EQ-5D Sample Questionnaire
For Demonstration Only
(Calculated scores are for illustration only and not based on official algorithms)

EQ-5D is a measure of health status for use in evaluating health and healthcare. It provides a simple descriptive profile and generates a single index value for heath status on which full health is assigned a value of 1 and death a value of 0. EQ-5D has been specially designed to complement other quality of life measures such as the SF-36, NHP, SIP or disease-specific measures.

One of the components of the EQ-5D is the self-classifier which describes health status according to 5 dimensions. Each dimension is divided into 3 levels.

                 
MOBILITY
I have no problems in walking about
I have some problems in walking about
I am confined to bed
SELF-CARE
I have no problems with self-care
I have some problems washing or dressing myself
I am unable to wash or dress myself
USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities)
I have no problems with performing my usual activities
I have some problems with performing my usual activities
I am unable to perform my usual activities
PAIN / DISCOMFORT
I have no pain or discomfort
I have moderate pain or discomfort
I have extreme pain or discomfort
ANXIETY / DEPRESSION
I am not anxious or depressed
I am moderately anxious or depressed
I am extremely anxious or depressed

By combining different levels from each dimension, EQ-5D defines a total of 243 health states. These may be converted to a score using "sets of values" derived from general population samples.

Return to HDS Home Page

Adapted by Health Decision Strategies, LLC