| P1 |
Does looking up increase your problem? |
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| E2 |
Because of your problem, do you feel frustrated? |
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| F3 |
Because of your problem, do you restrict your travel for business or pleasure? |
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| P4 |
Does walking down the aisle of a supermarket increase your problem? |
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| F5 |
Because of your problem, do you have difficulty getting into or out of bed? |
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| F6 |
Does your problem significantly restrict your participation in social
activities, such as going out to dinner, going to movies, dancing or to
parties? |
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| F7 |
Because of your problem, do you have dlfficulty reading? |
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| F8 |
Does performing more ambitious activities like sports,dancing, and
household chores, such as sweeping or putting dishes away; increase
your problem? |
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E9 |
Because of your problem, are you afraid to leave your home without
having someone accompany you? |
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| E10 |
Because of your problem, have you been embarrassed in front of
others? |
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| P11 |
Do quick movements of your head increase your poblem? |
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| F12 |
Because of your problem, do you avoid heights? |
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| P13 |
Does turning over in bed increase your problem? |
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| F14 |
Because of your problem, is lt difficut for you to do strenuous
housework or yard work? |
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| E15 |
Because of your problem, are you afraid people may think that you
are intoxicated? |
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| F16 |
Because of your problem, is it difficut for you to go for a walk by
yourself? |
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| P17 |
Does walking down a sidewalk increase your problem? |
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| E18 |
Because of your problem, is it dfficut for you to concentrate? |
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| F19 |
Because of your problem, is it difficult for you to walk around your
house in the dark? |
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| E20 |
Because of your problem, are you afraid to stay home alone? |
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| E21 |
Because of your problem, do you feel handicapped? |
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| E22 |
Has your problem placed stress on your relatlonship with members of
your family or friends? |
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| E23 |
Because of your problem, are you depressed? |
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| F24 |
Does your problem interfere with your job or household
responsibilities? |
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| P25 |
Does bending over increase your problem? |
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