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    QVAS

    Uploaded by

    Anjaswati Farida Adyana
    The document provides instructions for a patient to complete a quadrupled visual analogue scale to self-report pain levels. It asks the patient to circle a number between 0-10 for four questions to indicate their pain right now, average pain, best pain, and worst pain, with 0 being no pain and 10 being worst possible pain. Space is provided under each question to circle the number. The form also requests other comments and includes the patient ID number.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    QVAS

    Uploaded by

    Anjaswati Farida Adyana
    480 views1 page
    The document provides instructions for a patient to complete a quadrupled visual analogue scale to self-report pain levels. It asks the patient to circle a number between 0-10 for four questions to indicate their pain right now, average pain, best pain, and worst pain, with 0 being no pain and 10 being worst possible pain. Space is provided under each question to circle the number. The form also requests other comments and includes the patient ID number.

    Original Description:

    Quadruple Visual analogue Scale

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    © © All Rights Reserved

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    The document provides instructions for a patient to complete a quadrupled visual analogue scale to self-report pain levels. It asks the patient to circle a number between 0-10 for four questions to indicate their pain right now, average pain, best pain, and worst pain, with 0 being no pain and 10 being worst possible pain. Space is provided under each question to circle the number. The form also requests other comments and includes the patient ID number.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    480 views1 page

    QVAS

    Uploaded by

    Anjaswati Farida Adyana
    The document provides instructions for a patient to complete a quadrupled visual analogue scale to self-report pain levels. It asks the patient to circle a number between 0-10 for four questions to indicate their pain right now, average pain, best pain, and worst pain, with 0 being no pain and 10 being worst possible pain. Space is provided under each question to circle the number. The form also requests other comments and includes the patient ID number.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    QUADRUPLE VISUAL ANALOGUE SCALE

    Patient ID Number:_______________________________
    Please read carefully:
    Instructions: Please circle the number that best describes the question being asked.
    Note:

    If you have more than one complaint, please answer each question for each individual complaint and indicate the score for each
    complaint. Please indicate your pain level right now, average pain, and pain at its best and worst.

    Example:

    No pain

    Elbow
    Wrist
    Shoulder
    ________________________________________________________________________________
    0
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    worst possible pain

    1 What is your pain RIGHT NOW?

    No pain
    0

    ________________________________________________________________________________
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    worst possible pain

    2 What is your TYPICAL or AVERAGE pain?

    No pain
    0

    ________________________________________________________________________________
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    worst possible pain

    3 What is your pain level AT ITS BEST (How close to 0 does your pain get at its best)?

    No pain
    0

    ________________________________________________________________________________
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    worst possible pain

    4 What is your pain level AT ITS WORST (How close to 10 does your pain get at its worst)?

    No pain
    0

    ________________________________________________________________________________
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    worst possible pain

    OTHER COMMENTS:
    ________________________________________________________________________________________________________________
    ________________________________________________________________________________________________________________
    ______________________________________________
    Examiner
    Reprinted from Spine, 18, Von Korff M, Deyo RA, Cherkin D, Barlow SF, Back pain in primary care: Outcomes at 1 year, 855-862, 1993, with permission from Elsevier
    Science.

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