RODS for GBS – CIDP - MGUSP - PDF Document

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  1. RODS for GBS – CIDP - MGUSP INSTRUCTIONS: This is a questionnaire about the relationship between daily activities and your health. Your answers give information about how your polyneuropathy affects your daily and social activities and to what degree you are able to perform your usual activities. Answer each question by marking the correct box (“x”). If you are not sure about your ability to perform a task, you are still requested to mark an answer that comes as close as possible to your judged ability to complete such a task. All questions should be completed. You can only choose one answer to each question. If you situation fluctuates, your answer should be based on how you usually perform the task. If you need assistance or you are using special devices to perform the activity, you are requested to mark "possible, but with some difficulty ". In case you never perform the activity due to your polyneuropathy mark "not possible". Are you able to Mark the best option with “x” Not possible to perform Possible, but with some difficulty Possible, without any difficulty Task [0] [1] [2] 1. read a newspaper/book? eat? brush your teeth? wash upper body? sit on a toilet? make a sandwich? dress upper body? wash lower body? move a chair? 10. turn a key in a lock? 11. go to the general practitioner? 12. take a shower? 13. do the dishes? 2. 3. 4. 5. 6. 7. 8. 9.

  2. 14. do the shopping? 15. catch an object (e.g., ball)? 16. bend and pick up an object? 17. walk one flight of stairs? 18. travel by public transportation? 19. walk and avoid obstacles? 20. walk outdoor < 1 km? 21. carry and put down a heavy object? 22. dance? 23. stand for hours? 24. run?