OPUS LE Functional Status Measure

Please read the following questions and answer to the best of your ability. After completion of all questions, please press the submit button at the bottom of the page. Thank you

First name

Last name

Email

Phone

How easy or difficult is it for you to do the following?

Do you typically wear an orthotic or prosthetic device to perform this activity?

1. Get in/out of the tub or shower

Question 1

Yes

No

2. Dress your lower body

Question 2

Yes

No

3. Get on/off the toilet

Question 3

Yes

No

4. Get up from the floor

Question 4

Yes

No

5. Balance while standing

Question 5

Yes

No

6. Stand for 30 min

Question 6

Yes

No

7. Pick up object from the floor while standing

Question 7

Yes

No

8. Get up from a chair

Question 8

Yes

No

9. Get in/out of a car

Question 9

Yes

No

10. Walk around indoors

Question 10

Yes

No

11. Walk outside on uneven ground

Question 11

Yes

No

12. Walk in bad weather (e.g., snow, rain)

Question 12

Yes

No

13. Walk up to two hours

Question 13

Yes

No

14, Walk up a steep ramp

Question 14

Yes

No

15. Get on/off an escalator

Question 15

Yes

No

16. Climb one flight of stairs with a rail

Question 16

Yes

No

17. Climb one flight of stairs without a rail

Question 17

Yes

No

18. Run one block

Question 18

Yes

No

19. Carry plate of food while walking

Question 19

Yes

No

20. Put on and take off orthosis or prothesis

Question 20

Yes

No