The next test measures the strength in your legs. I want you to try to stand up from a firm straight backed chair, like a dining chair. First, fold your arms across your chest and First explain and then demonstrate the sit so that your feet are on the floor; then procedure. stand up keeping your arms across your chest. Q471 Do you feel it would be safe to do this? 0. No 1. Yes IF YES CONTINUE, IF NO SKIP TO Q478 Q472 Record outcome of single chair rise. If respondent cannot rise without using arms, SAY Okay, try to stand up using “ 1. R stood without using arms your arms” 2. R used arms to stand 3. Test not completed. IF RATED 1 SKIP TO Q474 IF RATED 2 OR 3 RATE Q473 Q473 If test not completed record the reason why a. Tried but unable b. R could not hold position unassisted. c. Not attempted, interviewer felt unsafe d. Not attempted, respondent felt unsafe e. R unable to understand instructions f. Other reason g. R refused SKIP TO Q478 Now I would like you to repeat the When respondent is seated with feet resting procedure but this time I want you to stand on the and arms folded across the chest up straight as quickly as you can five times, say ready?, begin. without stopping in between and without using your arms to push off. Start the stopwatch as soon as you say Begin. Count out loudly as they rise each
The next test measures the strength in your legs. I want you to try to stand up from a firm straight backed chair, like a dining chair. First, fold your arms across your chest and sit so that your feet are on the floor; then stand up keeping your arms across your chest. Q471 Do you feel it would be safe to do this? 0. No 1. Yes First explain and then demonstrate the procedure. IF YES CONTINUE, IF NO SKIP TO Q478 Q472 Record outcome of single chair rise. 1. R stood without using arms 2. R used arms to stand 3. Test not completed. IF RATED 1 SKIP TO Q474 IF RATED 2 OR 3 RATE Q473 If respondent cannot rise without using arms, SAY “ Okay, try to stand up using your arms” Q473 If test not completed record the reason why a. Tried but unable b. R could not hold position unassisted. c. Not attempted, interviewer felt unsafe d. Not attempted, respondent felt unsafe e. R unable to understand instructions f. Other reason g. R refused SKIP TO Q478 Now I would like you to repeat the procedure but this time I want you to stand up straight as quickly as you can five times, without stopping in between and without using your arms to push off. When respondent is seated with feet resting on the and arms folded across the chest say ready?, begin. Start the stopwatch as soon as you say Begin. Count out loudly as they rise each
CFAS-Questionnaire-part-IIv5-1110081.docx