Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
Forms
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Patients Name
*
First
Last
Date of Birth
*
MM slash DD slash YYYY
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Physician Name
*
Date
*
MM slash DD slash YYYY
1. How would you describe the overall level of fatigue/tiredness you have experienced?
0
none
1
2
3
4
5
6
7
8
9
10
Very severe
Score
Please enter a number from
0
to
10
.
2. How would you describe the overall level of AS neck, back or hip pain you have had?
0
none
1
2
3
4
5
6
7
8
9
10
Very severe
Score
Please enter a number from
0
to
10
.
3. How would you describe the overall level of pain/swelling in joints other than neck, back or hips you have had?
0
none
1
2
3
4
5
6
7
8
9
10
Very severe
Score
Please enter a number from
0
to
10
.
4. How would you describe the overall level of discomfort you have had from any areas tender to touch or pressure?
0
none
1
2
3
4
5
6
7
8
9
10
Very severe
Score
Please enter a number from
0
to
10
.
Total of Q1 to Q4 = A
5. How would you describe the overall level of morning stiffness you have had from the time you wake up?
0
none
1
2
3
4
5
6
7
8
9
10
Very severe
Score
Please enter a number from
0
to
10
.
6. How long does your morning stiffness last from the time you wake up?
0
none
1
2
3
4
5
6
7
8
9
10
Very severe
Score
Please enter a number from
0
to
10
.
Average of Q5 + Q6 = B
Total score A + B
(A + B) รท 5 = Total BASDAI score
Last BASDAI score
Absolute change
% change
Name
This field is for validation purposes and should be left unchanged.
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