Skip to main content

Advertisement

Table 2 List of questions for the patients and caregivers

From: The updated retrospective questionnaire study of sporadic inclusion body myositis in Japan

Basic information Hospital
  Date
  Doctor’s name
  Patient’s Name
  Date of birth and age
  Sex
  Address/Phone/E-mail
Life/Past History Development
  Exercise Capacity at School
  Works
  Preference of food
  Economic matters
Symptoms Initial symptom: unable to stand-up etc.
  Milestones: wheelchair, cane, dysphagia
  Mental/psychological stress
Diagnosis Age at admission
  Method of diagnosis: muscle biopsy
  Family history, Past history
Therapy Rehabilitation
  Steroid/IVIG/others
  Interferon
For Caregiver Activities of daily life
  Mental/psychological stress
  Cognitive decline: none, age-appropriate, diagnosed as dementia, medication
Functional Scale Modified IBMFRS