Programmed by Stephen Z. Fadem, M.D., FACP, FASN
This survey asks for your views about your health. This information will demonstrate how you feel and how well you are able to do your usual activities.
These questions are from Kidney Disease and Quality of LifeTM(KDQOLTM-36) English Version 1. Copyright © 2000 by RAND and the University of Arizona
Study of Quality of Life For Patients on Dialysis. This site is posted for education purposes only. For more information contact the KDQOL WORKING GROUP WEBSITE.
The purpose is to assess the quality of life of patients with kidney disease.
Complete the questions below about your health, how you feel and your background.
No information is being recorded or stored. This is purely for your benefit to understand the concepts this test is based on. There are several other resources like KDQOL COMPLETE by the Medical Education Institute that can record and analyze scores in conjustion with your dialysis facility.
The information you provide will demonstrate how you feel about your care and further understanding about the effects of medical care on the health of patients. This information will help to evaluate the care delivered.
This survey includes a wide variety of questions about your health and your life. It will show how you feel about each of these issues.
1. In general, would you say your health is: [Check the one box that best describes your answer.]
The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
[Check the box on each line.]
During the past 4 weeks, have you had any of the following problems with your workor other regular daily activities as a result of your physical health?
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of anyemotional problems (such as feeling depressed or anxious)?
These questions are about how you feel and how things have been with you during the past 4 weeks.
For each question, please give the one answer that comes closest to the way you have been feeling.
How much of the time during the past 4 weeks
How true or false is each of the following statements for you?
During the past 4 weeks, to what extent were you bothered by each of the following?
Some people are bothered by the effects of kidney disease on their daily life, while others are not. How much does kidney disease bother you in each of the following areas?