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    EQ-5D-5L v1 Annotated CRF

    Uploaded by

    Fernanda Jimenez
    Eq custionarios

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    EQ-5D-5L v1 Annotated CRF

    Uploaded by

    Fernanda Jimenez
    203 views3 pages
    Eq custionarios

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Eq custionarios

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    203 views3 pages

    EQ-5D-5L v1 Annotated CRF

    Uploaded by

    Fernanda Jimenez
    Eq custionarios

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3
    At a glance
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    The document appears to be a health questionnaire that assesses mobility, self-care, usual activities, pain/discomfort and anxiety/depression. It provides options to rate each category from having no problems to being unable to do the activity.

    The document assesses a person's health status in terms of mobility, self-care, usual activities, pain/discomfort and anxiety/depression.

    For each category, options are given to rate from having no problems to having severe problems or being unable to do the activity.

    QS=Questionnaires QSCAT=EQ-5D-5L

    Health Questionnaire

    English version for the USA

    USA (English) 2009 EuroQol Group. EQ-5D is a trade mark of the EuroQol Group
    QSEVINTX=TODAY
    Under each heading, please check the ONE box that best describes your health TODAY

    MOBILITY QSORRES when QSTESTCD=EQ5D0201


    I have no problems walking QSSTRESC/QSSTRESN=1
    I have slight problems walking QSSTRESC/QSSTRESN=2
    I have moderate problems walking QSSTRESC/QSSTRESN=3
    I have severe problems walking QSSTRESC/QSSTRESN=4
    I am unable to walk QSSTRESC/QSSTRESN=5

    SELF-CARE QSORRES when QSTESTCD=EQ5D0202


    I have no problems washing or dressing myself
    I have slight problems washing or dressing myself
    I have moderate problems washing or dressing myself
    I have severe problems washing or dressing myself
    I am unable to wash or dress myself
    USUAL ACTIVITIES (e.g. work, study, housework,
    family or leisure activities) QSORRES when QSTESTCD=EQ5D0203
    I have no problems doing my usual activities
    I have slight problems doing my usual activities
    I have moderate problems doing my usual activities
    I have severe problems doing my usual activities
    I am unable to do my usual activities
    PAIN / DISCOMFORT QSORRES when QSTESTCD=EQ5D0204
    I have no pain or discomfort
    I have slight pain or discomfort
    I have moderate pain or discomfort
    I have severe pain or discomfort
    I have extreme pain or discomfort
    ANXIETY / DEPRESSION QSORRES when QSTESTCD=EQ5D0205
    I am not anxious or depressed
    I am slightly anxious or depressed
    I am moderately anxious or depressed
    I am severely anxious or depressed
    I am extremely anxious or depressed

    2
    USA (English) 2009 EuroQol Group. EQ-5D is a trade mark of the EuroQol Group
    The best health
    you can imagine
    QSEVINTX=TODAY
    100
    We would like to know how good or bad your health is
    TODAY. 95

    This scale is numbered from 0 to 100. 90

    100 means the best health you can imagine.


    85
    0 means the worst health you can imagine.
    80
    Mark an X on the scale to indicate how your health is TODAY.
    75
    Now, please write the number you marked on the scale in the
    box below. 70

    65
    QSORRES/QSSTRESC/QSSTRESN
    when QSTESTCD=EQ5D0206 60

    55

    YOUR HEALTH TODAY = 50

    45

    40

    35

    30

    25

    20

    15

    10

    The worst health


    you can imagine

    3
    USA (English) 2009 EuroQol Group. EQ-5D is a trade mark of the EuroQol Group

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