submit data - STAK Knee Stretcher

SHARE YOUR STAK RESULTS

If you’re currently working with a patient and using STAK we’d like to see how you’ve been getting on. Please leave some details in the fields below to help us complete important post-market product surveillance.

Patient Name / Id

Phone

Hospital Clinician's Email

Position

Employee

Performance Rating

Please fill in the fields below to help us understand more about the effectiveness of the STAK tool when working with patient .

How many weeks STAK use?

Oramorph Prescribed?

Yes No

start-date

end-date

Range of Movement (Degrees)

Flexion ROM Pre STAK

Extension ROM Pre STAK

Extension ROM Post STAK

Flexion ROM Post STAK

Patient Knee Surgery Information

Name of knee injury / surgery

Time since surgery

Manipulation under anaesthetic?

Manipulation Date

Have you used the STAK Extension Accessory Component?

Yes No

Score Data

Oxford Knee Score Start

Oxford Knee Score End

EQ-5D value pre STAK

EQ-5D score post STAK

WOMAC Score Before

WOMAC Score After

PLEASE CLICK TO CONFIRM YOU ACCEPT THE PRIVACY POLICY

SHARE YOUR STAK RESULTS

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