Item Number | ID**** | Items |
1* | PFA10 | Are you able to stand for one hour? |
2 | PFA11 | Are you able to do chores such as vacuuming or yard work? |
3 | PFA12 | Are you able to push open a heavy door? |
4 | PFA13 | Are you able to exercise for an hour? |
5 | PFA14 | Are you able to carry a heavy object (over 10 pounds)? |
6 | PFA15 | Are you able to stand up from an armless straight chair? |
7 | PFA16 | Are you able to dress yourself, including tying shoelaces and doing buttons? |
8 | PFA17 | Are you able to reach into a high cupboard? |
9 | PFA18 | Are you able to use a hammer to pound a nail? |
10 | PFA19 | Are you able to run or jog for two miles? |
11 | PFA20 | Are you able to cut your food using eating utensils? |
12 | PFA21 | Are you able to go up and down stairs at a normal pace? |
13 | PFA22 | Are you able to open previously opened jars? |
14 | PFA23 | Are you able to go for a walk of at least 15 minutes? |
15 | PFA25 | Are you able to do yard work like raking leaves, weeding, or pushing a lawn mower? |
16 | PFA28 | Are you able to open a can with a hand can opener? |
17 | PFA29 | Are you able to pull heavy objects (10 pounds) towards yourself? |
18 | PFA30 | Are you able to step up and down curbs? |
19 | PFA31 | Are you able to get up off the floor from lying on your back without help? |
20 | PFA32 | Are you able to stand with your knees straight? |
21 | PFA33 | Are you able to exercise hard for half an hour? |
22 | PFA34 | Are you able to wash your back? |
23 | PFA35 | Are you able to open and close a zipper? |
24 | PFA36 | Are you able to put on and take off a coat or jacket? |
25 | PFA37 | Are you able to stand for short periods of time? |
26 | PFA38 | Are you able to dry your back with a towel? |
27 | PFA39 | Are you able to run at a fast pace for two miles? |
28 | PFA40 | Are you able to turn a key in a lock? |
29 | PFA41 | Are you able to squat and get up? |
30 | PFA42 | Are you able to carry a laundry basket up a flight of stairs? |
31 | PFA43 | Are you able to write with a pen or pencil? |
32 | PFA44 | Are you able to put on a shirt or blouse? |
33 | PFA45 | Are you able to get out of bed into a chair? |
34 | PFA47 | Are you able to pull on trousers? |
35 | PFA48 | Are you able to peel fruit? |
36 | PFA49 | Are you able to bend or twist your back? |
37 | PFA50 | Are you able to brush your teeth? |
38 | PFA51 | Are you able to sit on the edge of a bed? |
39 | PFA52 | Are you able to tie your shoelaces? |
40 | PFA53 | Are you able to run errands and shop? |
41 | PFA54 | Are you able to button your shirt? |
42 | PFA55 | Are you able to wash and dry your body? |