Appendix 2.

Functional Health Scale

We are interested in how much difficulty people have with various activities because of a health or physical problem. Exclude any difficulties that you expect to last less than three months.
How difficult is it for you to (please check the appropriate box)...
	NOT AT ALL DIFFICULT (1)	A LITTLE DIFFICULT (2)	SOMEWHAT DIFFICULT (3)	VERY DIFFICULT/CAN'T DO (4)	DON'T DO (6)
1)... walk several blocks?
2) ... walk one block?
3) ... walk across a room?
4) ... sit for about 2 hours?
5) ... get up from a chair after sitting for long periods?
6) ... climb several flights of stairs without resting?
7) ... climb one flight of stairs without resting?
8)... lift or carry weights over 10 pounds, like a heavy bag of groceries?
9) ... stoop, kneel, or crouch?
10) ... pick up a dime from a table?
11) ...reach or extend your arms above shoulder level?
12) ...pull or push large objects like a living room chair?