Loading…

Protocol - Quality of Life - Adult

Add to My Toolkit
Description:

This protocol includes 29 self-administered quality of life-type questions from the PROMIS® Profile 29 for adults. The quality of life questions include physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles and activities, and pain intensity over the past 7 days. Each question, except for the pain intensity question, is measured on a 5-point scale.

Protocol:

PROMIS©-29 Profile v2.0

Physical Function

Without any difficulty

With a little difficulty

With some difficulty

With much difficulty

Unable to do

1

Are you able to do chores such as vacuuming or yard work?

[ ]

[ ]

[ ]

[ ]

[ ]

2

Are you able to go up and down stairs at a normal pace

[ ]

[ ]

[ ]

[ ]

[ ]

3

Are you able to go for a walk of at least 15 minutes?

[ ]

[ ]

[ ]

[ ]

[ ]

4

Are you able to run errands and shop? ......

[ ]

[ ]

[ ]

[ ]

[ ]

Anxiety
In the past 7 days…

Never

Rarely

Sometimes

Often

Always

5

I felt fearful

[ ]

[ ]

[ ]

[ ]

[ ]

6

I found it hard to focus on anything other than my anxiety

[ ]

[ ]

[ ]

[ ]

[ ]

7

My worries overwhelmed me

[ ]

[ ]

[ ]

[ ]

[ ]

8

I felt uneasy

[ ]

[ ]

[ ]

[ ]

[ ]

Depression
In the past 7 days...

Never

Rarely

Sometimes

Often

Always

9

I felt worthless

[ ]

[ ]

[ ]

[ ]

[ ]

10

I felt helpless

[ ]

[ ]

[ ]

[ ]

[ ]

11

I felt depressed

[ ]

[ ]

[ ]

[ ]

[ ]

12

I felt hopeless

[ ]

[ ]

[ ]

[ ]

[ ]

Fatigue
During the past 7 days…

Not at all

A little bit

Somewhat

Quite a bit

Very much

13

I feel fatigued

[ ]

[ ]

[ ]

[ ]

[ ]

14

I have trouble starting things because I am tired

[ ]

[ ]

[ ]

[ ]

[ ]

Fatigue
In the past 7 days…

Not at all

A little bit

Somewhat

Quite a bit

Very much

15

How run-down did you feel on average?

[ ]

[ ]

[ ]

[ ]

[ ]

16

How fatigued were you on average?

[ ]

[ ]

[ ]

[ ]

[ ]

Sleep Disturbance
In the past 7 days…

Very poor

Poor

Fair

Good

Very good

17

My sleep quality was

[ ]

[ ]

[ ]

[ ]

[ ]

In the past 7 days…

Not at all

A little bit

Somewhat

Quite a bit

Very much

18

My sleep was refreshing

[ ]

[ ]

[ ]

[ ]

[ ]

19

I had a problem with my sleep

[ ]

[ ]

[ ]

[ ]

[ ]

20

I had difficulty falling asleep

[ ]

[ ]

[ ]

[ ]

[ ]

Ability to Participate in Social Roles and Activities

Never

Rarely

Sometimes

Often

Always

21

I have trouble doing all of my regular leisure activities with others.

[ ]

[ ]

[ ]

[ ]

[ ]

22

I have trouble doing all of the family activities that I want to do

[ ]

[ ]

[ ]

[ ]

[ ]

23

I have trouble doing all of my usual work (include work at home)

[ ]

[ ]

[ ]

[ ]

[ ]

24

I have trouble doing all of the activities with friends that I want to do

[ ]

[ ]

[ ]

[ ]

[ ]

Pain Interference
In the past 7 days…

Not at all

A little bit

Somewhat

Quite a bit

Very much

25

How much did pain interfere with your day to day activities?

[ ]

[ ]

[ ]

[ ]

[ ]

26

How much did pain interfere with work around the home?

[ ]

[ ]

[ ]

[ ]

[ ]

27

How much did pain interfere with your ability to participate in social activities?

[ ]

[ ]

[ ]

[ ]

[ ]

28

How much did pain interfere with your household chores?

[ ]

[ ]

[ ]

[ ]

[ ]

Pain Intensity
In the past 7 days…

29

How would you rate your pain on average?

[ ] 0

No pain

[ ] 1

[ ] 2

[ ] 3

[ ] 4

[ ] 5

[ ] 6

[ ] 7

[ ] 8

[ ] 9

[ ] 10

Worst imaginable pain

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adult

Participants:

Adults aged 18 years and older

Specific Instructions:

Additional information about PROMIS® instruments-including the item bank development history, available banks, domain definitions, administration, scoring, validity, and interpretation-is available on the PROMIS® website: www.nihpromis.org.

Several questions in the PROMIS® Global Health protocol are also included in the Emotional Distress measure from the Gastrointestinal domain. Selecting the Global Health protocol and the Emotional Distress measure will result in some of the same questions being asked twice.

Selection Rationale

The PROMIS® protocols have been tested and have been found to be reliable and comparable to established measures of these same content areas. Additionally, they are quick and easy to administer, either via paper and pencil or as a computer-based instrument.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) 10 PROMIS Global Health Questionnaire General Rating Quality Of Life Score 5 Point Scale 3628749 CDE Browser
Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

U.S. Department of Health and Human Services. National Institutes of Health (NIH). PROMIS®-29 Profile v2.0 Adult Profile©. Available from www.assessmentcenter.net

For more information on PROMIS® see www.nihpromis.org

General References

Beaumont, J. L., Cella, D., Phan, A. T., Choi, S., Liu, Z., & Yao, J. C. (2012). Comparison of health-related quality of life in patients with neuroendocrine tumors with quality of life in the general U.S. population. Pancreas, 41(3), 461-466.

Butt, Z., Peipert, J., Webster, K., Chen, C., & Cella, D. (2013). General population norms for the Functional Assessment of Cancer Therapy-Kidney Symptom Index (FKSI). Cancer, 119(2), 429-437.

Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., Cook, K., DeVellis, R., DeWalt, D., Fries, J. F., Gershon, R., Hahn, E. A., Pilkonis, P., Revicki, D., Rose, M., Weinfurt, K., Hays, R., Lai, J-S, & on behalf of the PROMIS Cooperative Group. (2010). The Patient Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. Journal of Clinical Epidemiology, 63(11), 1179-1194.

Hinchcliff, M., Beaumont, J. L., Thavarahah, K., Varga, J., Chung, A., Podlusky, S., Carns, M., Chang, R. W., & Cella, D. (2011). Validity of two new patient-reported outcome measures in systemic sclerosis: Patient-reported outcomes measurement information system 29-item health profile and functional assessment of chronic illness therapy-dyspnea short form. Arthritis Care & Research, 63(11), 1620-1628.

Weaver, K. E., Forsythe, L. P., Reeve, B. B., Alfana, C. M., Rodrigues, J. L., Sabatino, S. A., Hawkins, N. A., & Rowland, J. H. (2012). Mental and physical health-related quality of life among U.S. cancer survivors: Population estimates from the 2010 National Health Interview Study. Cancer Epidemiology, Biomarkers & Prevention, 21(11), 2108-2117. doi:10.1158/1055-9965.EPI-12-0740.

Xia, T., Wilder, D. G., Gudavalli, M. R., DeVocht, J. W., Vining, R. D., Pohlman, K. A., Kawchuk, G. N., Long, C. R., & Goertz, C. M. (2014). Study protocol for patient response to spinal manipulation - a prospective observational clinical trial on physiological and patient-centered outcomes in patients with chronic low back pain. BMC Complementary and Alternative Medicine, 14(1), 292.

Protocol ID:

221302

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX221302_QualityOfLifeForAdults_Able_Do_Chores PX221302010000 Are you able to do chores such as vacuuming or yard work? 4 N/A
PX221302_QualityOfLifeForAdults_Able_Errands_Shop PX221302040000 Are you able to run errands and shop? ...... 4 N/A
PX221302_QualityOfLifeForAdults_Able_UpDown_Stairs_Normal PX221302020000 Are you able to go up and down stairs at a normal pace 4 N/A
PX221302_QualityOfLifeForAdults_Able_Walk_Least_15minutes PX221302030000 Are you able to go for a walk of at least 15 minutes? 4 N/A
PX221302_QualityOfLifeForAdults_Difficulty_Falling_Asleep_Past7days PX221302090300 In the past 7 days, I had difficulty falling asleep 4 N/A
PX221302_QualityOfLifeForAdults_Fatigued_Average_Past7days PX221302070200 In the past 7 days, How fatigued were you on average? 4 N/A
PX221302_QualityOfLifeForAdults_Feel_Fatigued_Past7days PX221302060100 During the past 7 days, I feel fatigued 4 N/A
PX221302_QualityOfLifeForAdults_Feel_Run_Down_Past7days PX221302070100 In the past 7 days, How run-down did you feel on average? 4 N/A
PX221302_QualityOfLifeForAdults_Felt_Depressed_Past7days PX221302050700 In the past 7 days, I felt depressed 4 N/A
PX221302_QualityOfLifeForAdults_Felt_Fearful_Past7days PX221302050100 In the past 7 days, I felt fearful 4 N/A
PX221302_QualityOfLifeForAdults_Felt_Helpless_Past7days PX221302050600 In the past 7 days, I felt helpless 4 N/A
PX221302_QualityOfLifeForAdults_Felt_Hopeless_Past7days PX221302050800 In the past 7 days, I felt hopeless 4 N/A
PX221302_QualityOfLifeForAdults_Felt_Uneasy_Past7days PX221302050400 In the past 7 days, I felt uneasy 4 N/A
PX221302_QualityOfLifeForAdults_Felt_Worthless_Past7days PX221302050500 In the past 7 days, I felt worthless 4 N/A
PX221302_QualityOfLifeForAdults_Hard_Focus_Anxiety_Past7days PX221302050200 In the past 7 days, I found it hard to focus on anything other than my anxiety 4 N/A
PX221302_QualityOfLifeForAdults_MyWorries_Overwhelmed_Past7days PX221302050300 In the past 7 days, My worries overwhelmed me 4 N/A
PX221302_QualityOfLifeForAdults_Pain_Interfere_Activities_Past7days PX221302140100 In the past 7 days, How much did pain interfere with your day to day activities? 4 N/A
PX221302_QualityOfLifeForAdults_Pain_Interfere_HouseholdChores_Past7days PX221302140400 In the past 7 days, How much did pain interfere with your household chores? 4 N/A
PX221302_QualityOfLifeForAdults_Pain_Interfere_ParticipateSocial_Past7days PX221302140300 In the past 7 days, How much did pain interfere with your ability to participate in social activities? 4 N/A
PX221302_QualityOfLifeForAdults_Pain_Interfere_WorkAroundHome_Past7days PX221302140200 In the past 7 days, How much did pain interfere with work around the home? 4 N/A
PX221302_QualityOfLifeForAdults_Problem_With_Sleep_Past7days PX221302090200 In the past 7 days, I had a problem with my sleep 4 N/A
PX221302_QualityOfLifeForAdults_RatePain_OnAverage_Past7days PX221302150000 How would you rate your pain on average? 4 N/A
PX221302_QualityOfLifeForAdults_Sleep_Quality_Past7days PX221302080000 In the past 7 days, My sleep quality was 4 N/A
PX221302_QualityOfLifeForAdults_Sleep_Refreshing_Past7days PX221302090100 In the past 7 days, My sleep was refreshing 4 N/A
PX221302_QualityOfLifeForAdults_Trouble_Doing_Activities_Friends PX221302130000 I have trouble doing all of the activities with friends that I want to do 4 N/A
PX221302_QualityOfLifeForAdults_Trouble_Doing_Family_Activities PX221302110000 I have trouble doing all of the family activities that I want to do 4 N/A
PX221302_QualityOfLifeForAdults_Trouble_Doing_Leisure_Activities PX221302100000 I have trouble doing all of my regular leisure activities with others. 4 N/A
PX221302_QualityOfLifeForAdults_Trouble_Doing_Usual_Work PX221302120000 I have trouble doing all of my usual work (include work at home) 4 N/A
PX221302_QualityOfLifeForAdults_Trouble_Starting_Things_Past7days PX221302060200 During the past 7 days, I have trouble starting things because I am tired 4 N/A
Research Domain Information
Measure Name:

Quality of Life

Release Date:

July 30, 2015

Definition

This is a measure to assess quality of life (QOL) based on how the individual has felt over the past 7 days.

Purpose

Information collected from this questionnaire can be used to assess the individual’s current quality of life, which may influence emotional and physical problems.

Keywords

Quality of Life, PROMIS, PROMIS-29, PROMIS Pediatric Profile 25, Patient-reported outcomes, Pain, Sleep, Function, Depression, Anxiety, Physical function, Social roles, Patient-Reported Outcomes Measurement Information System, PROMIS©, quality of life, qol, toddler, child, children, pediatrics, adolescent, physical function, mobility, fatigue, peer relationship, pain interference, pain intensity