From: Post-stroke Quality of Life Index: A quality of life tool for stroke survivors from Sri Lanka
Questions are covering the last 7 days | Best responses | |
---|---|---|
1. My illness/s have a negative effect on my ability to walk and move around | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
2. My illness/s have a negative effect on the ability i used to have to look after myself | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
3. My illness/s have a negative effect on my ability to select foods, cook, serve or to eat that I used to have | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
4. My illness/s have a negative effect in having a sound sleep | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
5. My illness/s have a negative effect in my ability to have sexual activities that I used to have | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
6. My illness/s cause discomfort in proper toilet practices | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
7. My illness/s have a negative effect on my ability to communicate with others | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
8. My illness has restricted me performing previous roles I played in my family | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
9. The society assumes that I am not capable of performing social activities that I used to do due to my illness | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
10. My illness has restricted me performing previous recreational activities I used to have | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
11. My income-generation activities are restricted by the illness | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
12. I am worried about the restrictions on life by having to be on regular attention (medications, attending clinics, getting investigations) | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
13. I am worried about the negative effect of my illness on my/my family’s financial stability | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
14. I am generally satisfied about the way I live in spite of my illnesses | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
15. I worry about my or my family’s future as a result of my illness/s | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
16. Due to the illness I suffer from pain | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
17. My health condition is getting worse with time | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
18. The equipment of my house (bed, chairs, equipment, toilet accessories) is not user-friendly considering my health condition | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
19. The living environment of my house (floor, stairs, space) is not user-friendly considering my health condition | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
20. I am worried about the transport in accessing health care | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always | ||
21. I have no restriction or problem in getting the medical care (medical advice, drugs, investigations) | Not at all | |
Rarely | ||
Occasionally | ||
Frequently | ||
Always |