Item | Category | Question |
---|---|---|
TFSQ 1 | Performance | 1) Choose the column that best matches what you usually do in a day (your usual activity level) (circle one) |
Column: A B C D E | ||
TFSQ 2 | Capacity | 2) Choose the column that best matches what you can do on your best day (circle one) |
Column: A B C D E | ||
TFSQ 3 | Activity level | 3) In the past 60 days has your usual activity level changed? |
a. I am now more active than I was 60 days ago. | ||
b. I am now less active than I was 60 days ago. | ||
c. My activity level is the same as it was 60 days ago. | ||
TFSQ 4 | Pain | 4) In the past 60 days have you had pain that affects your activity level? |
a. Yes | ||
b. No | ||
TFSQ 5 | Acute care | 5) In the past 60 days have you gone to the ER/hospital or had a surgery? |
a. Yes | ||
b. No |
Note: Columns of activities for TFSQ 1 and 2 are shown in Table 1.