The instrument consists of 40 statements:
Subgroups:
(1) cognitive: 1, 5, 6, 11, 18, 21, 26, 30, 34, 35
(2) social: 2, 3, 4, 7, 8, 9, 12, 15, 16, 19, 20, 22, 25, 27, 28, 29, 33, 36, 39, 40
(3) physical: 10, 13, 14, 17, 23, 24, 31, 32, 37, 38
|
Response
|
Points
|
|
no problem
|
0
|
|
small problem
|
1
|
|
moderate problem
|
2
|
|
big problem
|
3
|
|
extreme problem
|
4
|
The total points for each group and for the entire questionnaire are then summated.
Interpretation:
• cognitive: 10 questions, maximum score 40, minimum score 0
• physical: 10 questions, maximum score 40, minimum score 0
• social: 20 questions, maximum score 80, minimum score 0
• total score: maximum 160, minimum 0
• higher scores are associated with greater functional limitations
