Date of Completion

The Western Ontario Shoulder Instability Index (WOSI)
Clinician's name (or ref)
Patient's name (or ref)
Patient's d.o.b
The following questions concern the symptoms you have experienced due to your shoulder problem. In all cases, please enter the amount of the symptom you have experienced in the last week. (please move the slider on the horizontal line.)

During the past 4 weeks......

1. How much pain do you experience in your shoulder with overhead activities?
No pain
Extreme pain
2. How much aching or throbbing do you experience in your shoulder?
No aching/throbbing
Extreme aching/throbbing
3. How much weakness or lack of strength do you experience in your shoulder?
No weakness
Extreme weakness
4. How much fatigue or lack of stamina do you experience in your shoulder?
No fatigue
Extreme fatigue
5. How much clicking, cracking or snapping do you experience in your shoulder?
6. How much stiffness do you experience in your shoulder?
No stiffness
Extreme stiffness
7. How much discomfort do you experience in your neck muscles as a result of your shoulder?
No discomfort
Extreme discomfort
8. How much feeling of instability or looseness do you experience in your shoulder?
No instability
Extreme instability
9. How much do your compensate for your shoulder with other muscles?
Not at all
Extreme
10. How much loss of range of motion do you have in your shoulder?
No loss
Extreme loss
11. How much has your shoulder limited the amount you can participate in sports or recreational activities?
Not limited
Extremely limited
12. How much has your shoulder affected your ability to perform the specific skills required for your sport or work? (If your shoulder affects both sports and work, consider the area that is most affected.)
Not affected
Extremely affected
13. How much do you feel the need to protect your arm during activities?
Not at all
Extreme
14. How much difficulty do you experience lifting heavy objects below shoulder level
No difficulty
Extreme difficulty
15. How much fear do you have of falling on your shoulder?
No fear
Extreme fear
16. How much difficulty do you experience maintaining your desired level of fitness
No difficulty
Extreme difficulty
17. How much difficulty do you have “roughhousing” or “horsing around” with family or friends
No difficulty
Extreme difficulty
18. How much difficulty do you have sleeping because of your shoulder
No difficulty
Extreme difficulty
19. How conscious are you of your shoulder
Not conscious
Extremely conscious
20. How concerned are you about your shoulder becoming worse
No concern
Extremely concerned
21. How much frustration do you feel because of your shoulder
No frustration
Extremely frustrated

To save this data please print or

Physical symptoms Score is:
%
Sports/recreation/work Score is:
Lifestyle Score is:
Emotion Score is:
WOSI Score is:
%
Reference:

Waddell C, Newton M, Henderson I, et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52:157-168.

Fritz JM, George S.Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs. Phys Ther. 2002; 82(10): 973-983.

Lethem J, Slade PD, Troup JDG, Bendey G. Outline of a fear avoidance model of exaggerated pain perceptions, Behav Res Ther. 1983;21:401-408.

Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.

Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eck H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 36, 272.