We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb
Problem for which you are currently seeking attention. Please provide an answer for each activity.
Extreme Difficulty or Unable to Perform Activity
Quite a Bit of Difficulty
A Little Bit of Difficulty
Any of your usual work, housework, or school activities.
Your usual hobbies, re creational or sporting activities.
Getting into or out of the bath.
Walking between rooms.
YPutting on your shoes or socks.
Lifting an object, like a bag of groceries from the floor.
YPerforming light activities around your home.
Performing heavy activities around your home.
Getting into or out of a car.
YWalking 2 blocks.
Walking a mile.
Going up or down 10 stairs (about 1 flight of stairs).
Standing for 1 hour.
Sitting for 1 hour.
Running on even ground.
Running on uneven ground.
Making sharp turns while running fast.
Rolling over in bed.