Items | 25 items | 10 items |
---|---|---|
1. I stay at home most of the time | Yes | Not |
2. I change position frequently for comfort. | Yes | Not |
3. I avoid heavy jobs (e.g., cleaning, lifting more than 5kg or 10lbs, gardening, etc.). | Yes | Yes |
4. I rest more often. | Yes | Not |
5. I get others to do things for me. | Yes | Not |
6. I have the pain/problem almost all the time. | Yes | Yes |
7. I have difficulty lifting and carrying (e.g., bags, shopping up to 5kg or 10lbs). | Yes | Not |
8. My appetite is now different. | Yes | Not |
9. My walking or normal recreation or sporting activity is affected. | Yes | Not |
10. I have difficulty with normal home or family duties and chores. | Yes | Yes |
11. I sleep less well. | Yes | Yes |
12. I need assistance with personal care (e.g., washing and hygiene). | Yes | Yes |
13. My regular daily activities (work, social contacts) are affected. | Yes | Yes |
14. I am more irritable and/or bad tempered. | Yes | Not |
15. I feel weaker and/or stiffer. | Yes | Not |
16. My transport independence is affected (driving, public transport). | Yes | Not |
17. I require assistance or am slower with dressing. | Yes | Yes |
18. I have difficulty moving in bed. | Yes | Not |
19. I have difficulty concentrating and/or reading. | Yes | Not |
20. My sitting is affected. | Yes | Yes |
21. I have difficulty getting in and out of chairs. | Yes | Not |
22. I only stand for short periods of time. | Yes | Yes |
23. I have difficulty squatting and/or kneeling down. | Yes | Not |
24. I have trouble reaching down (e.g., pick-up things, put on socks). | Yes | Yes |
25. I go up stairs slower or use a rail. | Yes | Not |