11訪問(wèn)日期：口年月口口日(圈出適當(dāng)者）□62□7□8□9□10□11□12[如連以上的癥狀都沒(méi)有→sectionH,p.19]*或［圈出適當(dāng)者］膀?［圈出適當(dāng)者］3□13［填入編號(hào)］□14［填入編號(hào)］□15［圈出適當(dāng)者］有/無(wú)［圈出適當(dāng)者］4.嚴(yán)重的痛B部分：病歷 2.最近八至三十日內(nèi)6.超3.超過(guò)三十日至三個(gè)月內(nèi)7.超過(guò)兩年至四年內(nèi) 4［填入編號(hào)］□16［填入編號(hào)］□16［填入編號(hào)］□17［填入編號(hào)］□18 2.最近八至三十日內(nèi)6.超3.超過(guò)三十日至三個(gè)月內(nèi)7.超過(guò)兩年至四年內(nèi) 2.八至三十日內(nèi)7.超過(guò)兩年至四年內(nèi) C部份：頸痛的嚴(yán)重程度5［填入編號(hào)］□19［填入編號(hào)］□［填入編號(hào)］□19［填入編號(hào)］□20［填入編號(hào)］□214.使你每晚的睡眠時(shí)間少過(guò)五小時(shí)4.使你每晚的睡眠時(shí)間少過(guò)五小時(shí)5.使你每晚的睡眠時(shí)間少過(guò)兩6［填入編號(hào)］□22［填入編號(hào)］□23［填入編號(hào)］□22［填入編號(hào)］□23［填入編號(hào)］□244.你只可以拿起輕的物件4.頸痛逼使你提早停止這些活動(dòng)7［填入編號(hào)］□25［填入編號(hào)］□26［填入編號(hào)］□25［填入編號(hào)］□26［填入編號(hào)］□274.只能局限于家裹4.經(jīng)常限制你駕駛8□28［填入編號(hào)］□29□30□31□32□33□34□35□36□37□38□39□40有/無(wú)sectionE,p.11［讀出下列各項(xiàng)］其他(注明)其他(不讀出)［可圈一項(xiàng)或多項(xiàng)］有/無(wú)有/無(wú)有/無(wú)有/無(wú)有/無(wú)有/無(wú)有/無(wú)有/無(wú)有/無(wú)有/無(wú)有/無(wú)9□41□42□43□44□45□46□47□48□49□50□51□52E部份：醫(yī)療服務(wù)和支出［讀出下列各項(xiàng)］［圈出適當(dāng)者］有/無(wú)有/無(wú)有/無(wú)□53□54□57□60□63□66□69□72□75□78□81□84□87□90□93□□55-56□□58-59□□61-62□□64-65□□67-68□□70-71□□73-74□□76-77□□79-80□□82-83□□85-86□□88-89□□91-92□□94-95［圈出適當(dāng)者］有/無(wú)［圈出適當(dāng)者］□96□□97-98□99□□100-101□96□□97-98□99□□100-101□102［填入編號(hào)］［填入5b題編號(hào)］□103□□104-105［填入編號(hào)］□106無(wú)/有無(wú)/有 ［圈出適當(dāng)者］有有/無(wú)［圈出適當(dāng)者］有/無(wú)□107［填入次數(shù)］□□108-109［填入編號(hào)］□□107［填入次數(shù)］□□108-109［填入編號(hào)］□110［填入數(shù)字］□□111-112［填入編號(hào)］□113 次［圈出適當(dāng)者］ 晚 4.超過(guò)三個(gè)月至六個(gè)月內(nèi)［圈出適當(dāng)者］□114［填入數(shù)字］□115□114［填入數(shù)字］□115［填入編號(hào)］□116［填入編號(hào)］□117 次 4.超過(guò)三個(gè)月至六個(gè)月內(nèi)［圈出適當(dāng)者］［填入編號(hào)］□117a［填入編號(hào)］□□［填入編號(hào)］□117a［填入編號(hào)］□□118-119□120［圈出適當(dāng)者］□121［填入編號(hào)］□121［填入編號(hào)］□122□123［填入日數(shù)］［圈出適當(dāng)者］編號(hào)［圈出適當(dāng)者］活動(dòng)等)?［圈出適當(dāng)者］有/無(wú)□□□124-126□□□124-126□127［填入日數(shù)］□□□128-130□131［圈出適當(dāng)者］有/無(wú) 日以下問(wèn)題是問(wèn)關(guān)于你的工作的,［圈出適當(dāng)者］□□132-133［填入編號(hào)］□134□□132-133［填入編號(hào)］□134□135□□136-137［填入編號(hào)］□138［填入小時(shí)］全職□□139-140編號(hào)［圈出適當(dāng)者］4.超過(guò)三個(gè)月至六個(gè)月內(nèi)［圈出適當(dāng)者］有/無(wú)編號(hào)［圈出適當(dāng)者］兼職□□141-142全職+兼職□□兼職□□141-142全職+兼職□□143-144［填入編號(hào)］□145［填入編號(hào)］□146□147［填入編號(hào)］［圈出適當(dāng)者］［圈出適當(dāng)者］［圈出適當(dāng)者］有/無(wú)編號(hào)［圈出適當(dāng)者］□148［填入編號(hào)］□148［填入編號(hào)］□□149-1504.超過(guò)三個(gè)月至六個(gè)月內(nèi)編號(hào)[不讀出]［圈出適當(dāng)者］20［填入編號(hào)］□151［填入年齢］□□［填入編號(hào)］□151［填入年齢］□□152-153編號(hào)［圈出適當(dāng)者］6.其他[請(qǐng)注明]［填入年齢］歲21［填入編號(hào)］□154［填入編號(hào)］□［填入編號(hào)］□154［填入編號(hào)］□155［填入年數(shù)］□□156-157［填入編號(hào)］□158編號(hào)(不讀出)［圈出適當(dāng)者］［填入年數(shù)］年編號(hào)［圈出適當(dāng)者］ 22編號(hào)［圈出適當(dāng)者］調(diào)查員留意分訪問(wèn)需用時(shí)間:［填入編號(hào)］［填入編號(hào)］□1592312QuestionnaireforTelephoneSurveyonNeckPainDateofSurvey：yearmonth(Pleasecircletheappropriateone）□622e)severe2e)severe2a)Haveyoueverhadthefollowingsituationssince(Readoutthefollowingonebyone,circletheappropriateone)［Iftheclientcannotunderstandtheterms,youcanreadouttheexplanationsquoted］2.Anesthesia(Nosensation)4.Stiffness(Decreasesmoothnessofmovement)yes*Ifyouhadanyoneoftheabove,youhadsufferedfromneckpain![Ifnoneoftheabovesymptomswaschosen→sectionH,2b)Ifyouhavepaininotherbodyparts,doyouthinkneckpainisyourmain[Iftheclientcannotunderstandtheterms,youcanreadouttheexplanations*]thinkneckpainismoresevereincomparisonwitht［Circletheappropriateone］pointthatatthebackofyourhead)andshoul［Iftheclientcannotunderstandtheterms,youcanreadouttheexplanationquotedinthebracket］［Circletheappropriateone］yes/no→sectionH,2d)Doesyourneckpainextendtoupperarms,h［Circletheappropriateone］□7□8□9□10□11No=1□12□133［Fillinthecode］□［Fillinthecode］□144［Fillinthe［Fillinthecode］□15［Fillinthecode］□16［Fillinthecode］□17［Fillinthecode］□183a)Whendidyourfirstepisodeofneckpai years/months/days＊[4.3monthsago,butwi7.2yearsago,butwithi3b)Howmanyepisodesofneckpaindidyousufferduringlasttw episode(s)[Iftheclientcannotanswer,youcanreadoutthefollowingchoices]3c)Whendidyourrecentepisodeofneckpain(ortheprese 4.3monthsago,butwi7.2yearsago,butwithi3d)Howlongdidyourrecentepisodeofneckpain(ort 2.Between8to30da5［Fillin［Fillinthecode］□19［Fillinthecode］□20［Fillinthecode］□21［Fillinthecode］□22SectionC:Disabilityduetoneckpain3e)Howseveredidyoufeela1.Nopain3f)Thefollowingareabouttheimpactofyou［Readoutthefollowingitems,circlethemostappropriateoneonly］4.Becauseifpainyousleeplessthan5hourssleepintot5.Becauseofpainyousleeplessthen2hourssleepintotal3g)Howlongdidthepins［Readoutthefollowingitems,circlethemostappropriateoneonly］2.Youhaveoccasion3.Yoursleepisregularlydistu4.Becauseofpinsandneedlesyouhavelessthan5hourssleepintotal5.Becauseofpinsandneedlesyouhavelessthan2hourssleepintotal3h)Howlongdidyou［Readoutthefollowingitems,circlethemostappropriateoneonly］3.Symptomsarepresentonandoffforatotalperiodof1-4hoursperday4.Symptomsarepresentonandoffforatotalofmorethan4hoursperday5.Symptomsarepresentcont［Readoutthefollowingitems,circlethemostappropriateoneonly］6ofyourrecentneckpain(orthepresentone)oofyourrecentneckpain(orthepresentone)o2.Youcancarryheavyobjects,3.Painpreventsyoufromcarryingheavyobjects,bu4.Youcanliftlightweightobjects［Readoutthefollowingitems,circlethemostappropriateoneonly］2.Youcandothisa4.Paincausesyoutostopdoingthissoonertha5.Painpreventsmefworkingandhousework［Readoutthefollowingitems,circlethemostappropriateoneonly］2.Paindisturbsyoutodoyourusualworkandshorten<25%ofyourusualworkinghours3.Paindisturbsyoutodoyourusualworkandshortenbetween25%and50%ofyourusualworkinghours4.Paindisturbsyoutodoyourusualworkandshorten>50%ofyourusualworkinghours5.Painpreventsyoufrsocialactivities(eg.［Readoutthefollowingitems,circlethemostappropriateoneonly］2.Yoursociallifeisnormal,butincreasesthedegreeo3.Painhasrestrictedyoursociallife,bu4.Painhasrestrictedyoursociallifetothe5.Youhavenosociallifebecause3m)(Omitthisquestionifth［Fillinthecodes］□23［Fillinthecode］□24［Fillinthecode］□25［Fillinthecode］□267［Fillinthecode］□27No=1□28［Fillinthecode］［Fillinthecode］□27No=1□28［Fillinthecode］□29□30□31□32□33□34□35□36□37□38□39□403.Neckpainlimitsyourdrivingoccasiona4.NeckpainlimitsyourdrivingfrequentlySectionD:MedicalDiagnosis4a)Haveyoureversoughtanymedicalconsultationfor4b)Whichmedicalprofessiondidyouseekthecons4c)DidthemedicalprofessionmakeanydiagnosDidtheysayyouhadthefollowingsituatio［Readoutthefollowingitems］Bonepain/neckpain/cervicalspinedisProtrudedintervertebalPresenceofosteophytesOthers(donotreadout)8SectionE:MedicalServicesandRelatedExpenses5a)Haveyoutriedthefollowingmethodsindeal［Readoutthefollowing］2.Domassagewithointment/creamb(eg.Chineseherbcream,deephe4.Doonyourown:(Readoutthefollowing)b□41□42□43□44□45□46□47□48□49□50□51□52No=1□53yesyes/no/no/no/no/no/no/no/no/no/no/no/no5b)Haveyoubeentreatedbyotherpeople［Circletheappropriateone］9No=0Yes=1［FillintheNo=0Yes=1［Fillinthetimes］□54□57□60□63□66□69□72□75□78□81□84□87□90□93□96□□55-56□□58-59□□61-62□□64-65□□67-68□□70-71□□73-74□□76-77□□79-80□□82-83□□85-86□□88-89□□91-92□□94-95□□97-98□99□□100-101□102［FillinthecodeFillinthecodefrom□103□□104-105［Iftheclientcannotanswer,youcanreadoutthefollowingchoices］Now,Ireadoutthefollowingprofession,youjustneedtoansweryesorno［Circletheappropriateone］a.Generalpracticenb.Orthopedicsno/yesc.Otherspecialties2.Privatedoctors,howmanytimesda.Generalpracticeno/yes____b.Orthopedicsno/yes___c.Otherspecialtiesno/yes3.Physiotherapy(Howmanytimes?)no/yes4.Bonesetter(Howmanytimes?)no/yes6.Acupuncture(Howmanytimes?)no/y7.Herbmedicine,excludedbonesetter(Howmanyti8.Chiropractics(Howmanytimes?)no9.Solereflextherapy(Howmanytimes?10.Others[pleasespecify]12.AccidentandEmergencyservice5c)Wasthereanyimprovemen［Circletheappropriateone］Question5f5d)Whatwasthemosteffectivetreatmentamongthoseyou2.Allwereno——→5e)Ifyouthoughtthetreatmentwaseffective,howwastheeffect?［Fillinthecode］□106［Fillinthecode］□106□107［Fillinthecode］□□108-109［Fillin□thecode］［Fillinthenumberofnights］□□111-112［Fillin□thecode］No=1□1143.Improvedbymoret5f)iHaveyoustayedatthehospitalsforthereas［Circletheappropriateone］ iiiHowwastheeffectofstayingathospitaltoyourne［Circletheappropriateone］2.Improvedby4.Improvedbymorethan55g)iHowmanynights________night(s) 4.3monthsago,butwi7.2yearsago,butwithi5h)iHaveyoureceivedanysurgery［Circletheappropriate］［Fillin□thenumberofsurgery［Fillin□thenumberofsurgerydone］［Fillin□thecode］［Fillin□thecode］［Fillin□117athecode］ 4.3monthsago,butwi7.2yearsago,butwithinivHowwastheeffectofsur［Circletheappropriateone］2.Improvedbyless4.Improvedbymorethan5i)WhatwasthetotalexpensethatyIftheclientcannotanswer,lethimchoosefromthefo［Fillinthecode［Fillinthecode］□□118-119□121［Fillin□thecode］6a)Whatdoyouthinkaboutthemaincauseofyourneckpownfirst,iftheycannotanswer,readoutthefollowing］6b)Didthedoctorsaythatyourneckpainwas［Circletheappropriateone］6c)Ifyes,wasyourneckpainrelatedwiththefull-timeorpart-timej［Circletheappropriateone］6d)HowclosewastherelationbetweenneckpainandyourjoCodes［Circletheappropriateone］□123［Fillinthedays］□□□□127［Fillinthedays］□□□SectionG:EffectonDailyLife7a)Didyouchangethehabitofyourdailylife(eg.woreasonofneckpainduringthelasttwelv［Circletheappropriateone］7b)Howmanydaysdidyoucha7c)Didyoutakeanyleavesforthereasonofneckpainduring［Circletheappropriateone］7d)Howmanydaysofleavedidff□131［Classifythe□131［Classifytheoccufillinthecode］□□132-133［Fillin□thecode］□135［Classifytheoccufillinthecode］□□136-137［Fillin□thecode］Thefollowingquestionsareabou8a)Didyougotoworkdurin［Circletheappropriateone］8c)Howlonghadyouworkedwiththisjob/howlonghadyCodes［Circletheappropriateone］4.3monthsago,but7.2yearsago,butwithin［Circletheappropriateone］8e)Whatisyouroccupationin8f)Howlonghadyouworkedwiththispart-timCodes［Circletheappropriateone］3.30daysago,butwith4.3monthsago,butw［Fillintheworkinghours］Full［Fillintheworkinghours］Full-time□□139-140Part-time□□141-142□□143-144［Fillin□thecode］［Fillin□thecode］No=1□147［Fillin□thecode］2.Part-time:8h)Didyourfull-timejobrequi［Circletheappropriateone］2.Mildmanualwork(eg3.Moderatemanualwork(eg.t4.Intensivemanualwork(eg.constructionsiteworker)8i)Didyourpart-timejobreq［Circletheappropriateone］2Mildmanual3Moderatemanualwork(eg.technic4.Intensivemanualwork(eg.constructionsiteworker)8j)Haveyouchangedyourjobforthereasonofneckpain?［Circletheappropriateone］8k)WhendidyouchangeyourCodes［Circletheappropriateone］3.30daysago,butwith4.3monthsago［Fillinthecode］［Fillinthecode］□□149-150［Fillin□thecode］[pleasespecify]9a)WhichdistrictdoyoulCodes[Donotreadout]［Circletheappropriateone］9b)WhatkindofhousingdoyouCodes［Circletheappropriateone］2.HousingundertheH3.Privatehousing(wholefloor/wh5.Apartmentprovided［Fillintheage［Fillintheage］□□152-153［Fillin□thecode］［Fillin□thecode］fyears］□□156-157［Fillinthecode］□158［Fillintheage］［Iftheclientsdonotwanttoanswertheexactage,aCodes［Circletheappropriateone］