| eq5d_done |
|
yesno |
Completed |
1, Yes ; 0, No |
| eq5d_date |
|
text |
Date |
|
| eq5d_timepoints |
|
radio |
Is this questionnaire evaluating health state for pre-COVID, current visit or both? |
1, Pre-COVID ; 2, Current visit ; 3, Both |
| eq5d5l_q1_pre |
|
radio |
Mobility - Pre-COVID |
1, I have no problems in walking about ; 2, I have slight problems in walking about ; 3, I have moderate problems in walking about ; 4, I have severe problems in walking about ; 5, I am unable to walk about |
| eq5d5l_q2_pre |
|
radio |
Self-Care - Pre-COVID |
1, I have no problems washing or dressing myself ; 2, I have slight problems washing or dressing myself ; 3, I have moderate problems washing or dressing myself ; 4, I have severe problems washing or dressing myself ; 5, I am unable to wash or dress myself |
| eq5d5l_q3_pre |
|
radio |
Usual activities (e.g. work, study, housework, family or leisure activities) - Pre-COVID |
1, I have no problems doing my usual activities ; 2, I have slight problems with doing my usual activities ; 3, I have moderate problems doing my usual activities ; 4, I have severe problems doing my usual activities ; 5, I am unable to do my usual activities |
| eq5d5l_q4_pre |
|
radio |
Pain/ Discomfort - Pre-COVID |
1, I have no pain or discomfort ; 2, I have slight pain or discomfort ; 3, I have moderate pain or discomfort ; 4, I have severe pain or discomfort ; 5, I have extreme pain or discomfort |
| eq5d5l_q5_pre |
|
radio |
Anxiety/ Depression - Pre-COVID |
1, I am not anxious or depressed ; 2, I am slightly anxious or depressed ; 3, I am moderately anxious or depressed ; 4, I am severely anxious or depressed ; 5, I am extremely anxious or depressed |
| eq5d5l_summary_pre |
|
text |
How good or bad is your health overall? - Pre-COVID |
Where 100 is the best health you can imagine and 0 is the worst health you can imagine. |
| eq5d5l_q1 |
|
radio |
Mobility - Current |
1, I have no problems in walking about ; 2, I have slight problems in walking about ; 3, I have moderate problems in walking about ; 4, I have severe problems in walking about ; 5, I am unable to walk about |
| eq5d5l_q2 |
|
radio |
Self-Care - Current |
1, I have no problems washing or dressing myself ; 2, I have slight problems washing or dressing myself ; 3, I have moderate problems washing or dressing myself ; 4, I have severe problems washing or dressing myself ; 5, I am unable to wash or dress myself |
| eq5d5l_q3 |
|
radio |
Usual activities (e.g. work, study, housework, family or leisure activities) - Current |
1, I have no problems doing my usual activities ; 2, I have slight problems with doing my usual activities ; 3, I have moderate problems doing my usual activities ; 4, I have severe problems doing my usual activities ; 5, I am unable to do my usual activities |
| eq5d5l_q4 |
|
radio |
Pain/ Discomfort - Current |
1, I have no pain or discomfort ; 2, I have slight pain or discomfort ; 3, I have moderate pain or discomfort ; 4, I have severe pain or discomfort ; 5, I have extreme pain or discomfort |
| eq5d5l_q5 |
|
radio |
Anxiety/ Depression - Current |
1, I am not anxious or depressed ; 2, I am slightly anxious or depressed ; 3, I am moderately anxious or depressed ; 4, I am severely anxious or depressed ; 5, I am extremely anxious or depressed |
| eq5d5l_summary |
|
text |
How good or bad is your health overall? - Current |
Where 100 is the best health you can imagine and 0 is the worst health you can imagine. |