SFESurvey

Survey/Test Generator and Grader

Multiple Sclerosis Impact Scale (MSIS-29)

In the past two weeks, how much has your MS limited your ability to... Do physically demanding tasks?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much has your MS limited your ability to... Grip things tightly (e.g. turning on taps)?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much has your MS limited your ability to... Carry things?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Problems with your balance?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Difficulties moving about indoors?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Being clumsy?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Stiffness?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Heavy arms and/or legs?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Tremor of your arms or legs?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Spasms in your limbs?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Your body not doing what you want it to do?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Having to depend on others to do things for you?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Limitations in your social and leisure activities at home?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Being stuck at home more than you would like to be?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Difficulties using your hands in everyday tasks?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Having to cut down the amount of time you spent on work or other daily activities?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Problems using transport (e.g. car, bus, train, taxi, etc.)?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Taking longer to do things?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Difficulty doing things spontaneously (e.g. going out on the spur of the moment)?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Needing to go to the toilet urgently?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Feeling unwell?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Problems sleeping?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Feeling mentally fatigued?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Worries related to your MS?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Feeling anxious or tense?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Feeling irritable, impatient, or short tempered?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Problems concentrating?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Lack of confidence?

Not at all

A little

Moderately

Quite a bit

Extremely

In the past two weeks, how much have you been bothered by... Feeling depressed?

Not at all

A little

Moderately

Quite a bit

Extremely