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As seen on CBS Minnesota for Prostate Artery Embolization
FADI Score Questionnaire
Step
1
of
5
20%
1. Standing
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
2. Walking on even ground
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
3. Walking on even ground without shoes
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
4. Walking up hills
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
5. Walking down hills
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
6. Going up stairs
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
7. Going down stairs
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
8. Walking on uneven ground
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
9. Stepping up and down curves
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
10. Squatting
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
11. Sleeping
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
12. Coming up to your toes
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
13. Walking initially
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
14. Walking 5 minutes or less
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
15. Walking approximately 10 minutes
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
16. Walking 15 minutes or greater
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
17. Home responsibilities
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
18. Activities of daily living
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
19. Personal care
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
20. Light to moderate work (standing, walking)
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
21. Heavy work (push/pulling, climbing, carrying)
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
22. Recreational activities
(Required)
No difficulty
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
23. General level of pain
(Required)
No pain
Mild
Moderate
Severe
Unbearable
24. Pain at rest
(Required)
No pain
Mild
Moderate
Severe
Unbearable
25. Pain during you normal activity
(Required)
No pain
Mild
Moderate
Severe
Unbearable
26. Pain first thing in the morning
(Required)
No pain
Mild
Moderate
Severe
Unbearable
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