|
Daily Activities
|
|
27
|
Need for help with grooming
| |
X
| |
|
40
|
Difficulty traveling around the town or city
| | |
X
|
|
41
|
Difficulty traveling between cities
| | |
X
|
|
42
|
Difficulty traveling overseas
| | |
X
|
|
Walking
|
|
3
|
Limitations in walking or climbing stairs
|
X
| | |
|
4
|
Usual ability to walk
|
X
| | |
|
23
|
Difficulty moving toes
|
X
| | |
|
28
|
Difficulty lifting one foot off the ground
| |
X
| |
|
30
|
Difficulty getting in and out of bed
| | |
X
|
|
35
|
Difficulty standing on toes
|
X
| | |
|
38
|
Description of ability to walk
|
X
| | |
|
Handling Objects
|
|
5
|
Difficulty scratching the lower back
|
X
| | |
|
22
|
Difficulty putting on shoes, socks, or stockings
|
X
| | |
|
24
|
Difficulty cutting fingernails
|
X
| | |
|
29
|
Difficulty cutting toenails
| | |
X
|
|
34
|
Difficulty making bed
|
X
| | |
|
37
|
Difficulty putting a hand in a pocket
| |
X
| |
|
38
|
Difficulty wiping mouth with a napkin
| |
X
| |
|
40
|
Difficulty picking up clothing from the floor
|
X
| | |
|
49
|
Difficulty lifting and moving light furniture
|
X
| | |
|
Pain or Discomfort
|
|
8
|
Time free from any physical complaints
|
X
| | |
|
19
|
Feeling perfectly healthy
|
X
| | |
|
26
|
Having minor pains and aches
| | |
X
|
|
Feelings
|
|
8
|
Feeling tense or "high strung"
|
X
| | |
|
15
|
Losing temper
|
X
| | |
|
19
|
Feeling calm and peaceful
| | |
X
|
|
29
|
Worrying about the future
| | |
X
|
|
31
|
Having crying spells
| |
X
| |
|
41
|
Planning to commit suicide*
| | | |
|
44
|
Feeling totally relaxed and free of tension
|
X
| | |
|
45
|
Feeling carefree
| | |
X
|
