Q1. During the past 4 weeks...How would you describe the pain you usually have from your knee?
NoneVery MildMildModerateSevere
Q2. During the past 4 weeks...Have you had any trouble with washing and drying yourself (all over) because of your knee?
Not trouble at allVery little troubleModerate troubleExtreme difficultyImpossible to do
Q3. During the past 4 weeks...Have you had any trouble getting in and out of a car or using public transport because of your knee? (whichever you would tend to use)
Q4. During the past 4 weeks...For how long have you been able to walk before pain from your knee becomes severe? (with or without a stick)
No pain/More than 30 minutes16 to 30 minutes5 to 15 minutesAround the house onlyNot at all/pain severe when walking
Q5. During the past 4 weeks...After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your knee?
Not at all painfulSlightly painfulModerately painfulVery painfulUnbearable
Q6. During the past 4 weeks...Have you been limping when walking, because of your knee?
Rarely/neverSometimes, or just at firstOften, not just at firstMost of the timeAll of the time
Q7. During the past 4 weeks...Could you kneel down and get up again afterwards?
Yes easilyWith little difficultyWith moderate difficultyWith extreme difficultyNo, impossible
Q8. During the past 4 weeks...Have you been troubled by pain from your knee in bed at night
No nightsOnly 1 or 2 nightsSome nightsMost nightsEvery night
Q9. During the past 4 weeks...How much has pain from your knee interfered with your usual work (including housework)?
Not at allA little bitModeratelyGreatlyTotally
Q10. During the past 4 weeks...Have you felt that your knee might suddenly 'give way' or let you down?
Q11. During the past 4 weeks...Could you do the household shopping on your own?
Q12. During the past 4 weeks...Could you walk down one flight of stairs?
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