Duke Activity Index
Please answer the questions to the best of your ability. We are trying to see what your activity level is like before and after physiotherapy.
Can you:
1.
Take care of yourself that is eating, dressing, bathing, or using the toilet?
Yes
No
2.
Walk indoors, such as around the house?
Yes
No
3.
Walk a block or two on level ground?
Yes
No
4.
Climb a flight of stairs, or walk up a hill?
Yes
No
5.
Run a short distance
Yes
No
6.
Do light work around the house e.g. dusting, washing dishes
Yes
No
7.
Do moderate work around the house like vacuuming, sweeping the floors, or carrying in the groceries?
Yes
No
8.
Can you do heavy work around the house, such as scrubbing floors or lifting and moving heavy furniture?
Yes
No
9.
Can you do yard work, such as raking leaves, weeding or pushing a power mower?
Yes
No
10.
Can you have sexual relations?
Yes
No
11.
Can you participate in moderate recreational activities, such as golf, bowling, dancing, doubles tennis or throwing a baseball or football?
Yes
No
12.
Can you participate in strenuous sports, such as swimming, singles tennis, football, basketball or skiing?
Yes
No