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. 2014 Dec 26;57(4):137–145.

Table 1.

Questions on ambulatory ability, functional status, knee pain and other joint pain

Domain Questions
Ambulatory ability Do you use a walking device? (without an assistive device, one cane or walker)
How much do you walk in a day? (1: almost no walking, 2: walking in only one room, 3: walking mainly in the house, 4: walking outside, 5: walking over 1 km)
Functional status Can you put on socks while standing?
Can you climb up and down stairs?
Can you stand up from a chair without using your arms?
Are you very worried about falling?
Do you have a regular exercise routine?
Knee pain Do you have stiffness in your knees on a regular basis?
Do you have knee pain while walking?
Do you have knee pain while climbing up or down stairs?
Do you have knee pain while standing up from a chair?
Do you restrict from joining social activities due to knee pain in your daily life?
Can you bend your knees in a sitting position? (1: excellent, 2: good, 3: average, 4: poor, 5: bad)
Other joint pain Do you have joint pain in any other joints besides the knees?