Questionnaire Text

Questionnaire form view entire document:  text  image

6. Resident characteristics


Disability - for all residents


6.16 Do you have any permanent difficulty in walking or climbing stairs?
(If you use a prosthesis, cane or assistive device, make your evaluation while using it)

[] 1 Yes, cannot do it at all
[] 2 Yes, major trouble
[] 3 Yes, some difficulty
[] 4 No, no difficulty

Questionnaire instructions view entire document:  text  image

6.16 - Do you have difficulty walking or climbing stairs?
(If using a prosthetic limb, a cane or other walking aid, use them to determine walking ability)

Depending on the situation, record:
1 - Yes, unable to walk: A person who declares himself/herself unable to walk or climb stairs without the help of another person, because of physical disability.
2 - Yes, has difficulty walking: A person that has great difficulty walking and/or climbing stairs without the help from another person, even when using prosthesis or walking aids.
3 - Yes, some difficulty walking: A person that has some difficulty walking and/or climbing stairs without the help from another person, even when using prosthesis or walking aids.


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4 - No, can walk very well: A person that does not have any difficulty walking and/or climbing stairs, even if she/he uses prosthesis or walking aids. Include children who have not yet learned how to walk and have no motor difficulties.