| pre_psq_version |
|
radio |
Pre-COVID Patient Symptom Questionnaire completed |
1, 1.0 |
| pre_psq_date |
|
text |
Date of questionnaire completion |
|
| psq_scale_blness_pre2 |
Rate these symptoms on a scale 0 - 10 |
radio |
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_pre2 |
|
radio |
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_pre2 |
|
radio |
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_pre2 |
|
radio |
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_pre2 |
|
radio |
Pain |
0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10 |
| pre_psq_mrcds |
MRC Dyspnoea Scale |
yesno |
Have you completed a MRC dyspnoea scale form? |
1, Yes ; 0, No |
| pre_psq_social |
Occupation and Work |
yesno |
Have you completed an Occupation and Work (Social history) form? |
1, Yes ; 0, No |
| pre_psq_eq5d5l |
EQ-5D-5L |
yesno |
Have you completed a EQ-5D-5L form? |
1, Yes ; 0, No |
| patient_sq_l_b_seeing2 |
Difficulties due to health problem |
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_hearing2 |
|
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_walking2 |
|
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_remembering2 |
|
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_care2 |
|
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_communicate2 |
|
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 |
| psq_tinnitus_before2 |
Hearing and balance disturbance |
radio |
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_before2 |
|
radio |
a) Attacks of dizziness in which things seem to spin around you? |
1, Yes ; 0, No |
| psq_balance_q2_before2 |
|
radio |
b) Attacks of dizziness in which you seem to move? |
1, Yes ; 0, No |