Please consider the duration of the (last 2 weeks) while answering this questionnaire | ||||
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Questions | 0 Never | 1 Few times | 2 Sometimes | 3 Most of the time |
1. How often have you felt afraid of falling and breaking a bone? | ||||
2. How often did you have to rely on others for assistance in performing daily activities? | ||||
3. How often do you have any backache or pain? | ||||
4. How often did your back pain disturb your sleep or you have difficulty to lie on your back? | ||||
5. How difficult has it been for you to reach things above the level of your head? | ||||
6. How often do you have trouble getting in or out of a chair without arms? | ||||
7. How often did you have trouble walking a 50-m distance or climbing one flight of stairs? | ||||
8. How often do you feel unable to deal with feelings of low self-esteem or feeling anxious? | ||||
9. How often do you feel problem with your memory or have difficulty in remembering than most? | ||||
10. How often did feel unable to cope with social/family activities? |