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King’s Sarcoidosis Questionnaire
This questionnaire is designed to assess the impact of sarcoidosis
on various aspects of your life. Read each question carefully and
select the answer that best applies to you. Please answer ALL
questions, as honestly as you can. This questionnaire is
confidential. All questions relate to how SARCOIDOSIS has affected
your health.
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General Health Status
In the last 2 weeks ... |
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1. |
I have felt frustrated |
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2. |
I have had trouble concentrating |
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3. |
I have lacked motivation |
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4. |
I have felt tired |
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5. |
I have felt anxious |
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6. |
I have felt aches and pains in my muscles/joints |
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7. |
I have felt embarrassed |
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8. |
I have worried about my weight |
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9. |
I have worried about my sarcoidosis |
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10. |
Tiredness has interfered with my normal social
activities such as going out with friends/family
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Lung
Does sarcoidosis affect your lungs?
yes
no (go to next section)
In the last 2 weeks ... |
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11. |
My cough has caused pain/discomfort |
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12. |
I have been breathless climbing stairs or walking
up slight inclines |
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13. |
I have had to take deep breaths, also known as
‘air hunger’ |
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14. |
My chest has felt tight |
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15. |
I have had episodes of breathlessness |
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16. |
I have experienced chest pains
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Medication
Are you taking any medication for sarcoidosis?
yes
no (go to next section)
In the last 2 weeks ... |
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17. |
I have worried about side effects of my medication
for sarcoidosis |
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18. |
I have felt worse because of my medication |
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19. |
I have gained weight because of my medication
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Skin
Does sarcoidosis affect your skin?
yes
no (go to next section)
In the last 2 weeks ... |
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20. |
I have been bothered by my skin problems |
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21. |
I have been concerned about changes in colour of
my skin lesions |
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22. |
I have been embarrassed about my skin
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Eyes
Does sarcoidosis
affect your eyes?
yes
no (go to the end of the questionnaire)
In the last 2 weeks ... |
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23. |
I have had dry eyes |
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24. |
I have had difficulty with bright lights |
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25. |
My eyes have been red |
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26. |
I have had pain in/or around the eyes |
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27. |
I have had difficulty reading |
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28. |
I have had blurred vision |
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29. |
I have been worried about my eyesight |
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