| Question | Response |
|---|---|
| Date Collected |
QS.QSDTC |
| Perfomed |
QS.QSSTAT Yes No |
| Reason if not performed |
QS.QSREASND |
| Mobility |
QS.QSORRES when QS.QSTESTCD="EQ5D201" I have no problems walking I have slight problems walking I have moderate problems walking I have severe problems walking I am unable to walk |
| Self-care |
QS.QSORRES when QS.QSTESTCD="EQ5D202" 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 |
QS.QSORRES when QS.QSTESTCD="EQ5D203" 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 |
QS.QSORRES when QS.QSTESTCD="EQ5D204" 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 |
QS.QSORRES when QS.QSTESTCD="EQ5D205" 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 |
| Health state Visual Analog Score |
QS.QSORRES when QS.QSTESTCD="EQ5D206" |