Instructions: Please answer the following questions.
Score 0-2 per item
0 = no difficulty
1 = some difficulty
2 = a lot/unable
1.Strength: How much difficulty do you have lifting and carrying 4.5 kg? 012
2.Assistance with walking across a room: 012
3.Rise from a chair: How much difficulty do you have transferring from a chair or bed? 012
4.Climb a flight of 10 stairs: 012
5.Falls: How many times have you fallen in the past year? 0 (none)1 (1–3 falls)2 (≥4 falls)
