1. Mobility
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1. Pain
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I have no problems in walking about.
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How would you describe your hip pain?
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I have some problems in walking about.
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I am confined to bed.
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2. Self-care
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2. Support
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I have no problems with self-care.
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How much support do you need when walking?
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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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3. Distance Walked
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3. Usual activities
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How much are you able to walk?
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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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4. Limp
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Do you walk with a limp?
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4. Pain/Discomfort
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I have no pain or discomfort.
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5. Shoes/Socks
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I have moderate pain or discomfort.
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Are you able to put on your own shoes and socks?
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I have extreme pain or discomfort.
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5. Anxiety/Depression
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6. Stairs
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I am not anxious or depressed.
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Are you able to climb stairs?
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I am moderately anxious or depressed.
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7. Public transportation
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I am extremely anxious or depressed.
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Are you able to board a bus?
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6. Quality-of-life scale question
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8. Sitting
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To help people say how good or bad a health state is, imagine a scale on which the best state you can imagine is marked 100 and the worst state you can imagine is marked 0. We would like you to indicate on this scale how good or bad your own health is today, in your opinion. |
Are you able to sit comfortably? |