P1. Does looking up increase your problem? | | | |
E2. Because of your problem, do you feel frustrated? | | | |
F3. Because of your problem, do you restrict your travel for business or recreation? | | | |
P4. Does walking down the aisle of a supermarket increase your problem? | | | |
F5. Because of your problem, do you have difficulty getting into or out of bed? | | | |
F6. Does your problem significantly restrict your participation in social activities such as going out to dinner, going to the movies, dancing, or to parties? | | | |
F7. Because of your problem, do you have difficulty reading? | | | |
P8. Does performing more ambitious activities like sports, dancing, household chores such as sweeping or putting away dishes increase your problem? | | | |
E9. Because of your problem, are you afraid to leave your home without having someone accompany you? | | | |
E10. Because of your problem, have you been embarrassed in front of others? | | | |
P11. Do quick movements of your head increase your problem? | | | |
F12. Because of your problem, do you avoid heights? | | | |
P13. Does turning over in bed increase your problem? | | | |
F14. Because of your problem, is it difficult for you to do strenuous housework or yard work? | | | |
E15. Because of your problem, are you afraid people might think you are intoxicated? | | | |
F16. Because of your problem, is it difficult for you to go for a walk by yourself? | | | |
P17. Does walking down a sidewalk increase your problem? | | | |
E18. Because of your problem, is it difficult for you to concentrate? | | | |
F19. Because of your problem, is it difficult for you walk around the house in the dark? | | | |
E20. Because of your problem, are you afraid to stay home alone? | | | |
E21. Because of your problem, do you feel handicapped? | | | |
E22. Has your problem placed stress on your relationships with members of your family or friends? | | | |
E23. Because of your problem, are you depressed? | | | |
F24. Does your problem interfere with your job or household responsibilities? | | | |
P25. Does bending over increase your problem? | | | |