Scale
|
Item No on ALSAQ-40
|
Items
|
Physical mobility (MOB): |
| 1 | Difficulty walking short distances |
| 2 | Fallen whilst walking |
| 3 | Stumbled or tripped whilst walking |
| 4 | Lost balance whilst walking |
| 5 | Concentrate when walking |
| 6 | Tired when walking |
| 7 | Pains in legs whilst walking |
| 8 | Difficulty going up and down stairs |
| 9 |
Difficulty standing up |
| 10 | Difficulty getting up out of chairs |
Adl/independence (ADL): |
| 11 |
Difficulty using arms and hands |
| 12 | Difficulty turning and moving in bed |
| 13 | Difficulty picking things up |
| 14 | Difficulty holding books and turning pages |
| 15 | Difficulty writing clearly |
| 16 | Difficulty doing jobs around the house |
| 17 | Difficulty feeding myself |
| 18 | Difficulty combing hair |
| 19 | Difficulty getting dressed |
| 20 | Difficulty washing at hand basin |
Eating and drinking (EAT): |
| 21 | Difficulty swallowing |
| 22 |
Difficulty eating solid food
|
| 23 | Difficulty drinking liquids |
Communication (COM): |
| 24 | Difficulty participating in conversations |
| 25 |
Speech not easy to understand
|
| 26 | Slurred or stuttered whilst speaking |
| 27 | Have to talk slowly |
| 28 | Talked less than I used to do |
| 29 | Frustrated by speech |
| 30 | Felt self conscious about speech |
Emotional reactions (EM): |
| 31 | Felt lonely |
| 32 | Felt bored |
| 33 | Felt embarrassed in social situations |
| 34 |
Felt hopeless about the future |
| 35 | Worried that I was a burden to others |
| 36 | Wondered why I kept going |
| 37 | Felt angry because of the disease |
| 38 | Felt depressed |
| 39 | Worried how disease will affect my future |
| 40 | Felt as if I had no freedom |