SS-QOL Scoring Sheet
Name/ID:___________________________ d.o.b.:____________ Δ:_________________ Date:________________
SAQOL-39g Scoring Sheet
DURING THE PAST WEEK (Repeat as in SAQOL-39)
|Item ID |How much trouble did you have |Couldn’t do it|A lot of |Some trouble|A little |No trouble |Domain scores |
| |(Repeat before each item or as necessary) |at all |trouble | |trouble |at all | |
| | | | | | | |Physical |Comm. |Psycho-social |
|SC1. |preparing food? |1 |2 |
| | | | |
| | | | |
| |Physical score |(SC items + M items + W items + UE items) / 16 | | | |
| |Communication score |(L items + FR9 + SR8) / 7 | | | |
| |Psychosocial score |(T items + P items + MD items + E items + FR7 + SR1+SR4+SR5+SR7) / 16 | |
1. During administration: For each item, circle number that correspondents to respondent’s choice
2. To calculate domain scores: Transfer each number to shaded area in same row. Average shaded boxes per column to calculate domain scores
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