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None Very Mild Mild Moderate Severe

Rarely/Never Sometimes or just at first Often, not just at first Most of the time All of the time

No pain > 60 minutes 16 to 60 minutes 5 to 15 minutes Around the house only Not at all - severe on walking

1-3 months 3-6 months 6-12 months 1-2 years 2+ years

Standing Sitting Kneeling Laying Walking Bending Climbing Stairs Other

Yes No

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