Appendix 1. Identified Patient Reported Outcome Measures, by Domain

Appendix 1. Identified Patient Reported Outcome Measures, by Domain.

1. PROMIS-Pain Intensity SF 3a

2. PROMIS-Pain Interference SF 6b

3. PROMIS-Pain Interference SF 8a (alternative to 6b)

4. PROMIS Pain Behavior SF 7a

5. PROMIS PAIN Behavior

6. Visual Analog Scale for Pain (VAS Pain)

7. Numeric Rating Scale for Pain (NRS Pain)

8. McGill Pain Questionnaire (MPQ)

9. McGill Pain Questionnaire (MPQ) Short Form

10. SF-36 Bodily Pain

11. Measure of Intermittent and Constant Arthritis (ICOAP) – KNEE

12. Measure of Intermittent and Constant Arthritis (ICOAP) – HIP

13. KOOS-Pain subscale

14. HOOS-Pain subscale

15. WOMAC-Pain subscale

16. BRFSS Pain question

17. AIMS2-Pain subscale

18. Brief Pain Inventory (BPI) -- Short Form

19. Chronic Pain Grade Scale – public domain

20. Lequesne Index of Severity for OA of the Hip (LISOH)

21. Lequesne Index of Severity for OA of the Knee (LISOK)

22. Oxford Knee Score-Pain subscale 23. Oxford Hip Score-Pain subscale

24. Harris Hip Score – SA and IA

25. Nottingham Health Profile pain scale

26. Knee Pain Screening Tool

FUNCTION

1. PROMIS Mobility

2. PROMIS Function SF

3. PROMIS Physical Functioning SF 10a

4. PROMIS Physical Functioning SF 20a

5. KOOS-PS

6. KOOS Knee Survey

7. HOOS Hip Survey

8. HOOS-PS

9. IKDC Subjective Knee Evaluation Form

10. KOS-ADL

11. Lysholm Knee Scoring Scale

12. Oxford Knee Score

13. WOMAC

14. Activity Rating Scale

15. Tegner Activity Scale

16. HAQ-20

17. MHAQ

18. SF-36 Physical Function subscale  fee required 19. Lequesne Index of Severity for OA of the Hip (LISOH)

20. AIMS2

21. AIMS2 SF

22. MMWR NRS

23. Lequesne Index of Severity for OA of the Hip (LISOH)

24. AAOS Hip and Knee Outcomes Questionnaire

25. Oxford Hip Score

26. Lower Extremity Functional Scale

27. EQ-5D-3L  fee required

FATIGUE

1. PROMIS Fatigue Short Form 8a

2. PROMIS Fatigue Short Form 7a

3. Bristol RA Fatigue Scale Multi-Dimensional Questionnaire (BRAF MDQ)

4. Bristol RA Fatigue Numerical Rating Scales (BRAF NRS)

5. Checklist Individual Strength Therapy (CI20R) -- 20 item

6. Checklist Individual Strength Therapy (CIS8R) -- 8 item

7. Fatigue Severity Scale (FSS)

8. Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F)

9. Multidimensional Assessment of Fatigue (MAF)

10. Multidimensional Fatigue Inventory (MFI-20)

11. Profile of Fatigue (ProF)

12. Short Form 36 Vitality (SF 36 VT)

13. Visual Analog Scale (VAS) – Fatigue 14. Numerical (10com) 0-10 scale (Stanford)

1. PROMIS Sleep Disturbance SF 8a

2. PROMIS Sleep Disturbance SF 8b

3. PROMIS Sleep Related Impairment SF 8a

4. Medical Outcome Study (MOS) Sleep scale

5. Epworth Sleepiness Scale (ESS)

6. Functional Outcome of Sleep Questionnaire (FOSQ)

7. Functional Outcome of Sleep Questionnaire Short Form (FOSQ-SF)

8. Insomnia Severity Index

9. Pittsburgh Sleep Quality Index (PSQI)

10. Berlin Questionnaire (for sleep apnea)

11. STOP-BANG Sleep Apnea Questionnaire

12. General Sleep Disturbance Scale

13. Leeds Evaluation Questionnaire

14. VAS sleep

15. Chronic Pain Sleep Inventory (CPSI)

16. Poor Sleep Quality

17. Sleep Impairment Index (SII)

18. Nottingham Health Profile sleep subscale

19. BPI interference with sleep item Appendix 2. Contact websites for Reviewed Patient Report Outcome Measures, by

Domain.

1. PROMIS-Pain Intensity SF 3a – contact the PCORI website for access to short forms 

https://www.assessmentcenter.net/PromisForms.aspx

2. PROMIS-Pain Interference SF 6b – contact the PCORI website for access to short forms 

3. PROMIS-Pain Interference SF 8a (alternative to 6b) – contact the PCORI website for access to short

forms  https://www.assessmentcenter.net/PromisForms.aspx

4. Numeric Rating Scale for Pain (NRS Pain) – Stanford Patient Education Research Center 

http://patienteducation.stanford.edu/research/

5. Measure of Intermittent and Constant Arthritis (ICOAP) KNEE – available through OARSI website 

http://www.oarsi.org/index2.cfm?section=Publications_and_Newsroom&content=Indexes

6. Measure of Intermittent and Constant Arthritis (ICOAP) HIP – available through OARSI website 

http://www.oarsi.org/index2.cfm?section=Publications_and_Newsroom&content=Indexes

7. KOOS-Pain subscale -- http://www.koos.nu/ (click on KOOS under “Questionnaires, user’s guides

and scoring files – click on English to secure the pdf -- go to the 9-item Pain scale)

8. HOOS-Pain subscale -- http://www.koos.nu/ (click on HOOS under “Questionnaires, user’s guides

and scoring files – click on English to secure the pdf -- go to the 9-item Pain scale)

9. AIMS2-Pain scale --

http://www.proqolid.org/instruments/arthritis_impact_measurement_scales_aims2?

private=yes&fromSearch= (under “Copy of the original questionnaire”, click on “AIMS2 in English for

the USA – go to the 5-item Pain scale, questions 38-42) FUNCTION

10. PROMIS Mobility – contact the PCORI website for access to short forms 

11. PROMIS Function SF – contact the PCORI website for access to short forms 

12. KOOS-PS -- http://www.koos.nu/ (click on KOOS-PS under “Questionnaires, user’s guides and

scoring files – click on English to secure the pdf)

13. HOOS-PS -- http://www.koos.nu/ (click on HOOS-PS under “Questionnaires, user’s guides and

scoring files – click on English to secure the pdf)

14. MHAQ – www.iche.edu/newsletter/MHAQ.pdf

15. MMWR NRS (Cheng) -- yes/no question “Have you ever been told by a doctor or other health

professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or

fibromyalgia?” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5939a1.htm

16. AAOS Hip and Knee Outcomes Questionnaire – www.aaos.org/research/outcomes/Hip_Knee.pdf

FATIGUE

15. PROMIS Fatigue Short Form 8a – contact the PCORI website for access to short forms 

16. PROMIS Fatigue Short Form 7a – contact the PCORI website for access to short forms 

17. Bristol RA Fatigue Numerical Rating Scales (BRAF NRS) -- available from the developer 

http://www1.uwe.ac.uk/hls/research/healthandclinicalresearch/researchareas/longtermconditions/

fatiguescales/brafscales.aspx 18. Fatigue Severity Scale (FSS) – requires permission from the author (Lauren B Krupp, MD)  email

[email protected]

19. Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) – access through the FACIT.org

website  http://www.facit.org/FACITOrg/Questionnaires

20. Multidimensional Assessment of Fatigue (MAF) – register at the author’s website 

http://www.son.washington.edu/research/maf/

21. Numeric Rating Scale – Stanford Patient Education Research Center 

http://patienteducation.stanford.edu/research/

20. PROMIS Sleep Disturbance SF 8a – contact the PCORI website for access to short forms 

21. PROMIS Sleep Disturbance SF 8b – contact the PCORI website for access to short forms 

22. PROMIS Sleep Related Impairment SF 8a – contact the PCORI website for access to short forms 

23. Medical Outcome Study (MOS) Sleep scale --

http://www.rand.org/health/surveys_tools/mos/mos_sleep.html

24. Insomnia Severity Index (ISI) -- contact Charles M. Morin, PhD for permission 

[email protected]

25. Pittsburgh Sleep Quality Index (PSQI) -- permission for use from Daniel J. Buysse, MD 

[email protected]

26. Berlin Questionnaire (for sleep apnea) -- http://www.google.com/url?

sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CC8QFjAA&url=http%3A%2F %2Fwww.commondataelements.ninds.nih.gov%2FCRFs%2FBerlin%2520Questionnaire.pdf%3FCrfId

%3DF0781&ei=jE3pUaTnFdWv4AOC4YHgCg&usg=AFQjCNE9en_t7wqzwFa7q8l9qkRN_xf-

3w&sig2=VGetAhBmT0tarJWdtlgVmA&bvm=bv.49478099,d.dmg

27. STOP-BANG Sleep Apnea Questionnaire -- http://www.google.com/url?

sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CC8QFjAA&url=http%3A%2F

%2Fwww.sleepapnea.org%2Fassets%2Ffiles%2Fpdf%2FSTOP-BANG

%2520Questionnaire.pdf&ei=y03pUe3iOJXj4AOL14GoAg&usg=AFQjCNEX3ODJ4A1xbWgSLKw-

o9s47mnlFg&sig2=WDh7peKIfQ_6gHWuO14bRg&bvm=bv.49478099,d.dmg