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Boston Carpal Tunnel Syndrome Questionnaire (BCTQ)
(一) Symptom severity scale (11 items)
1 2 3 4 5
1. How severe is the hand or wrist pain that you have at
night?
Normal Slight Medium Severe Very serious
2. How often did hand or wrist pain wake you up during a
typical night in the past two weeks?
Normal Once 2 to 3 times 4 to 5 times
More than 5
times
3. Do you typically have pain in your hand or wrist during
the daytime?
No pain Slight Medium Severe Very serious
4. How often do you have hand or wrist pain during
daytime?
Normal 1-2 times / day 3-5 times / day
More than 5
times
Continued
5. How long on average does an episode of pain last during
the daytime?
Normal <10minutes 10~60 Continued >60minutes Continued
6. Do you have numbness (loss of sensation) in your hand? Normal Slight Medium Severe Very serious
7. Do you have weakness in your hand or wrist? Normal Slight Medium Severe Very serious
8. Do you have tingling sensations in your hand? Normal Slight Medium Severe Very serious
9. How severe is numbness (loss of sensation) or tingling at
night?
Normal Slight Medium Severe Very serious
10. How often did hand numbness or tingling wake you up
during a typical night during the past two weeks?
Normal Once 2 to 3 times 4 to 5 times
More than 5
times
11. Do you have difficulty with the grasping and use of small
objects such as keys or pens?
Without difficulty Little difficulty
Moderately
difficulty
Very difficulty Very difficult
(二) Functional status scale (8 items:
No difficulty Little difficulty Moderate difficulty Intense difficulty
Cannot perform the
activity at all due to
hands and wrists
symptoms
Writing 1 2 3 4 5
Buttoning of clothes 1 2 3 4 5
Holding a book while reading 1 2 3 4 5
Gripping of a telephone handle 1 2 3 4 5
Opening of jars 1 2 3 4 5
Household chores 1 2 3 4 5
Carrying of grocery basket 1 2 3 4 5
Bathing and dressing 1 2 3 4 5
பபபபபபப பபபபபபப பபபபபப பபபபபபபபபப பபபபபபபபபபபப (BCTQ)
(一) பபபபபபப பபபபப பபபப (11 பபபபபபபபபபப)
1 2 3 4 5
1. இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ
இஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ
இஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇ
2. இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ
இஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇ இஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇ இஇஇஇ
இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ 2 இஇஇஇஇ 3
இஇஇஇ
4 இஇஇஇஇ 5
இஇஇஇ
5
இஇஇஇஇஇ
இஇ இஇஇஇ
3. இஇஇஇஇஇஇ இஇஇஇ இஇஇஇஇஇஇஇஇ
இஇஇஇஇஇ இஇ இஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇஇஇ இஇஇ
இஇஇஇஇஇஇஇஇஇ?
இஇஇ இஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇ
4. இஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇ இஇஇஇ இஇ இஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ 1-2 இஇஇஇ /
இஇஇஇ
3-5 இஇஇஇ /
இஇஇஇ 5 இஇஇஇஇஇஇஇ
இஇஇஇ
இஇஇஇஇஇஇஇ
இஇ
5. இஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇ
இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
இஇஇஇஇ இஇஇஇஇஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ 10 இஇஇஇஇஇஇ
இஇஇ
10~60
இஇஇஇஇஇஇஇஇஇ
>60
இஇஇஇஇஇஇஇ
இஇ
இஇஇஇஇஇஇஇ
இஇ
6. இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ
(இஇஇஇஇஇ இஇஇஇஇஇ) இஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇ
7. இஇஇஇஇஇ இஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇஇ இஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇ
8. இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇ
இஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇ
9. இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ (இஇஇஇஇஇ
இஇஇஇஇஇ) இஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇ
இஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇ
10. இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ
இஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇ
இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇ
இஇஇஇஇஇஇஇஇஇ?
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ 2 இஇஇஇஇ 3
இஇஇஇ
4 இஇஇஇஇ 5
இஇஇஇ
5
இஇஇஇஇஇ
இஇ இஇஇஇ
11. இஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇ
இஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ?
இஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇஇ
இஇஇஇஇஇ
(二) பபபபபபபபபபப பபபப பபபப (8 பபபபபபபபபபப):
இஇஇஇஇஇ
இஇஇஇஇ
இஇஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇஇஇஇஇ
இஇஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇ 1 2 3 4 5
இஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇ 1 2 3 4 5
இஇஇஇஇஇஇஇஇ இஇஇஇ
இஇஇஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇஇஇஇ
1 2 3 4 5
இஇஇ இஇஇஇஇஇஇஇ
இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇ
1 2 3 4 5
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ 1 2 3 4 5
இஇஇஇஇஇ இஇஇஇஇஇஇ 1 2 3 4 5
இஇஇஇஇ இஇஇஇஇஇ
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ
1 2 3 4 5
இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇ
இஇஇஇஇஇ
1 2 3 4 5
Boston Carpal Tunnel Syndrome ප්රශ්නාවලිය
(BCTQ)
(一) රරෝග ලක්ෂණ බරපතලතා පරිමාණය (අයිතම 11)
1 2 3 4 5
1. රාත්රියේදී ඔබට ඇති වන අයත් ය ෝ මැණික්
කටුයේ යේදනාව යකතරම් දරුණුද?
සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා
බරපතල
2. පසුගිය සති යදක තුළ සාමාන්ය රාත්රියකදී අත්
ය ෝ මැණික් කටුයවහි යේදනාව ඔබ යකාපමණ
සාමාන්ය වරක් 2 සිට 3 4 සිට 5
5
වතාව
වාරයක් අවදි කළාද? වතාවක් වතාවක් කට
වඩා
3. ඔබට සාමාන්යයයන් දිවා කාලයේදී ඔයේ අයත්
ය ෝ මැණික් කටුයේ යේදනාවක් තියේද?
යේදනාවක්
නැත
මදක් මධ්යම දරුණුයි ඉතා
බරපතල
4. දිවා කාලයේ ඔබට අත් ය ෝ මැණික් කටුයවහි
යේදනාව යකාපමණ වාරයක් තියේද?
සාමාන්ය 1-2 වතාවක් /
දිනකට
3-5 වතාවක් /
දිනකට
5
වතාව
කට
වඩා
දිගටම
5. දිවා කාලයේ යේදනායේ කථාාංගයක් සාමාන්යයයන්
යකාපමණ කාලයක් පවතින්යන්ද?
සාමාන්ය 1 විනාඩි 10 යි 10~60 දිගටම >විනාඩි 60
යි
දිගටම
6. ඔයේ අයත් හිරිවැටීමක් (සාංයේදනය නැති වීම)
තියේද?
සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා
බරපතල
7. ඔබයේ අයත් ය ෝ මැණික් කටුයේ දුර්වලතාවයක්
තියේද?
සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා
බරපතල
8. ඔයේ අයත් හිරි වැටීමක් තියේද? සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා
බරපතල
9. රාත්රියේදී හිරිවැටීම (සාංයේදනය නැතිවීම) ය ෝ
හිරි වැටීම යකතරම් දරුණුද?
සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා
බරපතල
10. පසුගිය සති යදක තුළ සාමාන්ය රාත්රියකදී අත්
හිරිවැටීම ය ෝ හිරි වැටීම ඔබව යකාපමණ
වාරයක් අවදි කළාද?
සාමාන්ය වරක් 2 සිට 3
වතාවක්
4 සිට 5
වතාවක්
5
වතාව
කට
වඩා
11. යතුරු ය ෝ පෑන් වැනි කුඩා වස්තූන් ේර ණය කර
ගැනීමට ස ඒවා භාවිතා කිරීමට ඔබට අප සු
යේද?
අප සුවකින්
යතාරව
යපාඩි
අමාරුවක්
මධ්යස්තථ
දුෂ්කර
තා
ඉතා
අප සුයි
රිම
අමාරුයි
(二) ක්රියාකාරී තත්තත්තවය පරිමාණ (8 අයිතම:
අප සුවක්
නැ ැ
යපාඩි අමාරුවක් මධ්යස්තථ
දුෂ්කරතාව
දැඩි
දුෂ්කරතාව
සියලු නිසා ඇති
ක්රියාකාරකම
ඉටු කිරීයම්
ැකියාවක්
යනාමැති කිරීමට
අත් ස
මැණික්
කටුයවහි
යරෝග
ලක්ෂණ
යේඛන 1 2 3 4 5
ඇඳුම් යබාත්තම් දැමීම 1 2 3 4 5
කියවද්දදී යපාතක් අයත්
තියායගන
1 2 3 4 5
දුරකථන සුරුව අේලා ගැනීම 1 2 3 4 5
භාජන විවෘත කිරීම 1 2 3 4 5
යගදර යදායර් වැඩ 1 2 3 4 5
සිේලර බඩු කූඩය රැයගන යාම 1 2 3 4 5
ස්තනානය කිරීම ස ඇඳුම් ඇඳීම 1 2 3 4 5

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Boston Questionnaire-converted.docx

  • 1. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) (一) Symptom severity scale (11 items) 1 2 3 4 5 1. How severe is the hand or wrist pain that you have at night? Normal Slight Medium Severe Very serious 2. How often did hand or wrist pain wake you up during a typical night in the past two weeks? Normal Once 2 to 3 times 4 to 5 times More than 5 times 3. Do you typically have pain in your hand or wrist during the daytime? No pain Slight Medium Severe Very serious 4. How often do you have hand or wrist pain during daytime? Normal 1-2 times / day 3-5 times / day More than 5 times Continued 5. How long on average does an episode of pain last during the daytime? Normal <10minutes 10~60 Continued >60minutes Continued 6. Do you have numbness (loss of sensation) in your hand? Normal Slight Medium Severe Very serious 7. Do you have weakness in your hand or wrist? Normal Slight Medium Severe Very serious 8. Do you have tingling sensations in your hand? Normal Slight Medium Severe Very serious 9. How severe is numbness (loss of sensation) or tingling at night? Normal Slight Medium Severe Very serious 10. How often did hand numbness or tingling wake you up during a typical night during the past two weeks? Normal Once 2 to 3 times 4 to 5 times More than 5 times 11. Do you have difficulty with the grasping and use of small objects such as keys or pens? Without difficulty Little difficulty Moderately difficulty Very difficulty Very difficult
  • 2. (二) Functional status scale (8 items: No difficulty Little difficulty Moderate difficulty Intense difficulty Cannot perform the activity at all due to hands and wrists symptoms Writing 1 2 3 4 5 Buttoning of clothes 1 2 3 4 5 Holding a book while reading 1 2 3 4 5 Gripping of a telephone handle 1 2 3 4 5 Opening of jars 1 2 3 4 5 Household chores 1 2 3 4 5 Carrying of grocery basket 1 2 3 4 5 Bathing and dressing 1 2 3 4 5
  • 3. பபபபபபப பபபபபபப பபபபபப பபபபபபபபபப பபபபபபபபபபபப (BCTQ) (一) பபபபபபப பபபபப பபபப (11 பபபபபபபபபபப) 1 2 3 4 5 1. இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇ 2. இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇ இஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ 2 இஇஇஇஇ 3 இஇஇஇ 4 இஇஇஇஇ 5 இஇஇஇ 5 இஇஇஇஇஇ இஇ இஇஇஇ 3. இஇஇஇஇஇஇ இஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇஇஇஇஇ? இஇஇ இஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇ 4. இஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇ இஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ 1-2 இஇஇஇ / இஇஇஇ 3-5 இஇஇஇ / இஇஇஇ 5 இஇஇஇஇஇஇஇ இஇஇஇ இஇஇஇஇஇஇஇ இஇ 5. இஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ 10 இஇஇஇஇஇஇ இஇஇ 10~60 இஇஇஇஇஇஇஇஇஇ >60 இஇஇஇஇஇஇஇ இஇ இஇஇஇஇஇஇஇ இஇ 6. இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ (இஇஇஇஇஇ இஇஇஇஇஇ) இஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇ 7. இஇஇஇஇஇ இஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇ 8. இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇ
  • 4. 9. இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ (இஇஇஇஇஇ இஇஇஇஇஇ) இஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇ 10. இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇ இஇஇஇஇஇஇஇஇஇ? இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ 2 இஇஇஇஇ 3 இஇஇஇ 4 இஇஇஇஇ 5 இஇஇஇ 5 இஇஇஇஇஇ இஇ இஇஇஇ 11. இஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ? இஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇ (二) பபபபபபபபபபப பபபப பபபப (8 பபபபபபபபபபப): இஇஇஇஇஇ இஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ 1 2 3 4 5 இஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇ 1 2 3 4 5
  • 5. இஇஇஇஇஇஇஇஇ இஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇஇஇஇ 1 2 3 4 5 இஇஇ இஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇஇ 1 2 3 4 5 இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇஇ 1 2 3 4 5 இஇஇஇஇஇ இஇஇஇஇஇஇ 1 2 3 4 5 இஇஇஇஇ இஇஇஇஇஇ இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ 1 2 3 4 5 இஇஇஇஇஇஇஇஇ இஇஇஇஇஇஇ இஇஇ இஇஇஇஇஇ 1 2 3 4 5 Boston Carpal Tunnel Syndrome ප්රශ්නාවලිය (BCTQ) (一) රරෝග ලක්ෂණ බරපතලතා පරිමාණය (අයිතම 11) 1 2 3 4 5 1. රාත්රියේදී ඔබට ඇති වන අයත් ය ෝ මැණික් කටුයේ යේදනාව යකතරම් දරුණුද? සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා බරපතල 2. පසුගිය සති යදක තුළ සාමාන්ය රාත්රියකදී අත් ය ෝ මැණික් කටුයවහි යේදනාව ඔබ යකාපමණ සාමාන්ය වරක් 2 සිට 3 4 සිට 5 5 වතාව
  • 6. වාරයක් අවදි කළාද? වතාවක් වතාවක් කට වඩා 3. ඔබට සාමාන්යයයන් දිවා කාලයේදී ඔයේ අයත් ය ෝ මැණික් කටුයේ යේදනාවක් තියේද? යේදනාවක් නැත මදක් මධ්යම දරුණුයි ඉතා බරපතල 4. දිවා කාලයේ ඔබට අත් ය ෝ මැණික් කටුයවහි යේදනාව යකාපමණ වාරයක් තියේද? සාමාන්ය 1-2 වතාවක් / දිනකට 3-5 වතාවක් / දිනකට 5 වතාව කට වඩා දිගටම 5. දිවා කාලයේ යේදනායේ කථාාංගයක් සාමාන්යයයන් යකාපමණ කාලයක් පවතින්යන්ද? සාමාන්ය 1 විනාඩි 10 යි 10~60 දිගටම >විනාඩි 60 යි දිගටම 6. ඔයේ අයත් හිරිවැටීමක් (සාංයේදනය නැති වීම) තියේද? සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා බරපතල 7. ඔබයේ අයත් ය ෝ මැණික් කටුයේ දුර්වලතාවයක් තියේද? සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා බරපතල 8. ඔයේ අයත් හිරි වැටීමක් තියේද? සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා බරපතල 9. රාත්රියේදී හිරිවැටීම (සාංයේදනය නැතිවීම) ය ෝ හිරි වැටීම යකතරම් දරුණුද? සාමාන්ය මදක් මධ්යම දරුණුයි ඉතා බරපතල 10. පසුගිය සති යදක තුළ සාමාන්ය රාත්රියකදී අත් හිරිවැටීම ය ෝ හිරි වැටීම ඔබව යකාපමණ වාරයක් අවදි කළාද? සාමාන්ය වරක් 2 සිට 3 වතාවක් 4 සිට 5 වතාවක් 5 වතාව කට වඩා 11. යතුරු ය ෝ පෑන් වැනි කුඩා වස්තූන් ේර ණය කර ගැනීමට ස ඒවා භාවිතා කිරීමට ඔබට අප සු යේද? අප සුවකින් යතාරව යපාඩි අමාරුවක් මධ්යස්තථ දුෂ්කර තා ඉතා අප සුයි රිම අමාරුයි
  • 7. (二) ක්රියාකාරී තත්තත්තවය පරිමාණ (8 අයිතම: අප සුවක් නැ ැ යපාඩි අමාරුවක් මධ්යස්තථ දුෂ්කරතාව දැඩි දුෂ්කරතාව සියලු නිසා ඇති ක්රියාකාරකම ඉටු කිරීයම් ැකියාවක් යනාමැති කිරීමට අත් ස මැණික් කටුයවහි යරෝග ලක්ෂණ යේඛන 1 2 3 4 5 ඇඳුම් යබාත්තම් දැමීම 1 2 3 4 5 කියවද්දදී යපාතක් අයත් තියායගන 1 2 3 4 5 දුරකථන සුරුව අේලා ගැනීම 1 2 3 4 5 භාජන විවෘත කිරීම 1 2 3 4 5 යගදර යදායර් වැඩ 1 2 3 4 5 සිේලර බඩු කූඩය රැයගන යාම 1 2 3 4 5 ස්තනානය කිරීම ස ඇඳුම් ඇඳීම 1 2 3 4 5