adapted from
The American Chronic Pain Association
A Measure Of Function
For People With Pain
10 on the scale reflects activity in a "normal" life
0
- Non-functioning
- Stay in bed all day
- Feel hopeless and helpless about life
1
- Stay in bed at least half the day
- Have no contact with outside world
2
- Get out of bed but don’t get dressed
- Stay at home all day
3
- Get dressed in the morning
- Minimal activities at home
- Contact with friends via phone, email
4
- Do simple chores around the house
- Minimal activities outside of home two days a week
5
- Struggle but fulfill daily home
- responsibilities No outside activity
- Not able to work/volunteer
6
- Work/volunteer limited hours
- Take part in limited social activities on weekends
7
- Work/volunteer for a few hours daily. Can
be active at least five hours a day. - Can make plans to do simple activities on weekends
8
- Work/volunteer for at least six hours daily
- Have energy to make plans for one evening social activity during the week
- Active on weekends
9
- Work/volunteer/be active eight hours daily
- Take part in family life
- Outside social activities limited
10
Normal Quality of Life
- Go to work/volunteer each day
- Normal daily activities each day
- Have a social life outside of work
- Take an active part in family life
Note: This measurement guide is an abbreviated version of the one found at The American Chronic Pain Association (http://www.theacpa.org) website and is used here only for informational purposes. The original file (pdf) is found at
http://www.theacpa.org/documents/Quality_of_Life_Scale.pdf
For more information, contact the ACPA:
Post Office Box 850
Rocklin, CA 95677
916.632-0922 800.533.3231
Fax: 916.632.3208
E-mail: acpa@pacbell.net
Web Page url (for pdf file): http://www.theacpa.org/documents/Quality_of_Life_Scale.pdf
© Scale Copyright 2003 The American Chronic Pain Association Developed by Penney Cowan & Nicole Kelly. File downloaded and converted for use by Bowie PSG on 15 Apr 2007.
