| LP134320-3 | I am able to do my hobbies or leisure activities in the past 7 days | COMPONENT | 1 |
| LP134321-1 | I am able to do all of the community activities that I want to do in the past 7 days | COMPONENT | 1 |
| LP134322-9 | I am able to do all of the leisure activities that people expect me to do in the past 7 days | COMPONENT | 1 |
| LP134323-7 | I have to do my hobbies or leisure activities for shorter periods of time than usual for me in the past 7 days | COMPONENT | 1 |
| LP134324-5 | I have to limit social activities outside my home in the past 7 days | COMPONENT | 1 |
| LP134325-2 | I have trouble keeping in touch with others in the past 7 days | COMPONENT | 1 |
| LP134326-0 | I can do all the leisure activities that I want to do in the past 7 days | COMPONENT | 1 |
| LP134327-8 | I am able to do all of the community activities that people expect me to do in the past 7 days | COMPONENT | 1 |
| LP134328-6 | I am able to go out for entertainment as much as I want in the past 7 days | COMPONENT | 1 |
| LP134329-4 | I have to limit the things I do for fun outside my home in the past 7 days | COMPONENT | 1 |
| LP134330-2 | I am doing fewer social activities with groups of people than usual for me in the past 7 days | COMPONENT | 1 |
| LP134331-0 | I am able to run errands without difficulty in the past 7 days | COMPONENT | 1 |
| LP134332-8 | I am able to do all of my usual work in the past 7 days | COMPONENT | 1 |
| LP134333-6 | I am accomplishing as much as usual at work for me in the past 7 days | COMPONENT | 1 |
| LP134334-4 | My ability to do my work is as good as it can be in the past 7 days | COMPONENT | 1 |
| LP134335-1 | I can do everything for work that I want to do in the past 7 days | COMPONENT | 1 |
| LP134336-9 | I have trouble doing my regular chores or tasks in the past 7 days | COMPONENT | 1 |
| LP134337-7 | I am able to do all of the work that people expect me to do in the past 7 days | COMPONENT | 1 |
| LP134338-5 | I am limited in doing my work in the past 7 days | COMPONENT | 1 |
| LP134339-3 | I have to do my work for shorter periods of time than usual for me in the past 7 days | COMPONENT | 1 |
| LP134340-1 | I am bothered by my limitations in regular family activities in the past 7 days | COMPONENT | 1 |
| LP134341-9 | I am disappointed in my ability to socialize with my family in the past 7 days | COMPONENT | 1 |
| LP134342-7 | I am bothered by limitations in my regular activities with friends in the past 7 days | COMPONENT | 1 |
| LP134343-5 | I am disappointed in my ability to meet the needs of my friends in the past 7 days | COMPONENT | 1 |
| LP134344-3 | I am satisfied with my ability to do household chores or tasks in the past 7 days | COMPONENT | 1 |
| LP134345-0 | I feel that my family is disappointed in my ability to socialize with them in the past 7 days | COMPONENT | 1 |
| LP134346-8 | I am disappointed in my ability to meet the needs of my family in the past 7 days | COMPONENT | 1 |
| LP134347-6 | I am satisfied with my current level of activity with family members in the past 7 days | COMPONENT | 1 |
| LP134348-4 | I feel that my friends are disappointed in my ability to socialize with them in the past 7 days | COMPONENT | 1 |
| LP134349-2 | I am disappointed in my ability to do things for my friends in the past 7 days | COMPONENT | 1 |
| LP134350-0 | I am disappointed in my ability to socialize with friends in the past 7 days | COMPONENT | 1 |
| LP134351-8 | I am disappointed in my ability to keep in touch with others in the past 7 days | COMPONENT | 1 |
| LP134352-6 | I feel that others are disappointed in my ability to do community activities in the past 7 days | COMPONENT | 1 |
| LP134353-4 | I am disappointed in my ability to do leisure activities in the past 7 days | COMPONENT | 1 |
| LP134354-2 | I am bothered by limitations in doing my hobbies or leisure activities in the past 7 days | COMPONENT | 1 |
| LP134355-9 | I feel that I am disappointing other people at work in the past 7 days | COMPONENT | 1 |
| LP134356-7 | I am disappointed in my ability to perform my daily routines in the past 7 days | COMPONENT | 1 |
| LP134357-5 | I am disappointed in my ability to work in the past 7 days | COMPONENT | 1 |
| LP134358-3 | I am bothered by limitations in performing my daily routines in the past 7 days | COMPONENT | 1 |
| LP134359-1 | I am disappointed in my ability to take care of personal and household responsibilities in the past 7 days | COMPONENT | 1 |
| LP134360-9 | I am bothered by limitations in performing my work in the past 7 days | COMPONENT | 1 |
| LP134361-7 | I am satisfied with my ability to take care of personal and household responsibilities in the past 7 days | COMPONENT | 1 |
| LP134362-5 | I am satisfied with my ability to work in the past 7 days | COMPONENT | 1 |
| LP134363-3 | Lately, because of my illness, some people avoided me | COMPONENT | 1 |
| LP134364-1 | Lately, because of my illness, I felt left out of things | COMPONENT | 2 |
| LP134365-8 | Lately, because of my illness, people avoided looking at me | COMPONENT | 1 |
| LP134366-6 | Lately, I felt embarrassed about my illness | COMPONENT | 1 |
| LP134367-4 | Lately, because of my illness, some people seemed uncomfortable with me | COMPONENT | 1 |
| LP134368-2 | Lately, I felt embarrassed because of my physical limitations | COMPONENT | 1 |
| LP134369-0 | Lately, because of my illness, people were unkind to me | COMPONENT | 1 |