Table 6 Preliminary 45-item questionnaire
Please check the daily activities that you find difficult to do during last week. Please list the three activities that are most important to you. | |
|---|---|
Household | Outdoor |
Getting in/out of bed | Taking the first step |
Turning around in bed | Walking outside |
Sitting on the floor | Turning |
Getting up from the floor | Stopping walking |
Dressing | Walking up/down stairs |
Sex life | Crossing the street |
Running | |
Sitting on and rising from a chair | Getting in/out of a car |
Sitting upright | Getting on/off of a bus or subway |
Standing | Driving a car |
Walking inside | |
Grasping and releasing an object | If you (or the patient) cannot walk |
Moving an object | Moving from the bed or a chair to a wheelchair |
Writing | Using a wheelchair |
Wearing shoes | |
Social | |
Brushing teeth | Talking |
Getting in/out of the bath | Using the phone |
Taking a bath/shower | Shopping |
Using the toilet | Going out |
Walking around the neighborhood | |
Preparing a meal | Working |
Using a spoon and chopsticks | Taking exercise |
Swallowing | Doing hobbies |
Washing the dishes | Traveling |
Cleaning the house | |
Washing the clothes | Activities most important for you. |
1. | |
If you find any other activities difficult that are not in this list, please list them below. | 2. |
3. | |