The questions take approximately 1-2 minutes
The questionnaire can be completed anytime, even when you aren’t experiencing symptoms or when they seem very mild. You may like to do it regularly as a way of monitoring your symptoms.
Consider sharing the results with your doctor
They can quickly assess how your symptoms are impacting you, and make plans to help you manage them.
How to answer
Select the option that best describes how MS has affected each function. For example, if it takes you longer to type or text, you might rate your hand function as “mildly limited”. If you gave up typing you might rate your hand function as “very limited”.
1.How much has MS affected your walking and mobility?
2.How much has your hand function and dexterity (e.g. hand tremors and hand coordination) been affected by your MS?
3.How have you been impacted by muscle stiffness and spasticity (e.g. muscle cramps or muscle tightening)?
4.How much has any bodily pain (e.g. achiness and tenderness) impacted you?
5.How have any sensory symptoms such as numbness, tingling or burning affected you?
6.Have bladder control symptoms (e.g. urinary urgency, frequency or hesitancy) affected you?
7.What impact has fatigue had on you?
8.How has MS affected your vision (e.g. blurry vision, double vision)?
9.How much have you been affected by dizziness (e.g. feeling off balance, 'spinning' or vertigo)?
10.How much is MS impacting your cognitive functioning (e.g. memory, concentration)?
11.Are you experiencing depression (e.g. low mood or depressed thoughts) and how is this impacting you?
12.Are you feeling anxious (e.g. feelings of stress or panic attacks) & how does this affect you?
This tool is helpful to see how your MS symptoms are impacting your life. It is not intended to diagnose symptoms or measure their severity. That is something that your doctor will do.
Print your results and take them to your GP or neurologist appointment so that they can better understand how the symptoms are affecting you.