Qolie 10
Qolie 10
Qolie 10
QOLIE-10-P
QOLIE-10-P All versions copyright by the QOLIE Development Group All rights reserved.
Todays Date
dd
yy
Your Name_________________________
Your Age: ___ ___ years
INSTRUCTIONS
The QOLIE-10-P is a brief survey of health-related quality of life for adults with epilepsy. There are 10 questions
about health and daily activities, one question about how much distress you feel about problems and worries
related to epilepsy, and a review of what bothers you most. This questionnaire should be completed only by the
person who has epilepsy (not a relative or friend) because no one else knows how YOU feel.
Answer every question by circling the appropriate number (1, 2, 3...). If you are unsure about how to answer a
question, please give the best answer you can and write a comment or explanation on the side of the page.
These notes may be useful if you discuss the QOLIE-10-P with your doctor. Completing the QOLIE-10-P before
and after treatment changes may help you and your doctor understand how the changes have affected your life.
These questions are about how you have been FEELING and the types of problems you have been having
during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have
been feeling.
How much of the time during the past 4 weeks
Most
of the
time
A good bit
of the
time
Some
of the
time
A little
of the
time
None
of the
time
A great deal
A lot
Somewhat
Only a little
Not at all
3. How much of the time during the past 4 weeks your epilepsy
or antiepileptic drugs have caused trouble with
driving (or other transportation)
Not at all
bothersome
Extremely
bothersome
QOLIE-10-P All versions copyright by the QOLIE Development Group All rights reserved.
Page 1
Not at all
bothersome
Extremely
bothersome
Very
afraid
Somewhat
afraid
Not very
afraid
Not afraid
at all
9. How afraid are you of having a seizure during the next 4 weeks?
10. How has your QUALITY OF LIFE been during the past 4 weeks
(that is, how have things been going for you)?
(Circle one number
on the ladder)
Very good:
could hardly have been
better
Pretty good
Pretty bad
Very bad:
could hardly have been
worse
Page 2
Reviewing all the questions you have answered above, consider the overall impact of these problems on your
quality of life in the past 4 weeks. (Circle one number)
Not at all
Somewhat
Moderately
A lot
Very much
Considering ALL the questions you have answered, please indicate the areas related to your epilepsy that are
most IMPORTANT to you NOW.
12. Number the following topics from 1 to 7 with 1 corresponding to the most important topic and 7 to the
least important one. Please use each number only once.
A. Energy (tiredness)
B. Emotions (mood)
C. Daily activities (work, driving, social & other activities)
D. Mental function (thinking, concentrating, memory)
E. Medication effects (physical, mental)
F. Worry about seizures (impact of seizures)
G. Overall quality of life
This copy of the QOLIE-10-P is provided by the QOLIE Development Group.We wish you success in
living your life with epilepsy!
Page 3