Score : 1

Score : 1

Positives Negatives

No Mild Negative Results

No Dangerous Negative Results

Modified Gait Efficacy Scale

Instructions: Please answer the below questions.

1. Get dressed and undressed

0
Not Confident 1 1 3 4 5 6 7 8 9 10
Completely confident

2. Prepare a simple meal

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

3. Take a bath or a shower

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

4. Get in/out of a chair

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

5. Get in/out of bed

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

6. Answer the door or telephone

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

7. Walk around the inside of your house

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

8. Reach into cabinets or closet

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

9. Light housekeeping

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

10. Simple shopping

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

11. Using public transport

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

12. Crossing roads

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

13. Light gardening or hanging out the washing

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

14. Using front or rear steps at home

0
Not Confident 1 2 3 4 5 6 7 8 9 10
Completely confident

Bibliographic References (copyright belongs to the author/s of this instrument):

Newell, A. M., VanSwearingen, J. M., et al. (2012). "The modified Gait Efficacy Scale: establishing the psychometric properties in older adults." Phys Ther 92(2): 318-328.

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