|
Q2000
|
|
In general, how would you rate your health today? |
|
Q2001
|
|
Overall in the last 30 days, how much difficulty did you have with work or household activities? |
|
Q2002
|
|
Overall in the last 30 days, how much difficulty did you have with moving around? |
|
Q2003
|
|
Overall in the last 30 days, how much difficulty did you have in vigorous activities |
|
Q2004
|
|
Overall in the last 30 days, how much difficulty did you have with self-care, |
|
Q2005
|
|
Overall in the last 30 days, how much difficulty did you have in taking care of and maintaining your general appearance |
|
Q2006
|
|
Overall in the last 30 days, how much difficulty did you have in staying by yourself for a few days |
|
Q2007
|
|
Overall in the last 30 days, how much of bodily aches or pains did you have? |
|
Q2008
|
|
Overall in the last 30 days how much bodily discomfort did you have? |
|
Q2009
|
|
Overall in the last 30 days how much difficulty did you have in your daily life because of your pain? |
|
Q2010
|
|
Overall in the last 30 days, how much difficulty did you have with concentrating or remembering things? |
|
Q2011
|
|
Overall in the last 30 days, how much difficulty did you have in learning a new task |
|
Q2012
|
|
Overall in the last 30 days, how much difficulty did you have with personal relationships or participation in the community? |
|
Q2013
|
|
Overall in the last 30 days, how much difficulty did you have with conflicts and tensions with others? |
|
Q2014
|
|
Overall in the last 30 days, how much difficulty did you have with making new friendships or maintaining current friendships? |
|
Q2015
|
|
Overall in the last 30 days, how much difficulty did you have with dealing with strangers? |
|
Q2016
|
|
Overall in the last 30 days, how much difficulty did you have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning? |
|
Q2017
|
|
Overall in the last 30 days, how much difficulty did you have due to not feeling rested and refreshed during the day |
|
Q2018
|
|
Overall in the last 30 days, how much of a problem did you have with feeling sad, low or depressed? |
|
Q2019
|
|
Overall in the last 30 days how much of a problem did you have with worry or anxiety? |
|
Q2020
|
|
When was the last time you had your eyes examined by a medical professional? |
|
Q2021
|
|
Do you use eyeglasses or contact lenses to see far away (for example, across the street)? |
|
Q2022
|
|
Do you use eyeglasses or contact lenses to see up close (for example at arms length, like when you are reading)? |
|
Q2023
|
|
In the last 30 days, how much difficulty did you have in seeing and recognizing an object or a person you know across the road (from a distance of about 20 meters)? |
|
Q2024
|
|
In the last 30 days, how much difficulty did you have in seeing and recognizing an object at arm's length (for example, reading)? |
|
Q2025
|
|
In the last 30 days, how much difficulty did you have in sitting for long periods? |
|
Q2026
|
|
In the last 30 days, how much difficulty did you have in walking 100 meters? |
|
Q2027
|
|
In the last 30 days, how much difficulty did you have in standing up from sitting down |
|
Q2028
|
|
In the last 30 days, how much difficulty did you have in standing for long periods |
|
Q2029
|
|
In the last 30 days, how much difficulty did you have with climbing one flight of stairs without resting? |
|
Q2030
|
|
In the last 30 days, how much difficulty did you have with stooping, kneeling or crouching? |
|
Q2031
|
|
In the last 30 days, how much difficulty did you have picking up things with your fingers |
|
Q2032
|
|
In the last 30 days, how much difficulty did you have in taking care of your household responsibilities? |
|
Q2033
|
|
In the last 30 days, how much difficulty did you have in joining in community activities |
|
Q2034
|
|
In the last 30 days, how much difficulty did you have in extending your arms above shoulder level? |
|
Q2035
|
|
In the last 30 days, how much difficulty did you have concentrating on doing something for 10 minutes? |
|
Q2036
|
|
In the last 30 days how much difficulty did you have |
|
Q2037
|
|
In the last 30 days, how much difficulty did you have in bathing/washing your whole body? |
|
Q2038
|
|
In the last 30 days, how much difficulty did you have in bathing/washing your whole body? |
|
Q2039
|
|
In the last 30 days, how much difficulty did you have in your day to day work? |
|
Q2040
|
|
In the last 30 days, how much difficulty did you have with carrying things? |
|
Q2041
|
|
In the last 30 days, how much difficulty did you have with moving around inside your home |
|
Q2042
|
|
In the last 30 days, how much difficulty did you have with eating |
|
Q2043
|
|
In the last 30 days, how much difficulty did you have with getting up from lying down? |
|
Q2044
|
|
In the last 30 days, how much difficulty did you have with getting to and using the toilet? |
|
Q2045
|
|
In the last 30 days, how much difficulty did you have with getting where you want to go, using private or public transport if needed? |
|
Q2046
|
|
In the last 30 days, how much difficulty did you have getting out of your home? |
|
Q2047
|
|
In the last 30 days, how much have you been emotionally affected by your health condition(s)? |
|
Q2048
|
|
Overall, how much did these difficulties interfere with your life? |
|
Q2049
|
|
Besides any vision aids (eyeglasses or contact lenses) or hearing aids mentioned above, do you use any other assistive devices (cane, walker or other) for any difficulties you experience? |
