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© M.S. Lewis-Jones, A.Y. Finlay Jan 2000

This document is a quality of life index questionnaire for infants with dermatitis. It contains 10 questions about the infant's dermatitis severity, itching, mood, sleep, interference with activities, mealtimes, treatment problems, discomfort with dressing, and problems at bathtime over the last week.

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Marie Antoinette Villanueva
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96 views1 page

© M.S. Lewis-Jones, A.Y. Finlay Jan 2000

This document is a quality of life index questionnaire for infants with dermatitis. It contains 10 questions about the infant's dermatitis severity, itching, mood, sleep, interference with activities, mealtimes, treatment problems, discomfort with dressing, and problems at bathtime over the last week.

Uploaded by

Marie Antoinette Villanueva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Draft 7 INFANTS’ DERMATITIS QUALITY OF LIFE INDEX (IDQOL)

Name: Date: IDQOL


Address: SCORE

The aim of this chart is to record how your child’s dermatitis has been. Each question concerns THE LAST WEEK ONLY. Please
could you answer every question.

Dermatitis Severity
Over the last week, how severe do you Extremely severe 
think your child’s dermatitis has been?; Severe 
i.e. how red, scaly, inflamed or widespread. Average 
Fairly good 
None 
Life Quality Index
1. Over the last week, how much has your All the time 
child been itching and scratching? A lot 
A little 
None 

2. Over the last week, what has your child’s Always crying,
mood been? extremely difficult 
Very fretful 
Slightly fretful 
Happy 

3. Over the last week approximately how More than 2 hrs 


much time on average has it taken to 1 - 2 hrs 
get your child off to sleep each night? 15mins - 1 hr 
0-15mins 

4. Over the last week, what was the total 5 hrs or more 
time that your child’s sleep was disturbed 3 - 4 hrs 
on average each night? 1 - 2 hrs 
Less than 1 hour 

5. Over the last week, has your child’s eczema Very much 
interfered with playing or swimming? A lot 
A little 
Not at all 

6. Over the last week, has your child’s eczema Very much 
interfered with your child taking part in or A lot 
enjoying other family activities? A little 
Not at all 

7. Over the last week, have there been Very much 


problems with your child at mealtimes A lot 
because of the eczema? A little 
None 

8. Over the last week, have there been problems Very much 
with your child caused by the treatment? A lot 
A little 
None 

9. Over the last week, has your child’s eczema Very much 
meant that dressing and undressing the A lot 
child has been uncomfortable? A little 
None 

10. Over the last week how much has your child Very much 
having eczema been a problem at bathtime? A lot 
A little 
None 

Please can you check that you have answered every question.
© M.S. Lewis-Jones, A.Y. Finlay Jan 2000

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