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?