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    APS Patient Outcome Questionnaire (APS-POQ-R) APS Patient Outcome Questionnaire (APS-POQ-R)

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    Aryanto Anto
    This document is a 13-question patient outcome questionnaire assessing a patient's pain levels, pain interference, side effects, satisfaction with pain treatment, and use of non-pharmacological pain management strategies during the first 24 hours following a hospital procedure or surgery. The questionnaire uses 0-10 scales to rate levels of least, worst, and average pain; pain interference with activities; and severity of side effects. It also includes questions about pain relief received, participation in treatment decisions, and frequency of encouragement for non-medicine pain management methods.

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    APS Patient Outcome Questionnaire (APS-POQ-R) APS Patient Outcome Questionnaire (APS-POQ-R)

    Uploaded by

    Aryanto Anto
    48 views2 pages
    This document is a 13-question patient outcome questionnaire assessing a patient's pain levels, pain interference, side effects, satisfaction with pain treatment, and use of non-pharmacological pain management strategies during the first 24 hours following a hospital procedure or surgery. The questionnaire uses 0-10 scales to rate levels of least, worst, and average pain; pain interference with activities; and severity of side effects. It also includes questions about pain relief received, participation in treatment decisions, and frequency of encouragement for non-medicine pain management methods.

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    This document is a 13-question patient outcome questionnaire assessing a patient's pain levels, pain interference, side effects, satisfaction with pain treatment, and use of non-pharmacological pain management strategies during the first 24 hours following a hospital procedure or surgery. The questionnaire uses 0-10 scales to rate levels of least, worst, and average pain; pain interference with activities; and severity of side effects. It also includes questions about pain relief received, participation in treatment decisions, and frequency of encouragement for non-medicine pain management methods.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    48 views2 pages

    APS Patient Outcome Questionnaire (APS-POQ-R) APS Patient Outcome Questionnaire (APS-POQ-R)

    Uploaded by

    Aryanto Anto
    This document is a 13-question patient outcome questionnaire assessing a patient's pain levels, pain interference, side effects, satisfaction with pain treatment, and use of non-pharmacological pain management strategies during the first 24 hours following a hospital procedure or surgery. The questionnaire uses 0-10 scales to rate levels of least, worst, and average pain; pain interference with activities; and severity of side effects. It also includes questions about pain relief received, participation in treatment decisions, and frequency of encouragement for non-medicine pain management methods.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Code number:

    APS Patient Outcome Questionnaire (APS-POQ-R)


    The following questions are about pain you experienced during
    the first 24 hours in the hospital or after your operation.
    1. On this scale, please indicate the least pain you had in the first 24 hours:
    0 1 2 3 4 5 6 7 8 9 10
    no pain worst pain possible

    2. On this scale, please indicate the worst pain you had in the first 24 hours:
    0 1 2 3 4 5 6 7 8 9 10
    no pain worst pain possible

    3. On this scale, please indicate the average pain you had in the first 24 hours:
    0 1 2 3 4 5 6 7 8 9 10
    no pain worst pain possible

    4. How often were you in severe pain in the first 24 hours? Please mark your best estimate of the percentage
    of time you experienced severe pain:
    0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
    Never in Always in
    severe pain severe pain

    5. Mark the one number below that best describes how much pain interfered or prevented you from:
    a. Doing activities in bed such as turning, sitting up, repositioning.
    0 1 2 3 4 5 6 7 8 9 10
    Does not interfere Completely interferes
    b. Doing activities out of bed such as walking, sitting in a chair, standing at the sink.
    On 0 1 2 3 4 5 6 7 8 9 10
    bedrest Does not interfere Completely interferes
    c. Falling asleep
    0 1 2 3 4 5 6 7 8 9 10
    Does not interfere Completely interferes
    d. Staying asleep
    0 1 2 3 4 5 6 7 8 9 10
    Does not interfere Completely interferes

    6. Pain can affect our mood and emotions. On this scale, please circle the one number that best shows how
    much the pain caused you to feel:
    a. Anxious 0 1 2 3 4 5 6 7 8 9 10
    Not at all Extremely
    b. Depressed 0 1 2 3 4 5 6 7 8 9 10
    Not at all Extremely
    c. Frightened 0 1 2 3 4 5 6 7 8 9 10
    Not at all Extremely
    d. Helpless 0 1 2 3 4 5 6 7 8 9 10
    Not at all Extremely

    1 APS-POQ-R (-- Over --)


    5268388415
    Code number:

    APS Patient Outcome Questionnaire (APS-POQ-R)


    7. Have you had any of the following side effects? Please mark "0" if no; if yes, please circle the one number
    that best shows the severity of each:
    a. Nausea 0 1 2 3 4 5 6 7 8 9 10
    None Severe
    b. Drowsiness 0 1 2 3 4 5 6 7 8 9 10
    None Severe
    c. Itching 0 1 2 3 4 5 6 7 8 9 10
    None Severe
    d. Dizziness 0 1 2 3 4 5 6 7 8 9 10
    None Severe

    8. In the first 24 hours, how much pain relief have you received? Please circle the one percentage that best
    shows how much relief you have received from all of your pain treatments combined (medicine and
    non-medicine treatments):
    0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
    No Relief Complete Relief

    9. Were you allowed to participate in decisions about your pain treatment as much as you wanted to?
    0 1 2 3 4 5 6 7 8 9 10
    Not at all Very much so

    10. Mark the one number that best shows how satisfied you are with the results of your pain treatment while
    in the hospital:
    0 1 2 3 4 5 6 7 8 9 10
    Extremely Extremely
    Dissatisfied Satisfied

    11. Did you receive any information about your pain treatment options? No Yes
    a. If yes, please mark the number that best shows how helpful the information was:
    0 1 2 3 4 5 6 7 8 9 10
    Not at all helpful Extremely helpful

    12. Did you use any non-medicine methods to relieve your pain? No Yes
    a. If yes, mark all that apply:
    cold pack meditation deep breathing
    listen to music distraction (such as watching TV, reading)
    prayer heat relaxation
    imagery or visualization walking massage
    other (please describe)

    13. How often did a nurse or doctor encourage you to use non-medicine methods?
    Never Sometimes Often

    Thank you for your time and feedback


    2 APS-POQ-R 9239388417

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