Example

Results


Score meaning

0 to 30%
Very limited match

30 to 55%
Limited match

55 to 75%
Strong match

75 to 100%
Very strong match

Fully completed questionnaire

As an example, a small selection of the questionnaire follows below. Normally, you would receive the fully answered questionnaire from each patient.


How did the symptoms start?

  • At a clearly defined moment (it happened all of a sudden).
  • Developed gradually.
  • I don't know.

Did something or someone bump against your body that resulted in these symptoms?

  • Yes, it did.
  • No, it didn't.

How long have you had these symptoms for?

  • 1 day.
  • 2 to 6 days.
  • 1 to 3 weeks.
  • 3 to 6 weeks.
  • 6 weeks to 3 months.
  • 3 months to 6 months.
  • 6 months to 1 year.
  • More than 1 year.
  • More than 10 years.

How have the symptoms developed over time?

  • Increased (the symptoms have become worse).
  • Unchanged (the symptoms have remained the same).
  • Decreased (the symptoms have reduced).
  • Varying (sometimes I suffer more and sometimes I suffer less).

During which activity or activities are you experiencing your symptoms most severely?

  • Walking on flat terrain.
  • Walking on uneven terrain.
  • Walking down the stairs.
  • Walking up the stairs.
  • Walking downhill.
  • Walking uphill.
  • Running.
  • Running downhill.
  • Running uphill.
  • Sprinting.
  • Cycling on level terrain.
  • Cycling up a hill or mountain (or cycling against the wind).
  • None of these activities.

Perform the following strength test:

  1. Sit on a chair.
  2. Cross your affected leg over the other leg as shown in the video.
  3. Try to move the heel on the affected side back whilst resisting the movement with your other leg.

Does this cause recognisable symptoms?

  • Yes, it causes pain in my buttock area.
  • Yes, it causes pain at the back of my thigh.
  • Yes, it causes pain at the back of my knee.
  • No, it doesn't.

End of example.