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| Not at all | A little | A moderate amount | Very much | An extreme amount |
| 3 | To what extend do you feel that physical pain/problem prevents you from doing what you need to do? | 5 | 4 | 3 | 2 | 1 |
| 4 | How much do you need any medical treatment to function in your daily life? | 5 | 4 | 3 | 2 | 1 |
| 5 | How much do you enjoy life? | 1 | 2 | 3 | 4 | 5 |
| 6 | To what extent do you feel your life to be meaningful? | 1 | 2 | 3 | 4 | 5 |