PSQ - isaric4c/wiki GitHub Wiki

Variable / Field Name Section Header Field Type Field Label Choices or Calculations
symptom_version radio Symptom Assessment Version Completed 1, Unversioned ; 5, 1.0 ; 2, 1.1 ; 3, 1.2 ; 4, 2.0 ; 6, 3.0 ; 7, 4.1
patient_sq_date text Date of questionnaire completion
psq_recovered radio a) Do you feel fully recovered from COVID-19? 1, Yes ; 2, No ; 3, Not sure
psq_scale_blness_pre Rate these symptoms on a scale 0 - 10 - Before you had COVID-19 radio b) Breathlessness 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_cough_pre radio c) Cough 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_fatigue_pre radio d) Fatigue 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_sleep_pre radio e) Sleep quality 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_pain_pre radio f) Pain 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_blness_since Rate these symptoms on a scale 0 - 10 - Since you had  COVID-19 radio b) Breathlessness 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_cough_since radio c) Cough 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_fatigue_since radio d) Fatigue 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_sleep_since radio e) Sleep quality 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_pain_since radio f) Pain 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_blness_24hrs Rate these symptoms on a scale 0 - 10 - Worst in last 24hrs radio b) Breathlessness 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_cough_24hrs radio c) Cough 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_fatigue_24hrs radio d) Fatigue 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_sleep_24hrs radio e) Sleep quality 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_pain_24hrs radio f) Pain 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_traj_blness Trajectory radio b) Breathlessness 1, Same ; 2, Better ; 3, Worse
psq_traj_cough radio c) Cough 1, Same ; 2, Better ; 3, Worse
psq_traj_fatigue radio d) Fatigue 1, Same ; 2, Better ; 3, Worse
psq_traj_sleep radio e) Sleep quality 1, Same ; 2, Better ; 3, Worse
psq_traj_pain radio f) Pain 1, Same ; 2, Better ; 3, Worse
patient_sq_g text g) How many hours sleep do you get in general every 24 hours?
psq_blness Symptoms since COVID (CRF2A - 6 weeks) or Symptoms in the last seven days (PSQ) radio Breathlessness 1, Yes ; 0, No
psq_cough radio Cough 1, Yes ; 0, No
psq_fatigue radio Fatigue 1, Yes ; 0, No
psq_sleep radio Poor sleep 1, Yes ; 0, No
psq_pain radio Pain 1, Yes ; 0, No
loss_of_sense_of_smell Neurological and other radio Loss of sense of smell 1, Yes ; 0, No
loss_of_taste radio Loss of taste 1, Yes ; 0, No
confusion_fuzzy_head radio Confusion/fuzzy head 1, Yes ; 0, No
difficulty_with_communicat radio Difficulty with communication 1, Yes ; 0, No
difficulty_with_concentrat radio Difficulty with concentration 1, Yes ; 0, No
short_term_memory_loss radio Short term memory loss 1, Yes ; 0, No
physical_slowing_down radio Physical slowing down 1, Yes ; 0, No
slowing_down_in_your_think radio Slowing down in your thinking 1, Yes ; 0, No
headache radio Headache 1, Yes ; 0, No
altered_personality_behavi radio Altered personality/behaviour (not the same person) 1, Yes ; 0, No
limb_weakness radio Limb weakness 1, Yes ; 0, No
problems_with_balance radio Problems with balance 1, Yes ; 0, No
can_t_move_and_or_feel_one radio Can't move and / or feel one side of your body or face 1, Yes ; 0, No
problems_seeing radio Problems seeing 1, Yes ; 0, No
tingling_feeling_pins_and radio Tingling feeling/"pins and needles" 1, Yes ; 0, No
can_t_fully_move_or_contro radio Can't fully move or control movement 1, Yes ; 0, No
tremor_shakiness radio Tremor/shakiness 1, Yes ; 0, No
seizures radio Seizures 1, Yes ; 0, No
aching_in_your_muscles_pai Musculo-Skeletal radio Aching in your muscles (pain) 1, Yes ; 0, No
joint_pain_or_swelling radio Joint pain or swelling 1, Yes ; 0, No
leg_ankle_swelling Cardio-Respiratory radio Leg/ankle swelling 1, Yes ; 0, No
chest_pain radio Chest pain 1, Yes ; 0, No
chest_tightness radio Chest tightness 1, Yes ; 0, No
pain_on_breathing radio Pain on breathing 1, Yes ; 0, No
palpitations radio Palpitations 1, Yes ; 0, No
dizziness_or_lightheadness radio Dizziness or lightheadness 1, Yes ; 0, No
fainting_blackouts radio Fainting / blackouts 1, Yes ; 0, No
diarrhoea Gastro-intestinal / Genitourinary radio Diarrhoea 1, Yes ; 0, No
constipation radio Constipation 1, Yes ; 0, No
nausea_vomiting radio Nausea/vomiting 1, Yes ; 0, No
abdominal_pain radio Abdominal pain 1, Yes ; 0, No
loss_of_appetite radio Loss of appetite 1, Yes ; 0, No
loss_of_control_of_passing radio Loss of control of passing urine 1, Yes ; 0, No
loss_of_control_of_opening radio Loss of control of opening your bowels 1, Yes ; 0, No
weight_loss radio Weight loss 1, Yes ; 0, No
stomach_pain radio Stomach pain 1, Yes ; 0, No
psq_symp_ed radio Erectile Dysfunction 1, Yes ; 0, No ; 2, N/A
skin_rash Skin radio Skin rash 1, Yes ; 0, No
hair_loss radio Hair loss 1, Yes ; 0, No
lumpy_lesions_purple_pink radio Lumpy lesions (purple/pink/bluish) on toes 1, Yes ; 0, No
bleeding radio Bleeding 1, Yes ; 0, No
patient_sq_h_skin_rash checkbox For skin rash, please tick all body areas that apply: 1, Face ; 2, Trunk (stomach or back) ; 3, Arms ; 4, Legs ; 5, Buttocks ; 6, Toes ; 7, Fingers
patient_sq_h_bleeding_site text For bleeding, please specify bleeding site :
patient_sq_h_other yesno Any other ongoing symptoms? 1, Yes ; 0, No
patient_sq_h_other_detail notes Please specify any other ongoing symptom that has been included above:
patient_sq_i yesno i) Are you or your family concerned that you have lost significant weight (5-10%) in the past 12 months, or may now be underweight? 1, Yes ; 0, No
patient_sq_j radio j) Regarding your appetite or interest in eating (since COVID-19), please rank your appetite or interest in eating on a scale of 0-5: 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
psq_itu_admit radio k) Were you admitted to Intensive Care (ITU) during admission? 1, Yes ; 0, No
psq_itu_airway radio k1) Laryngeal/  airway complications 1, Yes ; 0, No
psq_itu_swallow radio k2) Swallowing 1, Yes ; 0, No
psq_itu_voice radio k3) Voice 1, Yes ; 0, No
psq_itu_airway_scale radio k1) Laryngeal/airway complications - Significance of impact 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
psq_itu_swallow_scale radio k2) Swallowing - Significance of impact 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
psq_itu_voice_scale radio k3) Voice - Significance of impact 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
patient_sq_l_t_seeing Difficulties due to a HEALTH PROBLEM (Today) radio Do you have difficulty seeing, even if wearing glasses? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_hearing radio Do you have difficulty hearing, even if using a hearing aid? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_walking radio Do you have difficulty walking or climbing steps? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_remembering radio Do you have difficulty remembering or concentrating? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_self_care radio Do you have difficulty (with self-care such as) washing all over or dressing? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_communicate radio Using your usual (customary) language, do you have difficulty communicating, for example understanding or being understood? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_seeing Difficulties due to a HEALTH PROBLEM (Before COVID) radio Do you have difficulty seeing, even if wearing glasses? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_hearing radio Do you have difficulty hearing, even if using a hearing aid? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_walking radio Do you have difficulty walking or climbing steps? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_remembering radio Do you have difficulty remembering or concentrating? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_self_care radio Do you have difficulty (with self-care such as) washing all over or dressing? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_communicate radio Using your usual (customary) language, do you have difficulty communicating, for example understanding or being understood? 0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_m text How many units of alcohol, on average, do you consume per week?
patient_sq_n radio n) Do you or have you ever smoked cigarettes? 0, Never ; 1, Ex-smoker ; 2, Current smoker
patient_sq_o yesno o) Do you currently use an e-cigarette or vape? 1, Yes ; 0, No
patient_sq_p_smoking Have you made lifestyle changes since your COVID-19 infection? radio Smoking 1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
patient_sq_p_drinking radio Drinking alcohol 1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
patient_sq_p_eating radio Eating healthy food 1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
patient_sq_p_activity radio Physical activity (include walking, cycling, & other activities) 1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
psq_work_pre_covid radio q) Before you got COVID-19, what was your occupation/working status (paid or unpaid work) 1, Working Full-time ; 2, Working Part-time ; 3, Full time carer (children or other) ; 4, Unemployed ; 5, Unable to work due to chronic illness ; 6, Student ; 7, Retired ; 8, Medically retired ; 9, Prefer not to say
patient_sq_q radio q) Compared to before your COVID-19 illness is your main occupation/working status: 1, Same as before ; 2, Different from before ; 3, Prefer not to say
patient_sq_q_today radio q) If different from before, please describe your occupation/working status today: 1, Working full-time ; 2, Working part-time ; 3, Full time carer (children or other) ; 4, Unemployed ; 5, Unable to work due to chronic illness ; 6, Student ; 7, Retired ; 8, Medically retired ; 9, Prefer not to say
patient_sq_q_change radio q) If different from before, why did your occupation/working status change? 1, Poor health ; 2, New caring responsibility ; 3, Working hours reduced by employer ; 4, Made redundant ; 5, Sick leave ; 6, Other ; 7, Prefer not to say
patient_sq_q_reason text q) Occupation/working status change - Other:
psq_employ_pre_lockdown checkbox q) What was your employment status? (Before COVID-19 lockdown) 1, FT employment ; 2, PT employment ; 3, Off sick ; 4, Caring for children ; 5, Caring for an adult ; 6, FT education ; 7, PT education ; 8, Unemployed ; 9, Retired
psq_employ_pre_ill checkbox q) What was your employment status? (Before you became ill) 1, FT employment ; 2, PT employment ; 3, Off sick ; 4, Caring for children ; 5, Caring for an adult ; 6, FT education ; 7, PT education ; 8, Unemployed ; 9, Retired ; 10, Furloughed ; 11, Laid off due to outbreak
psq_employ_since_home checkbox q) What was your employment status? (Since coming home) 1, FT employment ; 2, PT employment ; 3, Off sick ; 4, Caring for children ; 5, Caring for an adult ; 6, FT education ; 7, PT education ; 8, Unemployed ; 9, Retired ; 10, Furloughed ; 11, Laid off due to outbreak
psq_shift_work radio q) Prior to COVID did your work involve shift work? 0, Never ; 1, Rarely ; 2, Sometimes ; 3, Usually ; 4, Always ; 5, Don't know
psq_shift_night radio q) Prior to COVID did your work involve night shifts? 0, Never ; 1, Rarely ; 2, Sometimes ; 3, Usually ; 4, Always ; 5, Don't know
psq_feel_lonely radio Do you feel lonely? 1, Very lonely ; 2, Lonely at times ; 3, Never lonely
psq_bereavement yesno q) Have you experienced a close bereavement due to COVID-19? 1, Yes ; 0, No
psq_bereave_relation text q) Relationship in the bereavement
psq_furlough_yn yesno Have you ever been furloughed? 1, Yes ; 0, No
psq_furlough_when checkbox When were you furloughed? (Select all that apply) 1, Before you were admitted to hospital with COVID-19 ; 2, Since you were discharged from hospital after COVID-19
psq_furlough_months text For how long have you been/were you furloughed in total?
psq_ability_work yesno q) Has your illness affected your ability to do your usual work? 1, Yes ; 0, No
psq_lack_companion r) Regarding loneliness and mental health, please complete the following: radio How often do you feel that you lack companionship? 0, Hardly ever ; 1, Some of the time ; 2, Often
psq_left_out radio How often do you feel left out? 0, Hardly ever ; 1, Some of the time ; 2, Often
psq_isolated radio How often do you feel isolated from others? 0, Hardly ever ; 1, Some of the time ; 2, Often
psq_lonely radio How often do you feel lonely? 0, Hardly ever ; 1, Some of the time ; 2, Often
psq_satisfied_life radio s) Overall, how satisfied are you with your life nowadays, where 0 means 'not at all' and 10 means 'completely'? 0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_not_mentioned yesno s) Are you experiencing any new problems that we haven't mentioned? 1, Yes ; 0, No
psq_new_problems notes s) Please specify new problem(s) that we have not mentioned
psq_help_info notes s) What information would have been helpful to receive at discharge?
psq_feverish radio t1) Have you felt feverish recently? 1, Yes ; 0, No ; 2, Not sure
psq_feverish_time radio t2) Roughly when did you last feel feverish? 1, Within the last 7 days ; 2, Between 1 to 2 weeks ago ; 3, Between 2 to 4 weeks ago ; 4, Between 1 to 2 months ago ; 5, Between 2 to 3 months ago
psq_feverish_reason radio t3) What was the cause of your most recent feverish illness? 1, COVID-19 ; 2, Other respiratory infection (cough/cold/sore throat) ; 3, Somach infection (diarrhoea/vomiting) ; 4, Urinary infection ; 5, TB ; 6, Other ; 7, Unknown ; 8, Prefer not to say
psq_feverish_reason_other notes t4) Please specify the cause of your most recent feverish illness
psq_tinnitus_since u) Regarding hearing and balance disturbance: radio u) Since your COVID-19 illness - Have you had noises (such as ringing or buzzing) in your head or in one or both ears that lasts for more than 5 minutes at a time? 5, Yes, most or all of the time ; 4, Yes, a lot of the time ; 3, Yes, some of the time ; 2, No, not in the past year ; 1, No, never ; 0, Do not know/Prefer not to answer
psq_tinnitus_before radio u) Before your COVID-19 illness - Have you had noises (such as ringing or buzzing) in your head or in one or both ears that lasts for more than 5 minutes at a time? 5, Yes, most or all of the time ; 4, Yes, a lot of the time ; 3, Yes, some of the time ; 2, No, not in the past year ; 1, No, never ; 0, Do not know/Prefer not to answer
psq_balance_q1_since u) Since your COVID-19 illness radio a) Attacks of dizziness in which things seem to spin around you? 0, No ; 1, Yes
psq_balance_q2_since radio b) Attacks of dizziness in which you seem to move? 0, No ; 1, Yes
psq_balance_q1_before u) Before your COVID-19 illness radio a) Attacks of dizziness in which things seem to spin around you? 0, No ; 1, Yes
psq_balance_q2_before radio b) Attacks of dizziness in which you seem to move? 0, No ; 1, Yes
psq_vac_first_yn v) Vaccination radio Have you received a SARS-CoV-2 (Coronavirus) vaccine first dose? 1, Yes ; 0, No ; 2, Not known
psq_vac_first_date_yn radio Is date of SARS-CoV-2 (Coronavirus) vaccine first dose known? 1, Yes ; 0, No ; 2, Not known
psq_vac_first_date text Date of SARS-CoV-2 (Coronavirus) vaccine first dose
psq_vac_first_type_yn yesno Do you know which SARS-CoV-2 (Coronavirus) vaccine first dose you received? 1, Yes ; 0, No
psq_vac_first_type radio SARS-CoV-2 (Coronavirus) vaccine first dose received 1, Oxford/AstraZeneca ; 2, Pfizer/Bio-N-Tec ; 3, Moderna ; 4, Other
psq_vac_first_type_other text SARS-CoV-2 (Coronavirus) vaccine first dose received - Other
psq_vac_sec_yn radio Have you received a SARS-CoV-2 (Coronavirus) vaccine second dose? 1, Yes ; 0, No ; 2, Not known
psq_vac_sec_date_yn radio Is date of SARS-CoV-2 (Coronavirus) vaccine second dose known? 1, Yes ; 0, No ; 2, Not known
psq_vac_sec_date text Date of SARS-CoV-2 (Coronavirus) vaccine second dose
psq_vac_sec_type_yn yesno Do you know which SARS-CoV-2 (Coronavirus) vaccine second dose you received? 1, Yes ; 0, No
psq_vac_sec_type radio SARS-CoV-2 (Coronavirus) vaccine second dose received 1, Oxford/AstraZeneca ; 2, Pfizer/Bio-N-Tec ; 3, Moderna ; 4, Other
psq_vac_sec_type_other text SARS-CoV-2 (Coronavirus) vaccine second dose received - Other