| Question | Response |
|---|---|
| Date Collected |
QS.QSDTC |
| Perfomed |
QS.QSSTAT Yes No |
| Reason if not performed |
QS.QSREASND |
| Mobility |
QS.QSORRES when QS.QSTESTCD="EQ5D101" I have no problems in walking about I have some problems in walking about I am confined to bed |
| Self-care |
QS.QSORRES when QS.QSTESTCD="EQ5D102" I have no problems with self-care I have some problems washing or dressing myself I am unable to wash or dress myself |
| Usual activities |
QS.QSORRES when QS.QSTESTCD="EQ5D103" I have no problems with performing my usual activities I have some problems with performing my usual activities I am unable to perform my usual activities |
| Pain/Discomfort |
QS.QSORRES when QS.QSTESTCD="EQ5D104" I have no pain or discomfort I have moderate pain or discomfort I have extreme pain or discomfort |
| Anxiety/Depression |
QS.QSORRES when QS.QSTESTCD="EQ5D105" I am not anxious or depressed I am moderately anxious or depressed I am extremely anxious or depressed |
| Health state Visual Analog Score |
QS.QSORRES when QS.QSTESTCD="EQ5D106" |