People with this level of functional restriction would have gross lower limb joint deformity and restriction of joint movement. They may be on the waiting list for hip, knee or ankle replacement surgery, or for surgery to correct foot and/or toe deformities. Pain and/or stiffness would be present for up to two hours after rising, and may affect the person during the night.

A person with severe restriction would have joint destruction with marked deformities and weakness of ligaments, tendons and muscles. This would lead to an increased risk of falls and reduced mobility.

Mobility may be impaired, with active inflammation (flare-ups) of lower limb joints. When the feet are affected, there may be severe pain on walking. If the knees and hips are involved, standing and sitting can be difficult and painful, and mobility will be restricted even further.

Joint instability may also occur. Instability affecting the knee joint will lead to an increased risk of falls with restriction of mobility.

A person with severe restriction would need physical assistance from another person in getting around. They would not require guidance or supervision outdoors.

Such a person would need assistance from another person with dressing and washing, getting out of bed and attending to toilet needs, and to prevent falls. Help may be needed with care needs during the day for much of the time.