Arthritis Impact Measurement Scale (AIMS2)

Arthritis Impact Measurement Scale Short Form (AIMS2-SF)
1.    How often were you physically able to drive a car or use public transportation?
2.    How often were you in a bed or chair for most or all of the day?
3.    Did you have trouble doing vigorous activities such as running‚ lifting heavy objects‚ or participating in strenuous sports?
4.    Did you have trouble either walking several blocks or climbing a few flights of stairs?
5.    Were you unable to walk unless assisted by another person or by a cane‚ crutches‚ or walker?
6.    Could you easily write with a pen or pencil?
7.    Could you easily button a shirt or blouse?
8.    Could you easily turn a key in a lock?
9.    Could you easily comb or brush your hair?
10. Could you easily reach shelves that were above your head?
11. Did you need help to get dressed?
12.Did you need help to get in or out of bed?
13.How often did you have severe pain from your arthritis?
14.How often did your morning stiffness last more than one hour from the time you woke up?
15.How often did your pain make it difficult for you to sleep?
16.How often have you felt tense or high strung?
17.How often have you been bothered by nervousness or your nerves?
18.How often have you been in low or very low spirits?
19.How often have you enjoyed the things you do?
20.How often did you feel a burden to others?
21.How often did you get together with friends or relatives?
22.How often were you on the telephone with close friends or relatives?
23.How often did you go to a meeting of a church‚ club‚ team or other group?
24.Did you feel that your family or friends were sensitive to your personal needs?
25.How often were you unable to do any paid work‚ housework‚ or school work?
26.On the days that you did work‚ how often did you have to work a shorter day?
Arthritis Impact Measurement Scale-2 (AIMS)
These questions refer to MOBILITY LEVEL
(1) All days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
DURING THE PAST MONTH. . . .
1.    How often were you physically able to drive a car or use public transportation?
2.    How often were you out of the house for at least part of the day?
3.    How often were you able to do errands in the neighborhood?
4.    How often did someone have to assist you to get around outside your home?
5.    How often were you in a bed or chair for most or all of the day?
These questions refer to WALKING AND BENDING
(1) All days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
DURING THE PAST MONTH. . . .
6.    Did you have trouble doing vigorous activities such as running‚ lifting heavy objects‚ or participating in strenuous sports?
7.    Did you have trouble either walking several blocks or climbing a few flights of stairs?
8.    Did you have trouble bending‚ lifting or stooping?
9.    Did you have trouble either walking one block or climbing one flight of stairs?
10.Were you unable to walk unless assisted by another person or by a cane‚ crutches‚ or walker?
These questions refer to HAND AND FINGER FUNCTION
(1) All days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
DURING THE PAST MONTH. . . .
11.Could you easily write with a pen or pencil?
12.Could you easily button a shirt or blouse?
13.Could you easily turn a key in a lock?
14.Could you easily tie a knot or a bow?
15.Could you easily open a new jar of food?
These questions refer to ARM FUNCTION
(1) All days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
DURING THE PAST MONTH. . . .
16.Could you easily wipe your mouth with a napkin?
17.Could you easily put on a pullover sweater?
18.Could you easily comb or brush your hair?
19.Could you easily scratch your low back with your hand?
20.Could you easily reach shelves that were above your head?
These questions refer to SELF-CARE TASKS
(1) Always‚ (2) Very Often‚ (3) Sometimes‚ (4) Almost Never‚ (5) Never
DURING THE PAST MONTH. . . .
21.Did you need help to take a bath or shower?
22.Did you need help to get dressed?
23.Did you need help to use the toilet?
24.Did you need help to get in or out of bed?
These questions refer to HOUSEHOLD TASKS
(1) Always‚ (2) Very Often‚ (3) Sometimes‚ (4) Almost Never‚ (5) Never
DURING THE PAST MONTH. . . .
25.If you had the necessary transportation‚ could you go shopping for groceries without help?
26.If you had kitchen facilities‚ could you prepare your own meals without help?
27.If you had household tools and appliances‚ could you do your own housework without help?
28.If you had laundry facilities‚ could you do your own laundry without help?
These questions refer to SOCIAL ACTIVITY
(1) All days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
DURING THE PAST MONTH. . . .
29.How often did you get together with friends or relatives?
30.How often did you have friends or relatives over to your home?
31.How often did you visit friends or relatives in their homes?
32.How often were you on the telephone with close friends or relatives?
33.How often did you go to a meeting of a church‚ club‚ team or other group?
These questions refer to SUPPORT FROM FAMILY AND FRIENDS
(1) Always‚ (2) Very Often‚ (3) Sometimes‚ (4) Almost Never‚ (5) Never
DURING THE PAST MONTH. . . .
34.Did you feel that your family or friends would be around you if you needed assistance?
35.Did you feel that your family or friends were sensitive to your personal needs?
36.Did you feel that your family or friends were interested in helping you solve problems?
37.Did you feel that your family or friends understood the effects of your arthritis?
These questions refer to ARTHRITIS PAIN
DURING THE PAST MONTH. . . .
38. How would you describe the arthritis pain you usually had? (1) Severe‚ (2) Moderate‚ (3) Mild‚ (4) Very Mild‚ (5) None
DURING THE PAST MONTH. . . .
(1) All days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
39.How often did you have severe pain from your arthritis?
40.How often did you have pain in two or more joints at the same time?
41.How often did your morning stiffness last more than one hour from the time you woke up?
42.How often did your pain make it difficult for you to sleep?
These questions refer to WORK
DURING THE PAST MONTH. . . .
43.What has been your main form of work? (1) Paid Work‚ (2) Housework‚ (3) School work‚ (4) Unemployed‚ (5) Disabled‚ (6) Retired
If you answered unemployed‚ disabled or retired‚ please skip the next four questions and go to the next page.
(1) All days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
DURING THE PAST MONTH. . . .
44.How often were you unable to do any paid work‚ housework‚ or school work?
45.On the days that you did work‚ how often did you have to work a shorter day?
46.On the days that you did work‚ how often were you unable to do your work as carefully and accurately as you would like?
47.On the days that you did work‚ how often did you have to change the way your paid work‚ housework or school work is usually done?
These questions refer to LEVEL OF TENSION
(1) Always‚ (2) Very Often‚ (3) Sometimes‚ (4) Almost Never‚ (5) Never
DURING THE PAST MONTH. . . .
48.How often have you felt tense or high strung?
49.How often have you been bothered by nervousness or your nerves?
50.How often were you able to relax without difficulty?
51.How often have you felt relaxed and free of tension?
52.How often have you felt calm and peaceful?
These questions refer to MOOD
(1) Always‚ (2) Very Often‚ (3) Sometimes‚ (4) Almost Never‚ (5) Never
DURING THE PAST MONTH. . . .
53.How often have you enjoyed the things you do?
54.How often have you been in low or very low spirits?
55.How often did you feel that nothing turned out the way you wanted it to?
56.How often did you feel that others would be better off if you were dead?
57.How often did you feel so down in the dumps that nothing would cheer you up?
These questions refer to SATISFACTION WITH EACH HEALTH AREA.
(1) Very Satisfied‚  (2) Somewhat Satisfied‚ (3) Neither Satisfied Nor Dis satisfied‚ (4) Somewhat Dissatisfied‚ (5) Very Dissatisfied
DURING THE PAST MONTH…
58.How satisfied have you been with each of these areas of your health?
(0) Not A Problem For Me‚ (1) Due Entirely To Other Causes‚ (2) Due Largely To Other Causes‚ (3) Due Partly To Arthritis And Partly To Other Causes‚ (4) Due Largely To My Arthritis‚ (5) Due Entirely To My Arthritis
·         MOBILITY LEVEL (example: do errands)
·         WALKING AND BENDING (example: climb stairs)
·         HAND AND FINGER FUNCTION (example: tie a bow)
·         ARM FUNCTION (example: comb hair)
·         SELF-CARE (example: take bath)
·         HOUSEHOLD TASKS (example: housework)
·         SOCIAL ACTIVITY (example: visit friends)
·         SUPPORT FROM FAMILY (example: help with problems)
·         ARTHRITIS PAIN (example: joint pain)
·         WORK (example: reduce hours)
·         LEVEL OF TENSION (example: felt tense)
·         MOOD (example: down in dumps)
These questions refer to ARTHRITIS IMPACT ON EACH AREA OF HEALTH.
(0) Not A Problem For Me‚ (1) Due Entirely To Other Causes‚ (2) Due Largely To Other Causes‚ (3) Due Partly To Arthritis And Partly To Other Causes‚ (4) Due Largely To My Arthritis‚ (5) Due Entirely To My Arthritis
DURING THE PAST MONTH…
59.How much of your problem in each area of health was due to your arthritis?
·         MOBILITY LEVEL (example: do errands)
·         WALKING AND BENDING (example: climb stairs)
·         HAND AND FINGER FUNCTION (example: tie a bow)
·         ARM FUNCTION (example: comb hair)
·         SELF-CARE (example: take bath)
·         HOUSEHOLD TASKS (example: housework)
·         SOCIAL ACTIVITY (example: visit friends)
·         SUPPORT FROM FAMILY (example: help with problems)
·         ARTHRITIS PAIN (example: joint pain)
·         WORK (example: reduce hours)
·         LEVEL OF TENSION (example: felt tense)
·         MOOD (example: down in dumps)
You have now answered questions about different AREAS OF YOUR HEALTH.
check= 1‚ blank= 0
60.AREAS OF HEALTH THREE AREAS FOR IMPROVEMENT
  • MOBILITY LEVEL (example: do errands)
  • WALKING AND BENDING (example: climb stairs)
  • HAND AND FINGER FUNCTION (example: tie a bow)
  • ARM FUNCTION (example: comb hair)
  • SELF-CARE (example: take bath)
  • HOUSEHOLD TASKS (example: housework)
  • SOCIAL ACTIVITY (example: visit friends)
  • SUPPORT FROM FAMILY (example: help with problems)
  • ARTHRITIS PAIN (example: joint pain)
  • WORK (example: reduce hours)
  • LEVEL OF TENSION (example: felt tense)
  • MOOD (example: down in dumps)
These questions refer to your CURRENT and FUTURE HEALTH.
61.In general would you say that your HEALTH NOW is excellent‚ good‚ Fair or Poor?
(1) Excellent‚ (2) Good‚ (3) Fair‚ (4) Poor
62.How satisfied are you with your HEALTH NOW?
(1) Very Satisfied‚ (2) Somewhat Satisfied‚ (3) Neither Satisfied Nor Dissatisfied‚ (4) Somewhat Dissatisfied‚ (5) Very Dissatisfied
63.How much of your problem with your HEALTH NOW is due to your arthritis?
(0) Not A Problem For Me‚ (1) Due Entirely To Other Causes‚ (2) Due Largely To Other Causes‚ (3) Due Partly To Arthritis And Partly To Other Causes‚ (4) Due Largely To My Arthritis‚ (5) Due Entirely To My Arthritis
64.In general do you expect that your HEALTH 10 YEARS FROM NOW will be excellent‚ good‚ fair or poor?
(1) Excellent‚ (2) Good‚ (3) Fair‚ (4) Poor
65.How big a problem do you expect your arthritis to be10 YEARS FROM NOW?
(1) No Problem At All‚ (2) Minor Problem‚ (3) Moderate Problem‚ (4) Major Problem
This question refers to OVERALL ARTHRITIS IMPACT.
66.CONSIDERING ALL THE WAYS THAT YOUR ARTHRITIS AFFECTS YOU‚ how well are you doing compared to other people your age?
(1) Very Well‚ (2) Well‚ (3) Fair‚ (4) Poor‚ (5) Very Poorly
67.What is the main kind of arthritis that you have?
check= 1‚ blank= 0
•              Rheumatoid Arthritis
•              Osteoarthritis/Degenerative Arthritis
•              Systemic Lupus Erythematosis
•              Fibromyalgia
•              Scleroderma
•              Psoriatic Arthritis
•              Reiter’s Syndrome
•              Gout
•              Low Back Pain
•              Tendonitis/Bursitis
•              Osteoporosis
•              Other
68.How many years have you had arthritis? . . .
DURING THE PAST MONTH… (1) (2) (3) (4) (5)
69.How often have you had to take MEDICATION for your arthritis?
(1) All Days‚ (2) Most Days‚ (3) Some Days‚ (4) Few Days‚ (5) No Days
Please check (X) yes or no for each question.
70.Is your health currently affected by any of the following medical problems?
(1) Yes‚ (2) No
•              High blood pressure
•              Heart disease
•              Mental illness
•              Diabetes
•              Cancer
•              Alcohol or drug use
•              Lung disease
•              Kidney disease
•              Liver disease
•              Ulcer or other stomach disease
•              Anaemia or other blood disease
71.Do you take medicine every day for any problem other than your arthritis? (1) Yes‚ (2) No
72.Did you see a doctor more than three times last year for any problem other than arthritis? (1) Yes‚ (2) No
Please provide the following information about yourself:
73.What is your age at this time?
74.What is your sex?
75.What is your racial background?
76.What is your current marital status?
77.What is the highest level of education you received?
78.What is your approximate family income including wages‚ disability payment‚ retirement income and welfare?
 
 
 
AIMS2-SF
(1) Always‚ (2) Very Often‚ (3) Sometimes‚ (4) Almost Never‚ (5) Never
Physical (items 1- 12)‚ Symptom (items 13-15)‚ Affect (items 16- 20)‚ Social (items 21-24)‚ Work (items 25 and 26)
 

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