EQ-5D-3L
Mobility
1. I have no problems in walking about
2. I have some problems in walking about
3. I am confined to bed
Self-Care
1. I have no problems with self-care
2. I have some problems washing or dressing myself
3. I am unable to wash or dress myself
Usual Activities (e.g.‚ work‚ study‚ housework‚ family or leisure activities)
1. I have no problems with performing my usual activities (e.g. work‚ study‚ housework‚ family or leisure activities.
2. I have some problems with performing my usual activities
3. I am unable to perform my usual activities
Pain / Discomfort
1. I have no pain or discomfort
2. I have moderate pain or discomfort
3. I have extreme pain or discomfort
Anxiety / Depression
1. I am not anxious or depressed
2. I am moderately anxious or depressed
3. I am extremely anxious or depressed
To help people say how good or bad a health state is‚ we have drawn a scale (rather like a thermometer) on which the best state you can imagine is marked by 100 and the worst state is marked by 0.
We would like you to indicate on this scale how good or bad is your own health today‚ in your opinion. Please do this by drawing a line from the box “Your own health today” to whichever point on the scale indicates how good or bad your health state is.
EQ-5D-5L‚ 2005
MOBILITY
1. I have no problems in walking about
2. I have slight problems in walking about
3. I have moderate problems in walking about
4. I have severe problems in walking about
5. I am unable to walk about
SELF-CARE
1. I have no problems washing or dressing myself
2. I have slight problems washing or dressing myself
3. I have moderate problems washing or dressing myself
4. I have severe problems washing or dressing myself
5. I am unable to wash or dress myself
USUAL ACTIVITIES (e.g. work‚ study‚ housework‚ family or leisure activities)
1. I have no problems doing my usual activities
2. I have slight problems doing my usual activities
3. I have moderate problems doing my usual activities
4. I have severe problems doing my usual activities
5. I am unable to do my usual activities
PAIN / DISCOMFORT
1. I have no pain or discomfort
2. I have slight pain or discomfort
3. I have moderate pain or discomfort
4. I have severe pain or discomfort
5. I have extreme pain or discomfort
ANXIETY / DEPRESSION
1. I am not anxious or depressed
2. I am slightly anxious or depressed
3. I am moderately anxious or depressed
4. I am severely anxious or depressed
5. I am extremely anxious or depressed
• We would like to know how good or bad your health is TODAY.
• This scale is numbered from 0 to 100.
• 100 means the best health you can imagine.
0 means the worst health you can imagine.
• Mark an X on the scale to indicate how your health is TODAY.
• Now‚ please write the number you marked on the scale in the box below.
mobility‚ self-care‚ usual activities‚ pain/discomfort‚ and anxiety/depression
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