quite a bit Moderate A little bit None/Not at all Tying shoelaces, bows, etc? Extreme Quite a bit Moderate A little bit None/Not at all Picking up coins from a flat surface? Extreme Quite a bit Moderate A little bit None/Not at all Unlocking a door? Extreme Quite a bit Moderate A little bit None/Not at all Working in your old job performing your old duties? Extreme Quite a bit Moderate A little bit None/Not at all

To what extent does each of the following statements describe you?

I am troubled by feelings of loneliness Extreme Quite a bit Moderate A little bit None/Not at all I often feel sad or blue Extreme Quite a bit Moderate A little bit None/Not at all At times, I think I have had an emotional problem Extreme Quite a bit Moderate A little bit None/Not at all I am not interested in doing things with my friends Extreme Quite a bit Moderate A little bit None/Not at all I don't enjoy visiting people Extreme Quite a bit Moderate A little bit None/Not at all I have no one to talk to about my problems Extreme Quite a bit Moderate A little bit None/Not at all I have feelings of being trapped or caught Extreme Quite a bit Moderate A little bit None/Not at all My injury has put me further away from my family Extreme Quite a bit Moderate A little bit None/Not at all I would rather be alone than with my family Extreme Quite a bit Moderate A little bit None/Not at all I don't like the way my family acts around me Extreme Quite a bit Moderate A little bit None/Not at all My family would be better off without me Extreme Quite a bit Moderate A little bit None/Not at all I feel frustrated bcause I cannot be sexually aroused as well as I used to Extreme Quite a bit Moderate A little bit None/Not at all I am simply not interested in sex any more Extreme Quite a bit Moderate A little bit None/Not at all I no longer hug, hold or kiss Extreme Quite a bit Moderate A little bit None/Not at all Sometimes I would like to forget that my appearance has changed Extreme Quite a bit Moderate A little bit None/Not at all I feel that my burn is unattractive to others Extreme Quite a bit Moderate A little bit None/Not at all My general appearance bothers me Extreme Quite a bit Moderate A little bit None/Not at all

Below you will find a number of questions about your damage. To what extent does each of the following statements describe you?

The appearance of my scars bother me Extreme Quite a bit Moderate A little bit None/Not at all Being out in the sun bothers me Extreme Quite a bit Moderate A little bit None/Not at all Hot weather bothers me Extreme Quite a bit Moderate A little bit None/Not at all I can't get out and do things in hot weather Extreme Quite a bit Moderate A little bit None/Not at all It bothers me that I can't get out in the sun Extreme Quite a bit Moderate A little bit None/Not at all My skin is more sensitive than before Extreme Quite a bit Moderate A little bit None/Not at all Taking care of my skin is a bother Extreme Quite a bit Moderate A little bit None/Not at all There are things that I've been told to do for my burn that I dislike doing Extreme Quite a bit Moderate A little bit None/Not at all I wish that I didn't have to do so many things to take care of my burn Extreme Quite a bit Moderate A little bit None/Not at all I have a hard time doing all the things I've been told to take care of my burn Extreme Quite a bit Moderate A little bit None/Not at all Taking care of my burn makes it hard to do other things that are important to me Extreme Quite a bit Moderate A little bit None/Not at all My burn interferes with my work Extreme Quite a bit Moderate A little bit None/Not at all Being burned has affected my ability to work Extreme Quite a bit Moderate A little bit None/Not at all My burn has caused problems with my working Extreme Quite a bit Moderate A little bit None/Not at all

Itch during the past week

During the past week how much of the time have you experienced itch? All of the time Most of the time Some of the time A little of the time None of the time Over the past week rate the intensity of the itch None Very Mild Mild Moderate Severe Very Severe

Itch during the past 24 hours

Select one number that describes how, during the past 24 hours itch has interfered with your...

General Activity 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Mood 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Walking ability 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Normal work (includes both work outside and home and daily chores) 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Relationships with other people 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Enjoyment of Life 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes

QuickDASH

Open a tight or new jar No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Do heavy household chores (e.g. wash walls, floors) No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Carry a shopping bag or briefcase. No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Wash your back. No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Use a knife to cut food. No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis, etc.). No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? Not at all Slightly Moderately Quite a bit Extremely During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? Not limited at all Slightly limited Moderately limited Very limited Unable

Please rate the severity of the following symptoms in the last week.

Arm, shoulder or hand pain. None Mild Moderate Severe Extreme

Please rate the severity of the following symptoms in the last week.

Tingling (pins and needles) in your arm, shoulder or hand None Mild Moderate Severe Extreme During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? No difficulty Mild difficulty Moderate difficulty Severe difficulty So much that I cannot sleep

QuickDASH work module

I do not work

Please indicate what your job/work is: Do you have any difficulty using your usual technique for your work? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Do you have any difficulty doing your usual work because of arm, shoulder or hand pain? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Do you have any difficulty doing your work as well as you would like? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Do you have any difficulty spending your usual amount of time doing your work? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable

QuickDASH Sports/Performing Arts module

I do not play a sport or an instrument.

Please indicate the sport or instrument which is most important to you: Did you have any difficulty using your usual technique for playing your instrument or sport? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Did you have any difficulty playing your musical instrument or sport because of arm, shoulder or hand pain? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Did you have any difficulty playing your musical instrument or sport as well as you would like? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Did you have any difficulty spending your usual amount of time practising or playing your instrument or sport? No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable

SF36

In general, would you say your health is: Excellent Very good Good Fair Poor Compared to one week ago, how would you rate your health in general now? Much better now than one weekago Somewhat better now than one week ago About the same as one week ago Somewhat worse now than one week ago Much worse now than one week ago

The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports Yes, limited a lot Yes, limited a little No, not limited at all Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf Yes, limited a lot Yes, limited a little No, not limited at all Lifting or carrying groceries Yes, limited a lot Yes, limited a little No, not limited at all Climbing several flights of stairs Yes, limited a lot Yes, limited a little No, not limited at all Climbing one flight of stairs Yes, limited a lot Yes, limited a little No, not limited at all Bending, kneeling or stooping Yes, limited a lot Yes, limited a little No, not limited at all Walking more than a kilometre Yes, limited a lot Yes, limited a little No, not limited at all Walking several hundred metres Yes, limited a lot Yes, limited a little No, not limited at all Walking one hundred metres Yes, limited a lot Yes, limited a little No, not limited at all Bathing or dressing yourself Yes, limited a lot Yes, limited a little No, not limited at all

During the past week, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

During the past week, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)

Cut down on the amount of time you spent on work or other activities All of the time Most of the time Some of the time A little of the time None of the time Accomplished less than you would like All of the time Most of the time Some of the time A little of the time None of the time Did work or other activities less carefully than usual All of the time Most of the time Some of the time A little of the time None of the time During the past week, to what extent has your physical health or emotional problems interfered with yournormal social activities with family, friends, neighbours or groups? Not at all Slightly Moderately Quite a bit Extremely How much bodily pain have you had during the past week? None Very Mild Mild Moderate Severe Very Severe During the past week, how much did pain interfere with your normal work? (including both work outside the home and housework) Not at all A little bit Moderately Quite a bit Extremely

These questions are about how you feel and how things have been with you during the past week. For eachquestion, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past week...

Did you feel full of life? All of the time Most of the time Some of the time A little of the time None of the time Have you been very nervous? All of the time Most of the time Some of the time A little of the time None of the time Have you felt so down in the dumps that nothing could cheer you up? All of the time Most of the time Some of the time A little of the time None of the time Have you felt calm and peaceful? All of the time Most of the time Some of the time A little of the time None of the time Did you have a lot of energy? All of the time Most of the time Some of the time A little of the time None of the time Have you felt downhearted and depressed? All of the time Most of the time Some of the time A little of the time None of the time Did you feel worn out? All of the time Most of the time Some of the time A little of the time None of the time Have you been happy? All of the time Most of the time Some of the time A little of the time None of the time Did you feel tired? All of the time Most of the time Some of the time A little of the time None of the time During the past week, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives etc) All of the time Most of the time Some of the time A little of the time None of the time

How true or false is each of the following statements for you?

I seem to get sick a little easier than other people Definitely true Mostly true Dont know Mostly false Definitely false I am as healthy as anybody I know Definitely true Mostly true Dont know Mostly false Definitely false I expect my health to get worse Definitely true Mostly true Dont know Mostly false Definitely false My health is excellent Definitely true Mostly true Dont know Mostly false Definitely false

POSAS

Has the scar been painful the past few weeks? 1 No, not at all 2 3 4 5 6 7 8 9 10 Yes, very much Has the scar been itching the past few weeks? 1 No, not at all 2 3 4 5 6 7 8 9 10 Yes, very much Is the scar colour different from the colour of your normal skin at present? 1 No, not at all 2 3 4 5 6 7 8 9 10 Yes, very different Is the stiffness of the scar different from your normal skin at present? 1 No, not at all 2 3 4 5 6 7 8 9 10 Yes, very different Is the thickness of the scar different from your normal skin at present? 1 No, not at all 2 3 4 5 6 7 8 9 10 Yes, very different Is the scar more irregular than your normal skin at present? 1 No, not at all 2 3 4 5 6 7 8 9 10 Yes, very different What is your overall opinion of the scar compared to normal skin? 1 As normal skin 2 3 4 5 6 7 8 9 10 Very different

Fatigue

Throughout our lives, most of us have times when we feel very tired or fatigued.

Have you felt unusually tired or fatigued in the last week? Yes No Please rate your fatigue (weariness, tiredness) by selecting the one number that best describes your fatigue right NOW 0 No fatigue 1 2 3 4 5 6 7 8 9 10 As bad as you can imagine Please rate your fatigue (weariness, tiredness) by selecting the one number that best describes your USUAL level of fatigue during past 24 hours 0 No fatigue 1 2 3 4 5 6 7 8 9 10 As bad as you can imagine Please rate your fatigue (weariness, tiredness) by selecting the one number that best describes your WORST level of fatigue during past 24 hours 0 No Fatigue 1 2 3 4 5 6 7 8 9 10

Select the one number that describes how, during the past 24 hours, fatigue has interfered with your...

General Activity 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Mood 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Walking ability 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Normal work (includes both work outside the home and daily chores) 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Relations with other people 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes Enjoyment of life 0 Does not interfere 1 2 3 4 5 6 7 8 9 10 Completely interferes

SIP

Do you usually do work other than managing your home? Yes No Have you returned to work? Yes No

If you answered yes, check only those statements that you are sure describe you today...

I am doing part of my job at home I am not accomplishing as much as usual at work I often act irritable towards my work associates, for example, snap at them, give sharp answers, criticize them I am working shorter hours I am doing only light work I work only for short periods of time or take frequent rests I am working at my usual job but with some changes, for example, using different tools or special aids, trading some tasks with other workers I do not do my job as carefully and accurately as usual How many days from burn injury did it take for you to return to part time work? How many days from burn injury did it take for you to return to full time work? How many days per week did you work before your burn injury?

Last Updated: 19/09/2023

BIMS Upper Limb Burn