1. In the last 7 days, how often did you have nausea? |
Never | Rarely | Occasionally | Frequently | Almost constantly |
2. In the last 7 days, how often did you have loose or watery stools (diarrhea/diarrhoea)? |
Never | Rarely | Occasionally | Frequently | Almost constantly |
3. In the last 7 days, what was the severity of your constipation at its worst? |
None | Mild | Moderate | Severe | Very severe |
4. In the last 7 days, what was the severity of your pain at its worst? |
None | Mild | Moderate | Severe | Very severe |
5. In the last 7 days, how much did your shortness of breath interfere with your usual or daily activities? |
Not at all | A little bit | Somewhat | Quite a bit | Very much |
6. In the last 7 days, how often did you have sad or unhappy feelings? |
Never | Rarely | Occasionally | Frequently | Almost constantly |
7. In the last 7 days, how often did you feel anxiety? |
Never | Rarely | Occasionally | Frequently | Almost constantly |
8. Over the past week I would generally rate my activity as |
0, normal with no limitations |
1, not my normal self, but able to be up and about with fairly normal activities |
2, not feeling up to most things, but in bed or chair less than half the day |
3, able to do little activity and spend most of the day in bed or a chair |
4, pretty much bedridden, rarely out of bed |