| Daily Activities | # of Items | Social Roles | # of Items |
| 1. Nutrition | 4 | 7. Responsibilities | 7 |
| 2. Fitness | 4 | 8. InterpersonalRelationships | 6 |
| 3. Personal Care | 8 | 9. Community Life | 2 |
| 4. Communication | 8 | 10. Education | 6 |
| 5. Housing | 6 | 11. Work | 1 |
| 6. Mobility | 4 | 12. Recreation | 8 |