Wisconsin Quality of Life Index for Adults – A-QLI

In general, would you say your physical health is...

Compared to one year ago, how would you rate your health in general now?

Compared to others my age, my health is as good as can be expected.

I expect my health to get worse.

During the past four weeks, did physical health limit the kind of activities you could do?

During the past four weeks, did physical health limit the amount of activities you would like to do?

During the past four weeks, did physical health limit you in performing self-care?

In the past four weeks, did health limit you in moderate activities (e.g., moving a table, vacuuming)?

In the past four weeks, did health limit you in lifting or carrying groceries?

In the past four weeks, did health limit you in climbing several flights of stairs?

In the past four weeks, did health limit you in climbing one flight of stairs?

In the past four weeks, did health limit you in bending, kneeling, or stooping?

In the past four weeks, did health limit you in walking several blocks?

In the past four weeks, did health limit you in walking one block?

In the past four weeks, did health limit you in walking short distances (e.g., around your house)?

Did you need help from another person to take a bath or shower?

Did you need help from another person to get dressed?

Did you need help from another person to use the toilet?

Did you need help from another person to eat?

Did you need help from another person to get in or out of bed?

Have you been able to go shopping for groceries without help?

Have you been able to prepare your own meals without help?

Have you been able to do your own housework without help?

Have you been able to do your own laundry without help?

Have you been able to use public transportation or drive your own car?

How much pain have you had during the past four weeks?

During the past four weeks, how much has pain interfered with your normal activities?

Overall, to what degree is your pain controlled?

How satisfied or dissatisfied are you with your relationships with family or friends?

How satisfied or dissatisfied are you with the amount of support you receive from family and friends?

During the past four weeks, did you feel that your family or friends would be around if you needed assistance?

During the past four weeks, did your physical health limit your ability to socialize with family or friends?

During the past four weeks, did your emotional health limit your ability to socialize with family or friends?

During the past four weeks, how much of the time did you feel full of pep?

During the past four weeks, how much of the time have you been nervous?

During the past four weeks, how much of the time did you feel down in the dumps?

During the past four weeks, how much of the time have you felt peaceful and content?

During the past four weeks, how much of the time did you feel your life had purpose?

During the past four weeks, how much of the time have you felt hopeful about the future?

During the past four weeks, how much of the time have you worried about dying?

During the past four weeks, how much of the time did you feel life was worthwhile?

During the past four weeks, how much of the time did you feel in control of your life?

During the past four weeks, did emotional difficulties limit the kind of activities you could do?

During the past four weeks, did emotional difficulties limit the amount of time you could do activities?

During the past four weeks, did emotional difficulties limit you in performing self-care or attending social activities?

To what extent are you experiencing difficulty in managing day-to-day life (making decisions, handling money)?

To what extent are you experiencing difficulty in getting enough sleep?

To what extent are you experiencing difficulty in maintaining an adequate diet?

To what extent are you experiencing difficulty in concentration, memory, or confusion?

To what extent are you experiencing difficulty in depression or hopelessness?

To what extent are you experiencing difficulty in sexual activity?

To what extent are you experiencing difficulty in mood swings?

To what extent are you experiencing difficulty in drinking alcoholic beverages?

To what extent are you experiencing difficulty in misusing drugs?

I spend time in activities that nourish my spiritual life.

I am not interested in activities that nourish my spiritual life.

I am satisfied with my spiritual life.

I feel that I am treated with dignity and respect.

How satisfied or dissatisfied are you with your living arrangements?

How satisfied or dissatisfied are you with the amount of privacy that you have?

How satisfied or dissatisfied are you with the choices you have (e.g., control over time and daily activities)?

How do you feel about your quality of life overall during the past four weeks?