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How would you describe the pain you usually have in your knee?
 
None
 
Very Mild
 
Mild
 
Moderate
 
Severe
 
 
 
How long can you walk before the pain in your knee becomes severe (with or without a walking aid)?
 
No pain for 60 minutes or more
 
16 - 60 minutes
 
5 - 15 minutes
 
Around the house only
 
Not at all
 
 
 
After a meal, how painful is it for you to stand up from a chair because of your knee?
 
Not at all painful
 
Slightly painful
 
Moderately painful
 
Very painful
 
Unbearable
 
 
 
Have you been troubled by pain from your knee in bed at night?
 
No nights
 
Only 1 or 2 nights
 
Some nights
 
Most nights
 
Every night
 
 
 
How much has pain from your knee interfered with your usual work, including housework?
 
Not at all
 
A little bit
 
Moderately
 
Greatly
 
Totally
 
 
 
During the past 4 weeks, could you walk down one flight of stairs?
 
Yes, easily
 
With little difficulty
 
With moderate difficulty
 
With extreme difficulty
 
No, impossible
 
 
 
During the past 4 weeks, could you do the household shopping on your own?
 
Yes, easily
 
With little difficulty
 
With moderate difficulty
 
With extreme difficulty
 
No, impossible
 
 
 
During the past 4 weeks, have you felt that your knee might suddenly give way or let you down?
 
Rarely / never
 
Sometimes or just at first
 
Often, not just at first
 
Most of the time
 
All of the time
 
 
 
During the past 4 weeks, could you kneel down and get up again?
 
Yes, easily
 
With little difficulty
 
With moderate difficulty
 
With extreme difficulty
 
No, impossible
 
 
 
During the past 4 weeks, have you been limping when walking, because of your knee?
 
Rarely / never
 
Sometimes or just at first
 
Often, not just at first
 
Most of the time
 
All of the time
 
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