| PEDS QL |
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Number of Indicators |
ALL Peds QL instruments at a glance |
ALL Peds QL 4.0 instruments at a glance |
| DOMAIN |
Peds QL |
Shorter version Peds QL 4.0 SF15 |
Teen |
Teen by Parent |
Child |
Child by Parent |
Young Child |
Young Child by Parent |
Toddler by Parent |
Teen |
Teen by Parent |
Child |
Child by Parent |
Young Child |
Young Child by Parent |
Toddler by Parent |
| Physical Functioning |
8 |
5 |
8 |
8 |
8 |
8 |
8 |
8 |
8 |
5 |
5 |
5 |
5 |
5 |
5 |
5 |
| It is hard for [me/my child] to walking/walk more than one block |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| It is hard for [me/my child] to run |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| It is hard for [me/my child] to do sports activity, play or exercise |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| It is hard for [me/my child] to lift something heavy |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| It is hard for [me/my child] to take a bath of shower by myself |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| It is hard for [me/my child] to do chores around the house/help pick up toys |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| [I/my child] hurt or ache |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| [I/my child] have low energy |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| Emotional Functioning |
5 |
4 |
5 |
5 |
5 |
5 |
5 |
5 |
5 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
| [I/my child] feel afraid or scared |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| [I/my child] feel sad or blue |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| [I/my child] feel angry |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| [I/my child] have trouble sleeping |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| [I/my child] worry about what will happen to [me/him/her] |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| Social Functioning |
5 |
3 |
5 |
5 |
5 |
5 |
5 |
5 |
5 |
3 |
3 |
3 |
3 |
3 |
3 |
3 |
| I have trouble getting along with other [peers]/[adults] |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| Other [peers]/[adults] do not want to be [my/my child's] friend |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| Other [peers]/[adults] tease me |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
| I cannot do things that others my age can do |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| It is hard to keep up with my peers |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| School Functioning |
5 |
3 |
5 |
5 |
5 |
5 |
5 |
5 |
3 |
3 |
3 |
3 |
3 |
3 |
3 |
3 |
| It is hard to pay attention at work or school |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
| [I/my child] forget things |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
| [I/my child] have trouble keeping up with my work or studies |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
| [I/my child] miss work or school because of not feeling well |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
| [I/my child] miss work or school to go to the doctor or hospital |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
| My child has trouble doing the same school activities as peers |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
| SF |
|
Number of Indicators |
| DOMAIN |
SF36 |
SF8 |
| Overall Health |
6 |
1 |
| In general, would you say your health is |
1 |
0 |
| Compared to one year ago, how would you rate your health in general |
1 |
0 |
| Overall, how would you rate your health during the past 4 weeks? |
0 |
1 |
| How TRUE or FALSE is each of the following statements for you? |
| I seem to get sick a little easier than other people |
1 |
0 |
| I am as healthy as anybody I know |
1 |
0 |
| I expect my health to get worse |
1 |
0 |
| My health is excellent |
1 |
0 |
| Physical |
14 |
2 |
| During the past 4 weeks, how much did you physical health problems limit your usual physical activities (such as waslking or climbing stairs)? |
0 |
1 |
| During the past 4 weeks, how much difficulty did yo have doing your daily work, both at home and away from home, because of your physical health? |
0 |
1 |
| The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? |
| Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports |
1 |
0 |
| Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf |
1 |
0 |
| Lifting or carrying groceries |
1 |
0 |
| Climbing several flights of stairs |
1 |
0 |
| Climbing one flight of stairs |
1 |
0 |
| Bending, kneeling or stooping |
1 |
0 |
| Walking more than a mile |
1 |
0 |
| Walking several hundred yards |
1 |
0 |
| Walking one hundred yards |
1 |
0 |
| Bathing or dressing yourself |
1 |
0 |
| During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health? |
| Cut down on the amount of time you spent on work or other activities |
1 |
0 |
| Accomplished less than you would like |
1 |
0 |
| Were limited in the kind of work or other activities |
1 |
0 |
| Had difficulty performing the work or other activities (for example, it took extra effort) |
1 |
0 |
| Emotional |
12 |
3 |
| During the past 4 weeks, how much have you been bothered by emotional problems (such as feeling anxious, depressed or irritable)? |
0 |
1 |
| During the past 4 weeks, how much did personal or emotional problems keep you from doing your usual work, school or other daily activities? |
0 |
1 |
| During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? |
| Cut down on the amount of time you spent on work or other activities |
1 |
0 |
| Accomplished less than you would like |
1 |
0 |
| Did work or other activities less carefully than usual |
1 |
0 |
| 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... |
| Did you feel full of life? |
1 |
0 |
| Have you been very nervous? |
1 |
0 |
| Have you felt so down in the dumps that nothing could cheer you up? |
1 |
0 |
| Have you felt calm and peaceful? |
1 |
0 |
| Did you have a lot of energy? |
1 |
0 |
| Have you felt downhearted and depressed? |
1 |
0 |
| Did you feel worn out? |
1 |
0 |
| Have you been happy? |
1 |
0 |
| Did you feel tired? |
1 |
0 |
| During the past 4 weeks, how much energy did you have? |
0 |
1 |
| Social |
2 |
1 |
| During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? |
1 |
1 |
| During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? |
1 |
0 |
| Pain |
2 |
1 |
| How much bodily pain have you had during the past 4 weeks? |
1 |
1 |
| During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? |
1 |
0 |