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| ADL domain |
ADL items | ADL answered number | Movements |
|
| Locomotion | (1) How long can you walk without taking a rest? | (1) About 5–10 minutes | (1) Walk for approximately 5–10 min without taking rest |
| (2) About 20–40 minutes | (2) Walk for approximately 20–40 min without taking rest |
| (3) Over an hour | (3) Walk for over an hour without taking rest |
| Locomotion | (2) How long can you run without taking a rest? | (1) Impossible | (4) Cannot run without taking rest |
| (2) About 3–5 minutes | (5) Run for approximately 3–5 min without taking rest |
| (3) Over 10 minutes | (6) Run for >10 min without taking rest |
| Locomotion | (3) How wide a gutter can you jump over? | (1) Impossible | (7) Cannot jump across a ditch |
| (2) About 30 cm | (8) Jump across a ditch of approximately 30 cm |
| (3) About 50 cm | (9) Jump across a ditch of approximately 50 cm |
| Locomotion | (4) How do you go up the stairs? | (1) Need banister | (10) Ascend stairs using the banister |
| (2) Slowly (no use banister) | (11) Ascend stairs without using the banister (slowly) |
| (3) Fleetly (no use banister) | (12) Ascend stairs without using the banister (fleetly) |
| Posture change | (5) How do you stand up from a Japanese style sitting posture, that is, Seiza? | (1) Impossible | (13) Cannot stand up from a Japanese style sitting posture |
| (2) Use hands | (14) Stand up from a Japanese style sitting posture using hands |
| (3) Stand without use of hands | (15) Stand up from a Japanese style sitting posture without using hands |
| Stability | (6) How many seconds can you stand on one leg with eyes open? | (1) Impossible | (16) Cannot stand on one leg with eyes open |
| (2) About 10–20 seconds | (17) Stand on one leg with eyes open for approximately 10–20 seconds |
| (3) Over 30 seconds | (18) Stand on one leg with eyes open for >30 s |
| Stability | (7) Can you remain standing on a bus or train? | (1) Impossible | (19) Cannot stand within a bus or train |
| (2) Using the handhold | (20) Standing within a bus or train using the handhold |
| (3) Without using the handhold (except departing and stopping) | (21) Standing within a bus or train without using the handhold (except departing and stopping) |
| Stability | (8) Can you put on trousers or a skirt while standing? | (1) Sitting only | (22) Cannot put on trousers or a skirt while standing |
| (2) Use the handhold | (23) Put on trousers or a skirt while standing using a handhold |
| (3) Without use the handhold | (24) Put on trousers or a skirt while standing without using a handhold |
| Manipulation | (9) Can you do or undo the front buttons of a shirt? | (1) Both hands (slowly) | (25) Do or undo the front buttons of a shirt using both hands (slowly) |
| (2) Both hands (freely) | (26) Do or undo the front buttons of a shirt using both hands (fleetly) |
| (3) One hand | (27) Do or undo the front buttons of a shirt using one hand |
| Manipulation | (10) Can you roll up and put away the bedding? | (1) Impossible | (28) Cannot roll up and put away the bedding |
| (2) Lightweight only | (29) Roll up and put away lightweight bedding |
| (3) Heavy weight | (30) Roll up and put away heavy weight bedding |
| Locomotion | (11) What weight of baggage can you carry 10 m? | (1) Impossible | (31) Cannot carry baggage |
| (2) About 5 kg | (32) Can carry baggage of approximately 5 kg for 10 m |
| (3) About 10 kg | (33) Can carry baggage of approximately 10 kg for 10 m |
| Posture change | (12) Can you raise your upper body without using your hands when lying down and facing up? | (1) Impossible | (34) Cannot raise upper body |
| (2) About 1-2 times | (35) Raise the upper body approximately 1-2 times without using hands
when lying down and facing up |
| (3) About 3-4 times | (36) Raise the upper body approximately 3-4 times without using hands
when lying down and facing up |
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