RAPID-3 Patient Form

Questionanaire given to patients to rate their physical function and pain.

We are interested in learning how your illness affects your ability to function in daily life. Which best describes your usual abilities OVER THE PAST WEEK:

Dress yourself, including tying shoelaces and doing buttons?

Get in and out of bed?

Lift a full cup or glass to your mouth?

Walk outdoors on flat ground?

Wash and dry your entire body?

Bend down to pick up clothing from the floor?

Turn regular faucets on and off?

Get in and out of a car, bus, train, or airplane?

Walk two miles or three kilometers, if you wish?

Participate in recreational activities and sports as you would like, if you wish?

Get a good night's sleep?

Deal with feelings of anxiety or being nervous?

Deal with feelings of depression or feeling blue?

  • 0 being no pain
  • 10 being severe pain

  • 0 being very well.
  • 10 being very poor.

Interpretation

Source: RAPID 3
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