Pelvic Floor Impact Questionnaire

Please check one box for each item below choosing the one that best describes your situation.

Pelvic floor impact questionnaire.

0 up to 7 1 between 8 10 2 between 11 15 3 more than 15 2. Consider your experiences during the last month. People with pelvic floor disorders. Some women find that bladder bowel or vaginal symptoms affect their activities relationships and feelings.

Pelvic floor impact questionnaire short form 7 some women find that bladder bowel or vaginal symptoms affect their activities relationships and feelings. It was created by barber and colleagues 2004 to save time yet remain effective in clinical and research encounters. All of the items use the following response scale. For each question check the response that best.

This test was identified by apta s section on women s health for use in functional limitation reporting. Pelvic floor impact questionnaire short form 7 pfiq 7 pelvic floor impact questionnaire short form 7 pfiq 7 tests measures. These statements are included because they will help your health care provider. It is a health related quality of life questionnaire for women with pelvic floor conditions to fill out.

For each question place an x in the response that best describes how much your activities relationships or feelings have been. Pfiq 7 instructions. The pelvic floor impact questionnaire 7 pfiq 7 is a shortened less comprehensive version of the pelvic floor impact questionnaire pfiq. Pelvic floor impact questionnaire short form 7 pfiq 7 the pfiq 7 has 7 questions and each question has 3 separate responses one for each of 3 scales.

Pelvic floor disability index pfdi 20 questionnaire appropriate for women 20 questions assesses levels of disability and distress how much it bothers you subsections assess pelvic organ prolapse pop distress colorectal anal distress and urinary distress pelvic floor impact questionnaire pfiq 7 questionnaire appropriate for women 7 questions assesses impact of pelvic symptoms on. The australian pelvic floor questionaire please circle your most applicable answer. How many times to you get up at night to pass urine. Pelvic floor impact questionnaire short form 7 pfiq 7 name date dob instructions.

How many times do you pass urine in the day. Some of the statements deal with personal subjects. Pelvic floor impact questionnaire pfiq 7 patient name. A seven question self report measure assessing pelvic floor impact on qol daily activities and emotional health.

Previously the 93 item pfiq long form was used but the pfiq 7 has been developed and demonstrated substantial validity and reliability. For each question place an x in the response that best.