PRINT FOR REVIEW ONLYMissoula-Vitas Quality of Life Index (tm)
INSTRUCTIONS:
|
|
O
|
O
|
O
|
O
|
O
|
SYMPTOM
1. I feel sick all the time.
|
O
|
O
|
O
|
O
|
O
|
2. I am satisfied with current control
of my symptoms.
|
O
|
O
|
O
|
O
|
O
|
| 3. | Despite physical discomfort, in general I can enjoy my days. |
OR |
Physical discomfort overshadows and opportunity for enjoyment. |
|
O
|
O
|
O
|
O
|
O
|
FUNCTION
| 4. |
I am still able to do many of the
things I like to do.
|
OR |
I am no longer able to do many of the things I like to do. |
|
O
|
O
|
O
|
O
|
O
|
| 5. | I accept the fact that I can not do many of the things I used to do. |
OR |
I am disappointed that I can not do many of the things I used to do. |
|
O
|
O
|
O
|
O
|
O
|
6. My contentment with life depends upon being active and being independent in my personal care.
|
O
|
O
|
O
|
O
|
O
|
INTERPERSONAL
|
O
|
O
|
O
|
O
|
O
|
8. At present, I spend as much time as I want to with family
and friends.
|
O
|
O
|
O
|
O
|
O
|
9. It is important to me to have close personal relationships.
|
O
|
O
|
O
|
O
|
O
|
WELL BEING
| 10. | My affairs are in order; I could die today with a clear mind. |
OR |
My affairs are not in order; I am worried that many things are unresolved. |
|
O
|
O
|
O
|
O
|
O
|
11. I am more satisfied with myself as a person now than I was before my illness.
|
O
|
O
|
O
|
O
|
O
|
12. It is important to me to be at peace with myself.
|
O
|
O
|
O
|
O
|
O
|
TRANSCENDENT
| 13. | I have a better sense of meaning in my life now than I have had in the past. |
OR |
I have less of a sense of meaning in my life now than I have had in the past. |
|
O
|
O
|
O
|
O
|
O
|
| 14. | Life has become more precious to me; every day is a gift. |
OR |
Life has lost all value for me; every
day is a burden.
|
|
O
|
O
|
O
|
O
|
O
|
15. It is important to me to feel that my life has meaning.
|
O
|
O
|
O
|
O
|
O
|
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