Instruments
  The following is a list of all instruments that have been approved by the Scientific Advisory Committee of the Medical Outcomes Trust.  Click on the title of each instrument for a description and information about obtaining it. 
   Instruments are no longer distributed by the Medical Outcomes Trust. It will be necessary for you to contact the original author or the source cited in the information about each tool to determine where to obtain approval for use of a particular tool..

Generic Instruments
BASIS-32
Child Health Questionnaire (CHQ)
Child Health and Illness Profile--Adolescent Edition (CHIP-AE) 
Duke Health Profile (DUKE)
London Handicap Scale (LHS)
Quality of Well-Being Scale (QWB)
Primary Care Assessment Survey (PCAS)
SF-36 Health Survey (SF-36® Health Survey)
SF-12 Health Survey (SF-12® Health Survey)
Sickness Impact Profile (SIP)

 
Condition-Specific Instruments
Adult Asthma Quality of Life Questionnaire (AQLQ)
Pediatric Asthma Quality of Life Questionnaires (PAQLQ)
MOS-HIV Health Survey (MOS-HIV)
Migraine Specific Quality of Life (MSQOL)
Migraine Specific Quality of Life Questionnaire (MSQ v.2.1)
24-Hour Migraine Quality of Life Questionnaire (24-Hr-MQOLQ)
St. George's Respiratory Questionnaire- UK Parent  Version (SGRQ-UK)
Seattle Angina Questionnaire (SAQ)
Urinary Incontinence-Specific Quality of Life Questionnaire (I-QOL-US)

BASIS-32
Original Version Author: Susan V. Eisen
This instrument is a 32-item self-administered (or structured interview) questionnaire developed to assess outcomes of mental health treatment for populations undergoing inpatient psychiatric hospital care for a wide range of disorders (can also be used in outpatient populations). The five domains measured by the BASIS-32 are: psychosis; daily living/role functioning skills; relation to self/others; impulsive addictive behavior; and depression.

For more information, please go to www.basissurvey.org

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Child Health Questionnaire (CHQ)
Original Version Authors:  Jeanne M. Landgraf and John E. Ware, Jr.

The Child Health Questionnaire (CHQ) yields a 14-concept health status and well-being concepts as well as reliable and valid summary (physical and psychosocial health) scores. This instrument is comprised of scales specifically developed for children and adolescents five years of age and older.  The CHQ assesses a child's physical, emotional, and social well-being from the perspective of a parent or guardian (CHQ-PF50 and PF-28 (short form)) or, in some instances, the child directly (CHQ-CF87, for children ten years of age and older).  Areas measured include: physical functioning, bodily pain or discomfort, general health, change in health, limitations in schoolwork and activities with friends, mental health, behavior, self-esteem, family cohesion, limitations in family activities, emotional or time impact on the parent.

The CHQ has been shown to be useful in comparing groups of children within HMOs, doctor's offices, schools, including onsite clinics, clinical trials, and large population based research efforts (e.g., Medicaid).

 For more information, please go to www.qualitymetric.com or www.healthact.com

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Child Health and Illness Profile--Adolescent Edition (CHIP-AE)

Original Version Authors: Barbara Starfield and Anne Riley

The CHIP-AE is a generic self-report instrument to obtain reports from adolescents (11-17 years old) about their own health.  It was designed to identify systematic differences in health from subpopulations of adolescents, including the socioeconomically disadvantaged, and to assess the impact of health services interventions on health status.  It includes six domains that provide a comprehensive picture of health.  They are satisfaction, achievement, disorders, risks, discomfort, and resilience.  It was designed to describe the health of groups of adolescents and to evaluate changes in the health of groups of adolescents.  Each of the domains of health is amenable to health services intervention.  The computerized scoring program provides scores for the domains and the 20 sub-domains. 

For more information, please go to www.childhealthprofile.org

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Duke Health Profile (DUKE)

Original Version Author: George Parkerson

The DUKE is a 17-item generic questionnaire that measures respondent-reported functional health status and health-related quality of life during a one-week time period for adults 18 years or older.  It can be self-administered or interviewer-administered usually in less than five minutes.  Scoring for the 11 scales of the DUKE can be done manually or by computer. Six scales measure functional health.  They are physical, mental, social, general, perceived health, and self-esteem.  Five scales measure dysfunctional health.  They are anxiety, depression, anxiety-depression, pain, and disability.

The physical, mental, social, and perceived health scales and the disability scale are independent of each other in that none of their items are shared, whereas the other scales have shared items.

For more information, please go to http://healthmeasures.mc.duke.edu

 

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London Handicap Scale (LHS)

Original Version Author: Rowan H. Harwood
The London Handicap Scale is a six-item instrument that measures health status in patients with chronic, multiple, or progressive diseases, including evaluation of interventions deployed in their treatment, including rehabilitation.  The scale generates a profile of handicaps on six different dimensions (mobility, physical independence, occupation, social integration, orientation, and economic self-sufficiency) and an overall handicap severity score.  Each dimension has six levels, arranged in order of increasing disadvantage. Together this information forms a descriptive profile of the individual.  The scale is suitable for adults, but was not designed for use with children.  The particular issues of chronic disease, multiple pathologies, and the importance of environmental and social factors arise frequently in the elderly, for whom the scale is particularly appropriate.

(NOTE: This instrument may be obtained from Rowan H. Harwood, M.D. Clinical Gerontology Research Unit, Directorate of Medicine, South Corridor, Nottingham City Hospital, Nottingham NG5 1PB, UK, rowan.harwood@ntlworld.com.

The following translations are available from their developers:
Cantonese – Dr Raymond Lo; Department of Geriatric Medicine, Chinese University of Hong Kong, Hong Kong SAR, China; raymondlo@cuhk.edu.hk;
Dutch (adult) - Dr. A.M.J. Chorus, TNO Quality of Life, PO Box 2215, 2301 CE Leiden, The Netherlands; astrid.chorus@tno.nl
Dutch (child) - Symone Detmar, Dept. of Youth, TNO Prevention and Health, PO Box 2215, 2301-CE Leiden, The Netherlands; SB.Detmar@pg.tno.nl.
Swedish – Dr Albert Westergren, Dept of Health Science, Faculty of Medicine, University of Lund; PoBox157; SE-221 00 Lund, Sweden; albert.westergren@med.lu.se; or via Dept of Research and Development, Central Hospital Kristianstad, Northeast Skåne Health Care District; SE-291 85 Kristianstad, Sweden; albert.g.westergren@skane.se).
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Quality of Well-Being Scale (QWB)

Original Version Author: Robert Kaplan
The QWB is an interviewer-administered instrument that measures well-being in individuals based on the social preferences that society generally associates with a person's level of functioning at specific point in time.  For each individual the scale averages values across three ratings of functioning: mobility, physical activity, social activity, and across one rating of symptomatic complaints that might inhibit function.  Based upon the interview, a single functional level is assigned to each respondent within each of the four domains, and each level is given a weight based on large population surveys of preferences of each functional level.

For more information, please go to http://famprevmed.ucsd.edu/hoap

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Primary Care Assessment Survey (PCAS)

Original Version Author: Dana Gelb Safran
The PCAS is a 51-item, patient-completed questionnaire designed to measure the seven essential features of primary care:  access; continuity; comprehensiveness; integration; clinical management; "whole-person" orientation; and sustained clinical-patient relationship. The PCAS is intended for performance measurement and quality improvement at the individual physician, group practice, health plan, or delivery system level.  All concepts are measured in the context of a specific clinician-patient primary care relationship, and reference the entirety of that relationship (i.e., not visit-specific).

For more information, please go to http://160.109.101.132/icrhps/resprog/thi/pcas.asp


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SF-12® Health Survey

Original Version Author: John E. Ware, Jr.

The SF-12® is a multipurpose short-form (SF) generic measure of health status.  It was developed to be a much shorter, yet valid, alternative to the SF-36® for use in large surveys of general and specific populations as well as large longitudinal studies of health outcomes.  The 12 items in the SF-12® are a subset of those in the SF-36®; SF-12® includes one or two items from each of the eight health concepts.  Thus, the SF-12® measures eight concepts commonly represented in widely used surveys: physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality (energy/fatigue), social functioning, role limitations due to emotional problems and mental health (psychological distress and psychological well being).  Both standard (4-week) and acute (1-week) recall versions are available.

The Medical Outcomes Trust (MOT), Health Assessment Lab (HAL) and QualityMetric Incorporated, co-copyright holders of all SF-36®, SF-12® and SF-8™ Health Surveys, have merged their licensing and user registration programs, with the objectives of simplifying licensing and user registration and better meeting the needs of the many new academic, commercial, and other licensees.

For more information, please go to www.qualitymetric.com

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SF-36® Health Survey

Original Version Authors: John E. Ware
 

The SF-36® Health Survey is a 36-item instrument for measuring health status and outcomes from the patient's point of view.  Designed for use in surveys of general and specific populations, health policy evaluations, and clinical practice and research, the survey can be self administered by people 14 years of age or older, or administered by trained interviewers either in person or by telephone.  The SF-36® Health Survey measures the following eight health concepts, which are relevant across age, disease and treatment groups: physical functioning, role limitations due to physical health problems, bodily pain, general health, vitality (energy/fatigue), social functioning, role limitations due to emotional problems and mental health (psychological distress and psychological well being). Both standard (4-week) and acute (1-week) recall versions are available. The surveys standardized scoring system yields a profile of eight health scores and two summary measures and a self-evaluated change in health status.

The Medical Outcomes Trust (MOT) and QualityMetric Incorporated have merged their licensing and user registration programs, with the objectives of simplifying licensing and user registration and better meeting the needs of the many new academic, commercial, and other licensees.

 For more information, please go to www.qualitymetric.com

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Sickness Impact Profile (SIP)

Original Version Author: Marilyn Bergner

A 136-item self- or interviewer-administered, behaviorally-based, health status questionnaire.  Everyday activities in 12 categories (sleep and rest, emotional behavior, body care and movement, home management, mobility, social interaction, ambulation, alertness behavior, communication, work, recreation and pastimes, and eating) are measured.  Respondents endorse items that describe themselves and are related to their health.  The SIP is scored according to the number and type of items endorsed.  Scoring can be done at the level of categories and dimensions as well as at the total SIP level.

For more information, please e-mail Mapi Research Trust at trust@mapi.fr

 

 

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Adult Asthma Quality of Life Questionnaire (AQLQ)

Original Version Author: Elizabeth Juniper

This is a 32-item disease-specific instrument for adults with asthma. The aim of the AQLQ is to reflect areas of function important to adult asthmatics. Available in both interviewer-administered self-administered forms, the four domains measured by the AQLQ are activity limitations, emotional function, exposure to environmental stimuli, and symptoms.

For more information, please go to www.qoltech.co.uk

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Pediatric Asthma Quality of Life Questionnaires (PAQLQ)

Original Version Author: Elizabeth Juniper

This is a 13-item disease-specific instrument designed to measure the impact of children's asthma on their primary caregiver's quality of life, specifically, how it measures normal daily activities and contributes to anxieties and fears. The two domains measured by the PAQLQ are activities and emotions.

For more information, please go to www.qoltech.co.uk

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MOS-HIV Health Survey (MOS-HIV)

Original Version Author: Albert Wu

The MOS-HIV is a brief, comprehensive health status measure containing 35 questions that measure 10 dimensions of health: general health perceptions, pain, physical functioning, role functioning, social functioning, energy/fatigue, mental health, health distress, cognitive function, and quality of life. A single item is also included to assess health transition. Subscales of the MOS-HIV are scored as summated rating scales on a 0 to 100 scale; higher scores indicate better health. In addition to these subscales, two summary scores can be generated: physical health summary and mental summary scores. The instrument takes approximately five minutes to complete and can be self-administered. Alternatively, it can be given as a face-to-fact or telephone interview.

For more information, please e-mail Mapi Research Trust at trust@mapi.fr


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Migraine Specific Quality of Life (MSQOL)

Original Version Author: Donald Patrick

The MSQOL is a 25-item self-administered instrument developed to measure long-term effects of migraine and migraine treatment on quality of life. Items are summed to provide an overall score and three sub-scores measuring physical, emotional, and social domains. A total MSQOL score can also be calculated.

This instrument has also been translated in several languages.

For more information, please go to www.seaqolgroup.org or e-mail seaqol@u.washington.edu

 

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Migraine Specific Quality of Life Questionnaire, version 2.1 (MSQ v. 2.1)

Original Version Author: Jackie Kwong


The MSQv.2.1 is a 14-item, self-administered instrument covering areas of specific concern to persons with migraine. Specifically, it addresses the three factors of role restrictive, role preventive, and emotional function. It was developed from the MSQv.1.0; its content was improved by rewording of different items for greater clarification and it was shortened for easier administration. The MSQ v.2.1 is intended to respond to a perceived need to develop a health status measure that would adequately focus on the physical and emotional limitations which are typically associated with migraine headaches. This instrument has also been translated in a number of languages.

For more information, please e-mail M. Chris Runken at michael.c.runken@gsk.com

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24-Hour Migraine Quality of Life Questionnaire (24-hr-MQOLQ)

Original Version Author: Nancy C. Santanello

The 24-Hr-MQOLQ is a 15-item, self-administered questionnaire aimed at assessing the quality of life of migraine sufferers within a 24-hour period after having taken migraine medication and within the first 24 hours of a migraine attack. The items cover five domains, which are work, social, energy, vitality, feeling, concerns, and symptoms. The 24-Hr-MQOLQ is designed to assess the health of specific populations at a point in time.

For more information, please e-mail Nancy Santanello (nancy_santanello@merck.com) or Dawn Moyer (dawn_moyer@merck.com)

 

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St. George's Respiratory Questionnaire- UK Parent Version (SGRQ-UK)

Original Version Author:  Paul Jones

The St. George's Respiratory Questionnaire (SGRQ) is a disease-specific measure used to assess patients with mild to severe airway disease.  Developed by Paul Jones at St. George's Hospital in London in 1990, this measure is a disease-specific instrument designed to measure impact on overall health, daily life, and perceived well-being.  It was developed for use by patients with fixed and reversible airway obstruction.  The measure consists of 50 (76 responses) items that produce three domain scores and one overall score measuring:  Symptom (frequency and severity); Activity (activities that cause or are limited by breathlessness); and Impacts (social functioning, psychological disturbances resulting from airways disease).  It is important to note that Section I (Symptoms) contains items on a five-point Likert scale; Sections II (Activity) and III (Impacts) are dichotomous (yes/no) items.

For more information, please go to www.healthstatus.sgul.ac.uk

 

 

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Seattle Angina Questionnaire (SAQ)

Original Version Author: John Spertus


The SAQ is a 19-item, self-administered questionnaire designed to measure functional status of coronary artery patients. The questionnaire is composed of five scales to assess clinically important dimensions of coronary artery disease: physical limitation, angina stability, angina frequency, treatment satisfaction, and disease perception. The SAQ has been demonstrated to be responsive to both major changes in clinical status (i.e., improvement in angina-related problems as a result of angioplasty) and smaller changes in angina-related functional status.

For more information, please go to www.cvoutcomes.org


 

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Urinary Incontinence-Specific Quality of Life Instrument (I-QOL)

Original Version Authors: Donald L. Patrick, Mona Martin, Donald M. Bushnell

The I-QOL is a self-report instrument containing 22 items covering three domains of quality of life: avoidance and limiting behavior (8 items), psychosocial impacts (9 items) and social embarrassment (5 items). The I-QOL is intended to be a quality of life measure specific to persons with urinary incontinence and reflective of significant concerns related to urinary incontinence symptoms. Each item is rated from "extremely" to "not at all." Each domain can be scored separately, and a total score can also be calculated. Higher scores are better quality of life. The I-QOL is intended to be able to assess the health of specific populations at a point in time and to monitor health of specific populations over time. It is meant to be used in epidemiological investigations, clinical trials and program evaluations.

This instrument has also been translated into a number of languages.

Please visit www.seaqolgroup.org or e-mail seaqol@u.washington.edu for more information.


©January 2006 Medical Outcomes Trust