questionnaire about the left side of their body 5 Please tick one box for each statement. The respondent should enter a tick (check/mark) in one box only for each statement. In countries where it is more common to enter a cross, the term ‘cross’ may be used instead, with an X instead of 6* Q1 – 14 FA & Foot During the past 4 All the questions relate to within the four weeks leading up to the day when the questionnaire is filled in. ‘this has applied to me’: the respondent has experienced the following statement during the past four week period. weeks this has applied to me: 7 I have pain in my foot/ankle The respondent has pain in their foot or ankle. Pain: An unpleasant physical sensation ranging from mild discomfort to agonising distress. 8 Q1 Foot I have pain in my foot The respondent has pain in their foot. 1
14 Q4 FA I walk slowly because of pain in my foot/ankle The respondent walks slowly/not fast as a result of pain in their foot or ankle. Developer: ‘as a result of pain’ can include ‘in anticipation of pain’ Note to translators: ‘because of pain’ refers to both the pain felt by the respondent before they start the activity in question, and to the pain they anticipate/expect to experience after they have started the activity. This should be considered when translating this item, and items 19, 20 & 21. 15 Q4 Foot I walk slowly because of pain in my foot The respondent walks slowly/not fast as a result of pain in their foot. Developer: ‘as a result of pain’ can include ‘in anticipation of pain’ Note to translators: ‘because of pain’ refers to both the pain felt by the respondent before they the activity in question, and to the pain they anticipate/expect to experience after they have started the activity. This should be considered when translating this item, and items 40, 41 & 42. 16 I have to stop and rest my foot/ankle because of pain The respondent has to stop (walking, standing, other activities) and rest their foot or ankle as a result of pain. Rest: repose, relax, take weight off foot or ankle. Developer: Resting may include sitting or elevating foot/ankle to get the weight off it. 17 Q5 Foot I have to stop and rest my foot because of pain The respondent has to stop (walking, standing, other activities) and rest their foot as a result of pain. Developer: Resting may include sitting or elevating foot to get the weight off it.
Q14 FA my social or recreational activities because of pain in my foot/ankle able to do all of social or recreational activities as a result of pain in their foot or ankle. Social: involving the company of other people Recreational: any activity done for pleasure – this could be walking, sports, playing with children, etc. ‘Recreational activities’ can also be translated as ‘hobbies’. 34 Q14 Foot I am unable to do all The respondent is not able to do all of their social or recreational activities as a result of pain in their foot. Note to translators: ‘Recreational activities’ can also be translated as ‘hobbies’. my social or recreational activities because of pain in my foot 35* FA & Foot During the past 4 All the questions relate to within the four weeks leading up to the day when the questionnaire is filled in. weeks... 36 Q15 FA How would you describe the pain you usually have in your foot/ankle? The respondent is being asked how they would describe the pain they normally experience in their foot or ankle. Developer: Normally – as in ‘most often’ 37 Q15 Foot How would you describe the pain you usually have in your foot? The respondent is being asked how they would describe the pain they normally experience in their foot. Developer: Normally – as in ‘most often’ 38* R15 FA & Foot None Verymild Mild Moderate Severe The respondent does not usually have any pain. They usually have very mild/slight pain. They usually have mild/slight pain. They usually have a moderate/medium level of pain. They usually have severe pain.
39 Q16 FA Have you been troubled by pain from your foot/ankle in bed at night? The respondent is being asked if they have been troubled by pain from their foot or ankle in bed at night. Troubled: annoyed/bothered/distu rbed In bed at night: during the night, whilst the respondent is in bed, usually asleep. 40 Q16 Foot Have you been troubled by pain from your foot in bed at night? The respondent is being asked if they have been troubled by pain from their foot in bed at night. 41* R16 FA & Foot No nights Only or 2 nights Some nights Most nights Every night The respondent was not troubled by pain on any nights during the past 4 weeks. The respondent was troubled by pain only for one or two nights. They were troubled some nights. They were troubled most nights. They were troubled every night by pain. 42 FA & Foot Finally, please check that you have answered every Lastly (after reaching the end of the questionnaire), the respondent should go back and check (make sure) that they have given a response for every question. question. 43 FA & Foot Thank you very much. This line thanks the respondent for filling in the questionnaire.