Developed by: The Consortium of Multiple Sclerosis Centers Health Services Research Subcommittee
1. Do you have a relationship with one primary partner?
No [GO TO NEXT QUESTIONNAIRE] 0
Yes 1
2. During the past 4 weeks‚ how satisfied have you been with the amount of affection expressed physically in your relationship?
3. During the past 4 weeks‚ how satisfied have you been with the variety of sexual activities you engage in with your partner?
4. During the past 4 weeks‚ how satisfied have you been with your sexual relationship in general?
5. How satisfied do you think your partner has been with your sexual relationship in general‚ during the past 4 weeks?
Multiple Sclerosis Quality of Life Inventory (MSQLI)
· Health Status Questionnaire (SF-36)
· Modified Fatigue Impact Scale (MFIS)
· MOS Pain Effects Scale (PES)
· Sexual Satisfaction Scale (SSS)
· Bladder Control Scale (BLCS)
· Bowel Control Scale (BWCS)
· Impact of Visual Impairment Scale (IVIS)
· Perceived Deficits Questionnaire (PDQ)
· Mental Health Inventory (MHI)
· MOS Modified Social Support Survey (MSSS)
This instrument can be found at: http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/MSQLI_-A-User-s-Manual.pdf
1=Extremely Satisfied‚ 2=Moderately Satisfied‚ 3=Slightly Satisfied‚ 4=Slightly Dissatisfied‚ 5=Moderately Dissatisfied‚ 6=Extremely Dissatisfied
Stewart‚ A.L.‚ & Ware‚ J.E. (1992). Measuring functioning and well-being: The Medical Outcomes Study approach. Durham‚ NC: Duke University Press.