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Thank you for taking part in the Canterbury Ileal Pouch study. This is one of the questionnaires that we would like you to complete; it is about the impact your ileal pouch has had on your quality of life, and it should take approximately 15 minutes of your time.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can choose the option of "decline to answer". PLEASE NOTE that there is no save and continue option, so PLEASE DO NOT SHUT DOWN THE QUESTIONNAIRE BEFORE ITS COMPLETION. Thank you very much for your time. It is very important for us to learn your opinions.
Your questionnaire responses will be strictly confidential. If you have questions at any time about the questionnaires or the study, please feel free to contact me by email at: [email protected]
Please start the questionnaire now by clicking on the Continue button below.
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| This questionnaire is designed to find out how you have been feeling during the last 2 weeks. You will be asked about symptoms you have been having as a result of your inflammatory bowel disease, the way you have been feeling in general, and how your mood has been. |
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| * What is your Study ID? (This was given to you in an email or a letter; if you have lost your study ID please email Alex at [email protected]) | | |
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| * 1. How frequent have your bowel movements been during the last two weeks? Please indicate how frequent your bowel movements have been during the last two weeks by picking one of the options |
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| * 2. How often has the feeling of fatigue or of being tired and worn out been a problem for you during the last 2 weeks? Please indicate how often the feeling of fatigue or tiredness has been a problem for you during the last 2 weeks by picking one of the options |
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| * 3. How often during the last 2 weeks have you felt frustrated, impatient, or restless? Please choose an option |
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| * 4. How often during the last 2 weeks have you been unable to attend school or do your work because of your bowel problem? Please choose an option |
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| * 5. How much of the time during the last 2 weeks have your bowel movements been loose? Please choose an option |
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| * 6. How much energy have you had during the last two weeks? Please choose an option |
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| * 7. How often during the last 2 weeks did you feel worried about the possibility of needing to have surgery because of your bowel problem? Please choose an option |
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| * 8. How often during the last 2 weeks have you had to delay or cancel a social engagement because of your bowel problem? Please choose an option |
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| * 9. How often during the last 2 weeks have you been troubled by cramps in your abdomen? Please choose an option |
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| * 10. How often during the last 2 weeks have your felt generally unwell? Please choose an option |
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| * 11. How often during the last 2 weeks have you been troubled because of fear of not finding a washroom? Please choose an option |
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| * 12. How much difficulty have you had, as a result of your bowel problems, doing leisure or sports activities you would have liked to have done during the last two weeks? Please choose an option |
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| * 13. How often during the last 2 weeks have you been troubled by pain in the abdomen? Please choose an option |
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| * 14. How often during the last 2 weeks have you had problems getting a good night's sleep, or been troubled by waking up during the night? Please choose an option |
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| * 15. How often during the last 2 weeks have you felt depressed or discouraged? Please choose an option |
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| * 16. How often during the last 2 weeks have you had to avoid attending events where there was no washroom close at hand? Please choose an option |
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| * 17. Overall, in the last 2 weeks, how much of a problem have you had with passing large amounts of gas? Please choose an option |
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| * 18. Overall, in the last 2 weeks, how much a problem have you had maintaining or getting to, the weight you would like to be at? Please choose an option |
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| * 19. Many patients with bowel disorders often have worries and anxieties related to their illness. These includes worries about getting cancer, worries about never feeling any better, and worries about having a relapse. In general, how often during the last 2 weeks have you felt worried or anxious? Please choose an option |
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| * 20. How much of the time during the last 2 weeks have you been troubled by a feeling of abdominal bloating? Please choose an option |
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| * 21. How often during the last 2 weeks have you felt relaxed and free of tension? Please choose an option |
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| * 22. How much of the time during the last 2 weeks have you had a problem with rectal bleeding with your bowel movements? Please choose an option |
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| * 23. How much of the time during the last 2 weeks have you felt embarrassed as a result of your bowel problem? Please choose an option |
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| * 24. How much of the time during the last 2 weeks have you been troubled by a feeling of having to go to the toilet even though your bowels were empty? Please choose an option |
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| * 25. How much of the time during the last 2 weeks have you felt tearful or upset? Please choose an option |
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| * 26. How much of the time during the last 2 weeks have you been troubled by accidental soiling of your underpants? Please choose an option |
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| * 27. How much of the time during the last 2 weeks have you felt angry as a result of your bowel problem? Please choose an option |
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| * 28. To what extent has your bowel problem limited sexual activity during the last 2 weeks? Please choose an option |
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| * 29. How much of the time during the last 2 weeks have you been troubled by nausea or feeling sick to your stomach? Please choose an option |
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| * 30. How much of the time during the last 2 weeks have you felt irritable? Please choose an option |
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| * 31. How often during the past 2 weeks have you felt a lack of understanding from others? Please choose an option |
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| * 32. How satisfied, happy, or pleased have you been with your personal life during the past 2 weeks? Please choose an option |
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| This is an optional part of the study, where you can choose to share with us any thoughts or comments you have from your experience of living with an ileal pouch. We also welcome any feedback about the study. | | |
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