Table 1 Lists of questions for the patients and caregivers for questionnaire study
From: Multicenter questionnaire survey for sporadic inclusion body myositis in Japan
Basic information | Hospital |
Date | |
Doctor’s name | |
Name | |
Date of birth and age | |
Sex | |
Address/Phone/E-mail | |
Life/Past History | Development |
Exercise Capacity at School | |
Works | |
Preference | |
Symptoms | Initial symptom |
Milestones: wheelchair, cane | |
Mental/psychological stress | |
Economic matters | |
Diagnosis | Age at admission |
Method of diagnosis | |
Family history | |
For Caregiver | Activities of daily life |
Mental/psychological stress |