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Relapse/Rebound Questionnaire

Discussion in 'Patient Data Repository & Treatment Review Project' started by Cort, Jun 6, 2010.

  1. Cort

    Cort Phoenix Rising Founder

    Messages:
    7,025
    Likes:
    428
    Raleigh, NC
    Cycling:

    Since you were diagnosed with CFS have there been periods of time in which you felt
    that you were well or nearly well?

    If you did feel that you were well or nearly well, how long did that period of wellness last?


    • a day
    • a week
    • Less than a month
    • Less than 6 months
    • 6 months to a year
    • 1-5 years
    • Over 5 years

    What do you believe caused your period of wellness?

    • Starting A Treatment
    • Altered Activity levels
    • Housing Change
    • Move to a New Region
    • Relationship change
    • Don't Know

    What do you believe triggered a resumption of the symptoms you associate with CFS

    • Stopping A Treatment
    • Starting A Treatment
    • Infection
    • Vaccination
    • Altered Activity levels
    • Return to Work
    • Diagnosis of Another Disorder
    • Injury/Operation
    • Seasonal factors - hot/cold weather
    • Relationship change
    • Other Stressful Event
    • Don't Know


    I experience significant fluctuations in my health on a daily, weekly, monthly or longer basis yes/no..

    If you answered yes to the above question please answer the next question

    • I regularly experience significant fluctuations in my health over a 24 hour period
    yes/no

    If you answered yes to the question please answer the next question

    What time(s) of day do you feel significantly better?
    • Morning (need to quantify)
    • Early Afternoon
    • Late Afternoon
    • Early Evening
    • Late Even
    • Early Morning

    How would you characterize your improvement?

    • 10-20% better (somewhat better)
    • 20-40% better (quite a bit better)
    • 40-70% better (very much improved)
    • >70% better (I feel healthy or almost healthy)

    I have experienced very large fluctuations in my functional capacity on a weekly basis yes/no

    How would you characterize your improvement?

    • 10-20% better (somewhat better)
    • 20-40% better (quite a bit better)
    • 40-70% better (very much improved)
    • >70% better (I feel healthy or almost healthy)

    What do you believe triggered a week long fluctuation in your health?

    • Stopping or Starting A Treatment
    • Infection
    • Vaccination
    • Altered Activity levels
    • Return to Work
    • Diagnosis of Another Disorder
    • Injury/Operation
    • Seasonal factors - hot/cold weather
    • Relationship change
    • Other Stressful Event
    • Don't Know

    I've experienced very large fluctuations in my functional capacity on a monthly basis

    • 10-20% better (somewhat better)
    • 20-40% better (quite a bit better)
    • 40-70% better (very much improved)
    • >70% better (I feel healthy or almost healthy)

    What do you believe triggered a month long fluctuation in your health?

    • Stopping or Starting A Treatment
    • Infection
    • Vaccination
    • Altered Activity levels
    • Starting, Stopping or Reducing Work Levels
    • Diagnosis of Another Disorder
    • Injury/Operation
    • Exposure to chemicals
    • Seasonal factors - hot/cold weather
    • Relationship change
    • Other Stressful Event
    • Don't Know

    Do these fluctuations appear seasonal in nature? If yes, please click the season(s) in which you experience noticeable changes in your well-being

    • Fall
    • Winter
    • Spring
    • Summer
    How would you rate the change in your health?

    • 10-20% better (somewhat better)
    • 20-40% better (quite a bit better)
    • 40-70% better (very much improved)
    • >70% better (huge improvement)
    • 10-20% worse (somewhat worse)
    • 20-40% worse (quite a bit worse)
    • 40-70% worse (very much worse)
    • >70% worse (huge reduction in health)


    How would you characterize periods of improvement/getting worse.

    • I am somewhat better
    • I am quite a bit better
    • I am very much improved)
    • I am healthy or almost healthy

    I've experienced very large fluctuations in my functional capacity on a yearly basis - since I was diagnosed with CFS there have been years in which I felt much, much better and/or much, much worse.

    Please characterize how much better you felt

    • I was somewhat better
    • I was quite a bit better
    • I was very much improved
    • I was healthy or almost healthy
    Change In Symptoms Over Time

    After the person out the symptom questionnaire they submit it - Then they are given the list of symptoms they checked; At the top of the Current Symptom Box - please tell how this symptom has changed since the beginning of your illness; after each symptom they are given the choice to choose the following. New Symptom, Much worse, somewhat worse, no change, can't tell, somewhat better, much better

    At the bottom of the page they are asked to list symptoms which were present but are no longer present and rate their severity when they were present.
  2. awol

    awol *****

    Messages:
    417
    Likes:
    0
    Hi Cort,

    "Infectious event" does not quite capture vaccination. What about immunological event? Or alternatively, just add one outright for vaccination.
  3. OverTheHills

    OverTheHills

    Messages:
    267
    Likes:
    156
    New Zealand
    My major factor affecting level is seasonal - I go from a largely housebound/very prone to PEM state in summer/early autumn to a much better level of function in winter. I think others on this forum have seasonal patterns although mostly the other way round from me.
  4. Cort

    Cort Phoenix Rising Founder

    Messages:
    7,025
    Likes:
    428
    Raleigh, NC
    Just add vaccination - immunological event is too technical for most people.
  5. awol

    awol *****

    Messages:
    417
    Likes:
    0
    OTH,

    You are right. Seasonal is important too.

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