Table 2.
1. What is your present health condition? (1) Excellent. (2) Very good. (3) Good. (4) Not very good. (5) Poor. |
The following are questions about your feelings during the last month (circle the item number of each question that best applies) |
The following are ordinary daily activities. Please indicate if you have difficulty doing them because of your poor health condition and, if so, how difficult you think it is to do them. Circle the item number that most applies | 7. Were you discouraged and depressed? (1) Always (2) Almost always (3) Sometimes (4) Rarely (5) Not at all |
2. Climbing the stairs to one floor above (1) I have great difficulty (2) I have some difficulty (3) I do not have any difficulty |
8. Were you exhausted? (1) Always (2) Almost always (3) Sometimes (4) Rarely (5) Not at all |
3. Bending forward, kneeling, and stooping (1) I have great difficulty (2) I have some difficulty (3) I do not have any difficulty |
9. Did you feel pleasant? (1) Always (2) Almost always (3) Sometimes (4) Rarely (5) Not at all |
4. Walking a kilometer (1) I have great difficulty (2) I have some difficulty (3) I do not have any difficulty |
Circle the item number of each of the following topics that best applies to your condition |
When you engaged in your work or daily activities (including housework) during the last month, did you have any of the problems listed below because of your physical condition? (Circle the item number in each topic that best applies.) | 10. I am in decent health (1) Completely yes (2) Almost yes (3) I am not sure (4) I hardly think so (5) I do not think so |
5. I could not do my work or daily activities as well as I expected (1) Always (2) Almost always (3) Sometimes (4) Rarely (5) I was able to do my work or daily activities as well as I expected |
11. I feel my health will get worse (1) Completely yes (2) Almost yes (3) I am not sure (4) I hardly think so (5) I do not think so |
6. How severely was your work (including housework) hindered during the last month because of the pain? (1) Not at all (2) A little (3) Slightly (4) Fairly (5) Greatly |
This study utilized the tentative version of JOACMEQ, however, the final version of JOACMEQ was established [2]