Items | Item summary | Number of response categories | Response range |
---|---|---|---|
 | Dimension 1 Independent Living |  |  |
1 | help with household tasks | 5 | no help, efficient ↔ can do none |
2 | mobility outside house | 6 | easy, enjoyable ↔ need help |
3 | walking | 6 | running easy ↔ bedridden |
4 | self care | 5 | very easy ↔ need help |
 | Dimension 2 Relationships |  |  |
5 | intimate relationships | 5 | very happy ↔ very unhappy |
6 | health and family role | 4 | no affect ↔ incapacity |
7 | health and community | 4 | no affect ↔ incapacity |
 | Dimension 3 Mental Health |  |  |
8 | despair | 5 | never ↔ all the time |
9 | worry | 5 | never ↔ all the time |
10 | sadness | 5 | never ↔ all the time |
11 | calm, agitation | 5 | always calm ↔ always agitated |
 | Dimension 4 Coping |  |  |
12 | energy | 5 | always energetic ↔ always tired |
13 | control of life | 5 | always ↔ never |
14 | coping with problems | 5 | completely ↔ not at all |
 | Dimension 5 Pain |  |  |
15 | frequency | 4 | rarely ↔ most of the time |
16 | discomfort | 4 | none ↔ unbearable |
17 | interference with activities | 5 | never ↔ always |
 | Dimension 6 Senses |  |  |
18 | vision | 6 | excellent ↔ blind |
19 | hearing | 6 | excellent ↔ deaf |
20 | communication | 4 | no trouble ↔ cannot communicate |