Section 2 – Personal care (washing, dressing etc)* I can look after myself normally without causing extra pain (0) I can look after myself normally but it causes extra pain (1) It is painful to look after myself and I am slow and careful (2) I need some help but manage most of my personal care (3) I need help every day in most aspects of self-care (4) I do not get dressed, I wash with difficulty and stay in bed (5)
Section 3 – Lifting* I can lift heavy weights without extra pain (0) I can lift heavy weights but it gives extra pain (1) Pain prevents me from lifting heavy weights off the floor, but I can mange if they are conveniently placed eg. on a table (2) Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned (3) I can lift very light weights (4) I cannot lift or carry anything at all (5)
Section 5 – Sitting* I can sit in any chair as long as I like (0) I can only sit in my favourite chair as long as I like (1) Pain prevents me from sitting more than one hour (2) Pain prevents me from sitting more than 30 minutes (3) Pain prevents me from sitting more than 10 minutes (4) Pain prevents me from sitting at all (5)
Section 6 – Standing* I can stand as long as I want without extra pain (0) I can stand as long as I want but it gives me extra pain (1) Pain prevents me from standing for more than 1 hour (2) Pain prevents me from standing for more than 30 minutes (3) Pain prevents me from standing for more than 10 minutes (4) Pain prevents me from standing for more than 10 minutes (5)
Section 9 – Social Life* My social life is normal and gives me no extra pain (0) My social life is normal but increases the degree of pain (1) Pain has no significant effect on my socialite apart from limiting my more energetic interests eg. sport (2) Pain has restricted by social life and I do not go out as often (3) Pain has restricted my social life to my home (4) I have no social life because of pain (5)
Section 10 – Traveling* I can travel anywhere without pain (0) I can travel anywhere but it gives me extra pain (1) Pain is bad but I manage journeys over two hours (2) Pain restricts me to journeys of less than one hour (3) Pain restricts me to short necessary journeys under 30 minutes (4) Pain prevents me from travelling except to receive treatment (5)