Activity Status Questionnaire

#Activity Status Questionnaire Patient -> can you (+) yes or (-) no... (+) take care of yourself (eating, dressing, bathing or using the toilet)? (+) walk indoors such as around your house? (+) walk a block or two on level ground? (+) climb a flight of stairs or walk up a hill? (+) run a short distance? (+) sit in an upright chair for at least 30 minutes? (+) drive for at least 30 minutes? (+) bend down to reach your knees? (+) squat? (+) lift and carry light items (weighing up to 7 kg)? (+) raise your arms above your shoulders? (+) do light work around the house like dusting or washing dishes? (+) do moderate work around the house like vacuuming or sweeping floors or carrying in groceries? (+) do heavy work around the house like scrubbing floors or lifting and moving heavy furniture? (+) do yard work like raking leaves weeding or pushing a power mower? (+) participate in moderate recreational activities like golf, bowling, dancing, doubles tennis or throwing a ball? (+) participate in strenuous sports like swimming, singles tennis, football, basketball or skiing? Comments: Reference: Hltaky MA, Boineau RE et al. A brief self-administered questionnaire to determine functional capacity (The Duke Activity Status Index). Am J Cardio. 1989; 64: 651-654.

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The Activity Status Questionnaire is a tool for assessing and monitoring the functional limitations caused by medical conditions. The functions listed here are based on generic activities of daily living (ADL). This is a modified version incorporating additional questions about limb function and stamina.

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