Number | Question | Scores |
1 | While laying down, do you have Sensation of mesh Pain |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |
2 | While bending over, do you have Sensation of mesh Pain Movement limitations |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |
3 | While sitting up, do you have Sensation of mesh Pain Movement limitations |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |
4 | While performing activities of daily living (getting out of bed, bathing, getting dressed), do you have Sensation of mesh Pain Movement limitations |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |
5 | When coughing or deep breathing, do you have Sensation of mesh Pain Movement limitations |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |
6 | When walking or standing, do you have Sensation of mesh Pain Movement limitations |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |
7 | When walking up or down stairs, do you have Sensation of mesh Pain Movement limitations |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |
8 | When exercising (other than work-related), do you have Sensation of mesh Pain Movement limitations |
0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A 0 1 2 3 4 5 N/A |