Catalogue of Social Care Data

The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, please indicate how much?

a) Vigorous activities, such as running, lifting heavy
objects, participating in strenuous sports
b) Moderate activities, such as moving a table,
pushing a vacuum cleaner, bowling or playing golf
c) Lifting or carrying groceries
d) Climbing several flights of stairs
e) Climbing one flight of stairs
f) Bending, kneeling or stooping
g) Walking more than one mile
h) Walking half a mile
i) Walking one hundred yards
j) Bathing or dressing yourself

(One tick for each row)
Yes, limited a lot
Yes, limited a little
No, not limited at all
Not Applicable

In an average week, roughly how many hours would you spend doing the following activities? (Please answer each question)_x000D_

a) Working in a paid job (whether employed or self-employed)
b) Giving personal care to someone in your home or family
c) Working in an unpaid job for others outside your home and family (e.g. as a volunteer for a charity)

The following items are about activities you might do during a typical day.

Does your health now limit you in these activities? If so, please indicate how much?
(One tick for each row)

For each response option:
Yes limited a lot
Yes limited a little
No, not limited at al

Response options:
a) Vigorous activities, such as running, lifting heavy objects, participating in strenuous
sports
b) Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or
playing golf
c) Lifting or carrying groceries
d) Climbing several flights of stairs
e) Climbing one flight of stairs
f) Bending, kneeling or stooping
g) Walking more than one mile
h) Walking half a mile
i) Walking one hundred yards
j) Bathing or dressing yourself

Do you receive any state benefits?

a) income support
b) Incapacity benefit
c) Jobseeker’s allowance
d) Disability living allowance
e) Housing benefit f) Working tax credit
g) Statutory sick pay h) Employment and support allowance
i) Universal credit
j) Personal Independence payment
k) Carer’s allowance
l) Others (please specify below

In an average week, roughly how many hours would you spend doing the following
activities? (Please answer each question)

a) Working in a paid job (whether employed or self-employed)
b) Giving personal care to someone in your home or family
c) Working in an unpaid job for others outside your home and family (e.g. as a
volunteer for a charity)

How do you manage the following activities? (If you do not do any of the activities, try to
estimate how well you would be able to do them. Circle the number that applies; please circle a
number on every line).

Scale from 0 (without difficulty) to 10 (impossible)
a) Dressing (without help)
b) Out-door walks
c) Climbing stairs
d) Sitting for a long time
e) Standing bent over a sink
f) Carrying a bag
h) Making a bed
i) Running
j) Light work
k) Heavy work
l) Lifting heavy objects
m) Participating in exercise/sports

During the past 12 months, have you had pain in your LEG(S) for a month or longer that made
it difficult or impossible to get washed or dressed or do household chores?

Yes
No

During the past 12 months, have you had pain in your ARM(S) or SHOULDER(S) for a month or
longer that made it difficult or impossible to get washed or dressed or to do household chores?

Yes
No

During the past 12 months, have you had pain in your BACK or NECK for a month or longer
that made it difficult or impossible to get washed or dressed or do household chores?

Yes
No

In an average week, roughly how many hours would you spend doing the following
activities? (Please answer each question)

a) Working in a paid job (whether employed or self-employed)
b) Giving personal care to someone in your home or family
c) Working in an unpaid job for others outside your home and family (e.g. as a
volunteer for a charity)

During the past 12 months, have you had pain in your BACK or NECK for a month or longer that made it difficult or impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your LEG(S) for a month or longer that made it difficult or
impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your ARM(S) or SHOULDER(S) for a month or longer that
made it difficult or impossible to get washed or dressed or do household chores?

No
Yes

In an average week, roughly how many hours would you spend doing the following activities? (Please answer
each question)

1 Working in a paid job
2 Doing housework in your own home or for your
family
3 Doing DIY jobs in your own home or for your family
4 Giving personal care to someone in your home or
family
5 Working in an unpaid job for others outside your
home and family (e.g. as a volunteer for a charity)
6 Playing sports
7 Doing hobbies (other than sports and DIY in the
home)
8 Watching television
9 Reading for pleasure
10 Other leisure activities

Number of hours

Have you ever received any of the following benefits? (Please tick all that apply)

1 Incapacity benefit
2 Invalidity benefit
3 Disability Living Allowance (DLA)
4 Severe Disablement Allowance
5 Personal Independence Payment (PIP)
6 Employment and Support Allowance (ESA)
7 None of the above

In an average week, roughly how many hours would you spend doing the following activities? (Please answer
each question)

1 Working in a paid job (whether employed or self-employed)
2 Giving personal care to someone in your home or family
3 Working in an unpaid job for others outside your home and family (e.g. as a volunteer for a charity)
4 Doing hobbies

Number of hours

During the past 12 months, have you had pain in your LEG(S) for a month or longer that made it difficult or
impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your ARM(S) or SHOULDER(S) for a month or longer that
made it difficult or impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your BACK or NECK for a month or longer that made it difficult or impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your LEG(S) for a month or longer that made it difficult or
impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your ARM(S) or SHOULDER(S) for a month or longer that
made it difficult or impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your BACK or NECK for a month or longer that made it difficult or impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your LEG(S) for a month or longer that made it difficult or
impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your ARM(S) or SHOULDER(S) for a month or longer that
made it difficult or impossible to get washed or dressed or do household chores?

No
Yes

During the past 12 months, have you had pain in your BACK or NECK for a month or longer that made it difficult or impossible to get washed or dressed or do household chores?

No
Yes