Respondent number
Gender
Date of birth
Date of completion of the questionnaire
difficulty in walking up the stairs
bother: difficulty in walking up the stairs
difficulty in bending over/kneeling/stooping
bother: difficulty in bendinng etc
difficulty in walking 500 yards
bother: difficulty in walking 500 yards
difficulty lifting
bother: difficulty lifting
difficulty cutting paper with scissors
bother:difficulty cutting paper with scissors
difficulty fastening the buttons of a blouse/shirt
bother: difficulty fastening the buttons
difficulty opening a can
bother: difficulty opening a can
difficulty twistening the lid off a jar
bother: difficulty twisting the lid off a jar
difficulty concentrating what other said
bother: difficulty concentrating on what others said
difficulty remenmbering things
bother: difficulty remembering things
difficulty thinking in a concentrated way
bother: difficulty thinking in a concentrated way
your mind wandered
bother: your mind wandered
difficulty getting to sleep
bother: difficulty getting to sleep
you slept restlessly
bother: you slept restlessly
you lay awake a lot at night
bother: you lay awake a lot at night
you had a good night's sleep
bother: you had a good night's sleep
back-ache
bother: back-ache
pain/tension in neck or shoulders
bother: pain/tension in neck or shoulders
pain in joints/limbs
bother: pain in joints/limbs
pain in muscles
bother: pain in muscles
talk to others in confidence
bother: not talk with others in confidence
have a nice time with other people
bother: not have a nice time with other people
visit friends
bother: not visit friends
have a good talk with others
bother: not have a good talk with others
had difficulty with work, study or other day-to-day activities
bother: difficulty work, study or other day-to-day activities
done less work, studying or other day-to-day activities
bother: done less work, studying or other day-to-day activities
had problems doing certain types of work, study or other day-to-day activities
bother: had problems doing certain types of work, study or other day to day activities
done work, study or other day-to-day activities less conscientiously
bother: done work, study or other day-to-day activities less conscientiously
had less sex than previously
bother: less sex than previously
found sex less satisfying
bother: sex less satisfying
energetic
tired
fit
exhausted quickly
joyful
sad
in good spirits
angry
worried
gloomy
aggressive
happy
short-tempered
cheerful