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D-MAPP Standard Self-Referral

Date

Welcome to your D-MAPP Standard Self-Referral

1. Have you read and understood the participant information sheet?

2. Are you over 18?

3. Have you been medically diagnosed by a registered healthcare professional (GP, physiotherapist, Consultant, nurse Specialist, occupational therapist) with any of the following conditions:

  • Hand osteoarthritis
  • Wrist osteoarthritis
  • Thumb osteoarthritis
  • Elbow pain
  • Carpal tunnel syndrome
  • Non-specific arm pain or any combination of the above
  • Ulnar nerve pain
  • Trigger finger

4. How would you rate the pain caused by your condition?

5. Is your distal upper limb pain/symptoms due to any of the following conditions:

  • Fracture
  • Referred pain from the neck/spine
  • Systemic inflammatory conditions or inflammatory arthritis, for example gout, rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, or polymyalgia rheumatica
  • Diabetic peripheral neuropathies or peripheral nerve injuries involving the upper limbs
  • Connective tissue disorders including hypermobility syndrome affecting upper limb joints
  • Chronic regional pain syndrome

6. Do you frequently take oral steroids?

7. Are you happy to provide your contact details for the research team?

8. Are you happy for the research team to contact you in relation to this study?