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.