Health Utilities Index Mark 3 – HUI3

Vision: Choose the level that best describes your vision: 1. Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, without glasses or contact lenses. 2. Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, but with glasses. 3. Able to read ordinary newsprint with or without glasses but unable to recognize a friend on the other side of the street, even with glasses. 4. Able to recognize a friend on the other side of the street with or without glasses but unable to read ordinary newsprint, even with glasses. 5. Unable to read ordinary newsprint and unable to recognize a friend on the other side of the street, even with glasses. 6. Unable to see at all.

Hearing: Choose the level that best describes your hearing: 1. Able to hear what is said in a group conversation with at least three other people, without a hearing aid. 2. Able to hear what is said in a conversation with one other person in a quiet room without a hearing aid, but requires a hearing aid to hear what is said in a group conversation with at least three other people. 3. Able to hear what is said in a conversation with one other person in a quiet room with a hearing aid, and able to hear what is said in a group conversation with at least three other people, with a hearing aid. 4. Able to hear what is said in a conversation with one other person in a quiet room, without a hearing aid, but unable to hear what is said in a group conversation with at least three other people even with a hearing aid. 5. Able to hear what is said in a conversation with one other person in a quiet room with a hearing aid, but unable to hear what is said in a group conversation with at least three other people even with a hearing aid. 6. Unable to hear at all.

Speech: Choose the level that best describes your speech: 1. Able to be understood completely when speaking with strangers or friends. 2. Able to be understood partially when speaking with strangers but able to be understood completely when speaking with people who know me well. 3. Able to be understood partially when speaking with strangers or people who know me well. 4. Unable to be understood when speaking with strangers but able to be understood partially by people who know me well. 5. Unable to be understood when speaking to other people (or unable to speak at all).

Ambulation: Choose the level that best describes your ability to walk: 1. Able to walk around the neighbourhood without difficulty, and without walking equipment. 2. Able to walk around the neighbourhood with difficulty; but does not require walking equipment or the help of another person. 3. Able to walk around the neighbourhood with walking equipment, but without the help of another person. 4. Able to walk only short distances with walking equipment, and requires a wheelchair to get around the neighbourhood. 5. Unable to walk alone, even with walking equipment. Able to walk short distances with the help of another person, and requires a wheelchair to get around the neighbourhood. 6. Cannot walk at all.

Dexterity: Choose the level that best describes your dexterity: 1. Full use of two hands and ten fingers. 2. Limitations in the use of hands or fingers, but does not require special tools or help of another person. 3. Limitations in the use of hands or fingers, is independent with use of special tools (does not require the help of another person). 4. Limitations in the use of hands or fingers, requires the help of another person for some tasks (not independent even with use of special tools). 5. Limitations in use of hands or fingers, requires the help of another person for most tasks (not independent even with use of special tools). 6. Limitations in use of hands or fingers, requires the help of another person for all tasks (not independent even with use of special tools).

Emotion: Choose the level that best describes your emotional state: 1. Happy and interested in life. 2. Somewhat happy. 3. Somewhat unhappy. 4. Very unhappy. 5. So unhappy that life is not worthwhile.

Cognition: Choose the level that best describes your cognitive ability: 1. Able to remember most things, think clearly and solve day to day problems. 2. Able to remember most things, but have a little difficulty when trying to think and solve day to day problems. 3. Somewhat forgetful, but able to think clearly and solve day to day problems. 4. Somewhat forgetful, and have a little difficulty when trying to think or solve day to day problems. 5. Very forgetful, and have great difficulty when trying to think or solve day to day problems. 6. Unable to remember anything at all, and unable to think or solve day to day problems.

Pain: Choose the level that best describes your pain: 1. Free of pain and discomfort. 2. Mild to moderate pain that prevents no activities. 3. Moderate pain that prevents a few activities. 4. Moderate to severe pain that prevents some activities. 5. Severe pain that prevents most activities.