MS 12 item walking score

• These questions ask about limitations to your walking due to MS during the past 2 weeks.




• For each statement, please circle the one number that best describes your degree of limitation.



• Please answer all questions even if some seem rather similar to others, or seem irrelevant to you.



• If you cannot walk at all, please tick this box.









In the past two weeks, how much has your MS ... Not at all

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A little

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Moderately

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Quite a bit

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Extremely

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1. Limited your ability to walk? 1 2 3 4 5

2. Limited your ability to run? 1 2 3 4 5

3. Limited your ability to climb up and down stairs? 1 2 3 4 5

4. Made standing when doing things more difficult? 1 2 3 4 5

5. Limited your balance when standing or walking? 1 2 3 4 5

6. Limited how far you are able to walk? 1 2 3 4 5

7. Increased the effort needed for you to walk? 1 2 3 4 5

8. Made it necessary for you to use support when walking indoors (e.g., holding on to furniture, using a stick, etc.)? 1 2 3 4 5

9. Made it necessary for you to use support when walking outdoors (e.g., using a stick, a frame, etc.)? 1

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2 3 4 5

10. Slowed down your walking? 1 2 3 4 5

11. Affected how smoothly you walk? 1 2 3 4 5

12. Made you concentrate on your walking? 1 2 3 4 5



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Please check that you have circled ONE number for EACH question

© 2000 Neurological Outcome Measures Unit.