Mobility
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I have no problems in walking about
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I have some problems in walking about
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I am confined to bed
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Self-care
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I have no problems with self-care
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I have some problems washing or dressing myself
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I am unable to wash or dress myself
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Usual activities (e.g. work, study, housework, family or leisure activities)
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I have no problems with performing my usual activities
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I have some problems with performing my usual activities
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I am unable to perform my usual activities
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Pain/discomfort
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I have no pain or discomfort
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I have moderate pain or discomfort
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I have extreme pain or discomfort
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Anxiety/depression
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I am not anxious or depressed
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I am moderately anxious or depressed
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I am extremely anxious or depressed |
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