Saturday 22 September 2018

2018 Survey Questions (for translation)

The table below is all the questions from my 2018 survey. Its here to allow me to get an easy google translate of all of them. Use the translate tool on this blog to convert this list to the language of your choice. Answer in the questionnaire: http://hspjourney.blogspot.com/2018/09/2018-survey-open.html


Question English
1) Personal Details
In this survey I ask for answers to two questions, your name and your country. I dont mind if you use your real name or a pseudonym of your choice, just enough to allow me to track people who may come back and answer any subsequent surveys. I am also collecting e-mail addresses, should you wish to be contacted about the results of this survey or participation in future surveys.

All other questions are optional, so answer if you want or dont if you dont want to. After this page there are 7 more pages:
2) Mobility,
3) HSP Symptoms,
4) Sleep,
5) Activities of Daily Living
6) Support and Tracking,
7) Wellbeing,
8) This questionnaire and my blog

By completing this survey your results will be used in the analysis to paint a picture of certain aspects of HSP. All analysis is anonymised. Your information will not be shared with any other person/company. The survey data is backed up using on-line file storage systems.
1 What is your name?
2 What is your City/Town/State/Province/County?
3 What country do you live in?
4 What is your e-mail address (for contact about these surveys)?
5 I only wanted to be e-mailed about these things:
5 The results this questionnaire
5 Future questionnaires
5 Not at all
6 Do you have HSP?
6 I have HSP - genetic test
6 I have HSP - other diagnosis
6 I am answering on behalf of someone else with HSP
6 I do not know if I have HSP
6 I do not have HSP
7 If known, what type of HSP do you have? (e.g. SPG4)
8 Were you diagnosed with any other conditions before you were diagnosed with HSP?
8 Yes
8 No
9 If yes, describe or list your other diagnoses.
10 Is there HSP in your family?
10 Other members of my family have HSP
10 Other members of my family do not have HSP
10 Some members of my family may have HSP
10 I do not know if other members of my family have HSP
11 Do you have any other long term health conditions?
11 Yes
11 No
12 If yes, please describe those conditions.
2) Mobility
These questions allow me to understand your level of mobility and to correlate your answers here with the other questions.
13 How does HSP affect your mobility at the moment? How did it affect your mobility in 2013?
13 HSP does not affect my mobility
13 I walk without aids, but there are some effects
13 I use walking sticks/poles/crutches some of the time
13 I use walking sticks/poles/crutches most of the time
13 I use walking sticks/poles/crutches all of the time
13 I use FES
13 I use orthotics/AFO
13 I use a rollator/walking frame some of the time
13 I use a rollator/walking frame most of the time
13 I use a rollator/walking frame all of the time
13 I use a wheelchair/mobility scooter some of the time
13 I use a wheelchair/mobility scooter most of the time
13 I use a wheelchair/mobility scooter all of the time
13 At the moment
13 In 2013
14 How has your mobility changed over the last 5 years?
15 How far can you walk?
15 I can walk as far as I want to
15 My spasticity means I get exhausted after a distance beyond 500m
15 I can walk up to 500m
15 I can walk up to 10m
15 I am unable to walk
16 Do you consider yourself to be disabled?
16 Yes
16 No
3) HSP Symptoms
This section explores which HSP symptoms you have. Most of the symptoms listed here are HSP symptoms, with some from 'pure' HSP and some from 'complex' HSP. Some of the symptoms listed are more general neurological symptoms.
17 Please select how you are affected by the following mobility symptoms.
17 Difficulty walking
17 Difficulty running
17 Difficulty using stairs
17 My muscles are stiff
17 My muscles are weak
17 Loss of balance
17 Regular falls
17 Get more stiff when it is cold
17 Get more stiff when it is hot
17 Do not have
17 Occasional symptom
17 Minor symptom
17 Frequent symptom
17 Regular symptom
17 Most of the time
17 All of the time
18 Please select how you are affected by the following muscular symptoms.
18 Stiffness/spasticity in arms/upper body
18 Poor co-ordination
18 Back/hip pain
18 Leg/foot pain
18 Clonus (jumping feet or other muscle spasms)
18 Epilepsy or seizures
18 Pes cavus (arched/high feet)
18 Hammer toes (toes curl under)
18 Affected by bladder problems
18 Affected by bowel problems
18 Difficulty swallowing
18 Legs swell up
18 Feet swell up
18 Do not have
18 Occasional symptom
18 Minor symptom
18 Frequent symptom
18 Regular symptom
18 Most of the time
18 All of the time
19 Please select how you are affected by the following other symptoms.
19 Fatigue
19 Stress
19 Depression
19 Numbness
19 Pins and needles
19 Ichthyosis (widespread persistent thick, dry, "fish-scale" skin)
19 Loss of vibration sensitivity in legs
19 HSP affecting learning or memory
19 HSP affecting hearing
19 HSP affecting vision
19 HSP affecting speech
19 HSP affecting sexual function
19 Fail to remember dreams
19 Changes in perceptions of smell/taste
19 Do not have
19 Occasional symptom
19 Minor symptom
19 Frequent symptom
19 Regular symptom
19 Most of the time
19 All of the time
20 Of these symptoms, describe which ones have the greatest overall effects/impacts for you.
21 Any other comments on these symptoms, or describe other symptoms you have.
4) Sleep
This page explores your sleep quality.
22 Please think about your sleep over the last four weeks and select the choice which best describes your situation.
22 Did you have difficulty falling asleep, staying asleep, or feeling poorly rested in the morning?
22 Did you fall asleep unintentionally or have to fight to stay awake during the day?
22 Did sleep difficulties or daytime sleepiness interfere with your daily activities?
22 Did work or other activities prevent you from getting enough sleep?
22 Did you snore loudly?
22 Did you hold your breath, have breathing pauses, or stop breathing in your sleep?
22 Did you have restless or "crawling" feelings in your legs at night that went away if you moved your legs?
22 Did you have repeated rhythmic leg jerks or leg twitches during your sleep?
22 Did you have nightmares, or did you scream, walk, punch, or kick in your sleep?
22 Did pain disturb you in your sleep?
22 Did other physical symptoms disturb you in your sleep?
22 Did worries disturb you in your sleep?
22 Did medications disturb you in your sleep?
22 Did needing the toilet disturb you in your sleep?
22 Did other factors disturb you in your sleep?
22 Did you feel sad or anxious?
22 Did you sleep in a bed at night?
22 Did you sleep in a chair at night?
22 never
22 sometimes
22 usually
22 always
22 Please describe any other factors which disturbed you in your sleep?
23 Any other comments on sleep
5) Activities of Daily Living
This page explores activities of daily living
24 Please select the answer which best describes your bathing.
24 Bathes self completely or needs help in bathing only a single part of the body such as the back, genital area or disabled extremity.
24 Needs help with bathing more than one part of the body, getting in or out of the tub or shower. Requires total bathing.
25 Please select the answer which best describes you getting dressed
25 Gets clothes from closets and drawers and puts on clothes and outer garments complete with fasteners. May have help tying shoes.
25 Needs help with dressing self or needs to be completely dressed.
26 Please select the answer which best describes your toileting
26 Goes to toilet, gets on and off, arranges clothes, cleans genital area without help.
26 Needs help transferring to the toilet, cleaning self or uses bedpan or commode.
27 Please select the answer which best describes your transferring
27 Moves in and out of bed or chair unassisted. Mechanical transferring aides are acceptable.
27 Needs help in moving from bed to chair or requires a complete transfer.
28 Please select the answer which best describes your continence
28 Exercises complete self control over urination and defecation
28 Is partially or totally incontinent of bowel or bladder
29 Please select the answer which best describes your eating
29 Gets food from plate into mouth without help. Preparation of food may be done by another person.
29 Needs partial or total help with feeding or requires parenteral feeding.
30 Any other comments on these activities of daily living?
6) Support and Tracking
This page examines if you are a member of a support group and how you track your progress.
31 Are you a member of a support group?
31 Yes
31 No
32 If yes, describe which support group you are a member of.
33 If yes, what do you think the key benefits of membership are?
34 If no, which of these best describe why?
34 i dont feel the need to be a member of one
34 I am not aware of any support groups
34 There are no groups near where I live
34 I feel it would be too much effort to be a member
34 I dont think the group would give me the support I need
34 Another reason
35 Do you track the progress of your symptoms?
35 Yes
35 No
36 If yes, describe how you track this
7) Wellbeing
This page investigates wellbeing.
37 Please select the option that best describes your feelings and thoughts over the last 2 weeks
37 I’ve been feeling optimistic about the future
37 I’ve been feeling useful
37 I’ve been feeling relaxed
37 I’ve been feeling interested in other people
37 I’ve had energy to spare
37 I’ve been dealing with problems well
37 I’ve been thinking clearly
37 I’ve been feeling good about myself
37 I’ve been feeling close to other people
37 I’ve been feeling confident
37 I’ve been able to make up my own mind about things
37 I’ve been feeling loved
37 I’ve been interested in new things
37 I’ve been feeling cheerful
37 None of the time
37 Rarely
37 Some of the time
37 Often
37 All of the time
8) My Survey and Blog
This final section aims to capture your awareness of my surveys and blog.
38 Did you take part in one or more of my previous surveys?
38 Yes, completed at least one
38 I started to fill out some answers
38 Didn't participate - I wasn't aware of these
38 Didn't participate - didn't want to answer
39 If you wish, please give me feedback about this survey, previous survey, or on my analyses.
40 Have you read my blog http://hspjourney.blogspot.co.uk?
40 I read regularly
40 I read occasionally
40 I have not read
41 If you wish, please give me feedback about my blog - perhaps things you like/dislike/would like to see etc.
42 If you read my blog, how did you become aware of it?

1 comment:

  1. Não consigo responder ao questionário. Não consigo escrever

    ReplyDelete