PSQ

Variable / Field Name	Section Header	Field Type	Field Label	Choices or Calculations
symptom_version		radio	Symptom Assessment Version Completed	1, Unversioned ; 5, 1.0 ; 2, 1.1 ; 3, 1.2 ; 4, 2.0 ; 6, 3.0 ; 7, 4.1
patient_sq_date		text	Date of questionnaire completion
psq_recovered		radio	a) Do you feel fully recovered from COVID-19?	1, Yes ; 2, No ; 3, Not sure
psq_scale_blness_pre	Rate these symptoms on a scale 0 - 10 - Before you had COVID-19	radio	b) Breathlessness	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_cough_pre		radio	c) Cough	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_fatigue_pre		radio	d) Fatigue	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_sleep_pre		radio	e) Sleep quality	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_pain_pre		radio	f) Pain	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_blness_since	Rate these symptoms on a scale 0 - 10 - Since you had  COVID-19	radio	b) Breathlessness	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_cough_since		radio	c) Cough	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_fatigue_since		radio	d) Fatigue	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_sleep_since		radio	e) Sleep quality	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_pain_since		radio	f) Pain	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_blness_24hrs	Rate these symptoms on a scale 0 - 10 - Worst in last 24hrs	radio	b) Breathlessness	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_cough_24hrs		radio	c) Cough	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_fatigue_24hrs		radio	d) Fatigue	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_sleep_24hrs		radio	e) Sleep quality	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_scale_pain_24hrs		radio	f) Pain	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_traj_blness	Trajectory	radio	b) Breathlessness	1, Same ; 2, Better ; 3, Worse
psq_traj_cough		radio	c) Cough	1, Same ; 2, Better ; 3, Worse
psq_traj_fatigue		radio	d) Fatigue	1, Same ; 2, Better ; 3, Worse
psq_traj_sleep		radio	e) Sleep quality	1, Same ; 2, Better ; 3, Worse
psq_traj_pain		radio	f) Pain	1, Same ; 2, Better ; 3, Worse
patient_sq_g		text	g) How many hours sleep do you get in general every 24 hours?
psq_blness	Symptoms since COVID (CRF2A - 6 weeks) or Symptoms in the last seven days (PSQ)	radio	Breathlessness	1, Yes ; 0, No
psq_cough		radio	Cough	1, Yes ; 0, No
psq_fatigue		radio	Fatigue	1, Yes ; 0, No
psq_sleep		radio	Poor sleep	1, Yes ; 0, No
psq_pain		radio	Pain	1, Yes ; 0, No
loss_of_sense_of_smell	Neurological and other	radio	Loss of sense of smell	1, Yes ; 0, No
loss_of_taste		radio	Loss of taste	1, Yes ; 0, No
confusion_fuzzy_head		radio	Confusion/fuzzy head	1, Yes ; 0, No
difficulty_with_communicat		radio	Difficulty with communication	1, Yes ; 0, No
difficulty_with_concentrat		radio	Difficulty with concentration	1, Yes ; 0, No
short_term_memory_loss		radio	Short term memory loss	1, Yes ; 0, No
physical_slowing_down		radio	Physical slowing down	1, Yes ; 0, No
slowing_down_in_your_think		radio	Slowing down in your thinking	1, Yes ; 0, No
headache		radio	Headache	1, Yes ; 0, No
altered_personality_behavi		radio	Altered personality/behaviour (not the same person)	1, Yes ; 0, No
limb_weakness		radio	Limb weakness	1, Yes ; 0, No
problems_with_balance		radio	Problems with balance	1, Yes ; 0, No
can_t_move_and_or_feel_one		radio	Can't move and / or feel one side of your body or face	1, Yes ; 0, No
problems_seeing		radio	Problems seeing	1, Yes ; 0, No
tingling_feeling_pins_and		radio	Tingling feeling/"pins and needles"	1, Yes ; 0, No
can_t_fully_move_or_contro		radio	Can't fully move or control movement	1, Yes ; 0, No
tremor_shakiness		radio	Tremor/shakiness	1, Yes ; 0, No
seizures		radio	Seizures	1, Yes ; 0, No
aching_in_your_muscles_pai	Musculo-Skeletal	radio	Aching in your muscles (pain)	1, Yes ; 0, No
joint_pain_or_swelling		radio	Joint pain or swelling	1, Yes ; 0, No
leg_ankle_swelling	Cardio-Respiratory	radio	Leg/ankle swelling	1, Yes ; 0, No
chest_pain		radio	Chest pain	1, Yes ; 0, No
chest_tightness		radio	Chest tightness	1, Yes ; 0, No
pain_on_breathing		radio	Pain on breathing	1, Yes ; 0, No
palpitations		radio	Palpitations	1, Yes ; 0, No
dizziness_or_lightheadness		radio	Dizziness or lightheadness	1, Yes ; 0, No
fainting_blackouts		radio	Fainting / blackouts	1, Yes ; 0, No
diarrhoea	Gastro-intestinal / Genitourinary	radio	Diarrhoea	1, Yes ; 0, No
constipation		radio	Constipation	1, Yes ; 0, No
nausea_vomiting		radio	Nausea/vomiting	1, Yes ; 0, No
abdominal_pain		radio	Abdominal pain	1, Yes ; 0, No
loss_of_appetite		radio	Loss of appetite	1, Yes ; 0, No
loss_of_control_of_passing		radio	Loss of control of passing urine	1, Yes ; 0, No
loss_of_control_of_opening		radio	Loss of control of opening your bowels	1, Yes ; 0, No
weight_loss		radio	Weight loss	1, Yes ; 0, No
stomach_pain		radio	Stomach pain	1, Yes ; 0, No
psq_symp_ed		radio	Erectile Dysfunction	1, Yes ; 0, No ; 2, N/A
skin_rash	Skin	radio	Skin rash	1, Yes ; 0, No
hair_loss		radio	Hair loss	1, Yes ; 0, No
lumpy_lesions_purple_pink		radio	Lumpy lesions (purple/pink/bluish) on toes	1, Yes ; 0, No
bleeding		radio	Bleeding	1, Yes ; 0, No
patient_sq_h_skin_rash		checkbox	For skin rash, please tick all body areas that apply:	1, Face ; 2, Trunk (stomach or back) ; 3, Arms ; 4, Legs ; 5, Buttocks ; 6, Toes ; 7, Fingers
patient_sq_h_bleeding_site		text	For bleeding, please specify bleeding site :
patient_sq_h_other		yesno	Any other ongoing symptoms?	1, Yes ; 0, No
patient_sq_h_other_detail		notes	Please specify any other ongoing symptom that has been included above:
patient_sq_i		yesno	i) Are you or your family concerned that you have lost significant weight (5-10%) in the past 12 months, or may now be underweight?	1, Yes ; 0, No
patient_sq_j		radio	j) Regarding your appetite or interest in eating (since COVID-19), please rank your appetite or interest in eating on a scale of 0-5:	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
psq_itu_admit		radio	k) Were you admitted to Intensive Care (ITU) during admission?	1, Yes ; 0, No
psq_itu_airway		radio	k1) Laryngeal/  airway complications	1, Yes ; 0, No
psq_itu_swallow		radio	k2) Swallowing	1, Yes ; 0, No
psq_itu_voice		radio	k3) Voice	1, Yes ; 0, No
psq_itu_airway_scale		radio	k1) Laryngeal/airway complications - Significance of impact	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
psq_itu_swallow_scale		radio	k2) Swallowing - Significance of impact	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
psq_itu_voice_scale		radio	k3) Voice - Significance of impact	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5
patient_sq_l_t_seeing	Difficulties due to a HEALTH PROBLEM (Today)	radio	Do you have difficulty seeing, even if wearing glasses?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_hearing		radio	Do you have difficulty hearing, even if using a hearing aid?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_walking		radio	Do you have difficulty walking or climbing steps?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_remembering		radio	Do you have difficulty remembering or concentrating?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_self_care		radio	Do you have difficulty (with self-care such as) washing all over or dressing?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_t_communicate		radio	Using your usual (customary) language, do you have difficulty communicating, for example understanding or being understood?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_seeing	Difficulties due to a HEALTH PROBLEM (Before COVID)	radio	Do you have difficulty seeing, even if wearing glasses?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_hearing		radio	Do you have difficulty hearing, even if using a hearing aid?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_walking		radio	Do you have difficulty walking or climbing steps?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_remembering		radio	Do you have difficulty remembering or concentrating?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_self_care		radio	Do you have difficulty (with self-care such as) washing all over or dressing?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_l_b_communicate		radio	Using your usual (customary) language, do you have difficulty communicating, for example understanding or being understood?	0, No - no difficulty ; 1, Yes - some difficulty ; 2, Yes - a lot difficulty ; 3, Cannot do at all
patient_sq_m		text	How many units of alcohol, on average, do you consume per week?
patient_sq_n		radio	n) Do you or have you ever smoked cigarettes?	0, Never ; 1, Ex-smoker ; 2, Current smoker
patient_sq_o		yesno	o) Do you currently use an e-cigarette or vape?	1, Yes ; 0, No
patient_sq_p_smoking	Have you made lifestyle changes since your COVID-19 infection?	radio	Smoking	1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
patient_sq_p_drinking		radio	Drinking alcohol	1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
patient_sq_p_eating		radio	Eating healthy food	1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
patient_sq_p_activity		radio	Physical activity (include walking, cycling, & other activities)	1, I do this more often ; 2, I do this less often ; 3, No difference ; 4, N/A
psq_work_pre_covid		radio	q) Before you got COVID-19, what was your occupation/working status (paid or unpaid work)	1, Working Full-time ; 2, Working Part-time ; 3, Full time carer (children or other) ; 4, Unemployed ; 5, Unable to work due to chronic illness ; 6, Student ; 7, Retired ; 8, Medically retired ; 9, Prefer not to say
patient_sq_q		radio	q) Compared to before your COVID-19 illness is your main occupation/working status:	1, Same as before ; 2, Different from before ; 3, Prefer not to say
patient_sq_q_today		radio	q) If different from before, please describe your occupation/working status today:	1, Working full-time ; 2, Working part-time ; 3, Full time carer (children or other) ; 4, Unemployed ; 5, Unable to work due to chronic illness ; 6, Student ; 7, Retired ; 8, Medically retired ; 9, Prefer not to say
patient_sq_q_change		radio	q) If different from before, why did your occupation/working status change?	1, Poor health ; 2, New caring responsibility ; 3, Working hours reduced by employer ; 4, Made redundant ; 5, Sick leave ; 6, Other ; 7, Prefer not to say
patient_sq_q_reason		text	q) Occupation/working status change - Other:
psq_employ_pre_lockdown		checkbox	q) What was your employment status? (Before COVID-19 lockdown)	1, FT employment ; 2, PT employment ; 3, Off sick ; 4, Caring for children ; 5, Caring for an adult ; 6, FT education ; 7, PT education ; 8, Unemployed ; 9, Retired
psq_employ_pre_ill		checkbox	q) What was your employment status? (Before you became ill)	1, FT employment ; 2, PT employment ; 3, Off sick ; 4, Caring for children ; 5, Caring for an adult ; 6, FT education ; 7, PT education ; 8, Unemployed ; 9, Retired ; 10, Furloughed ; 11, Laid off due to outbreak
psq_employ_since_home		checkbox	q) What was your employment status? (Since coming home)	1, FT employment ; 2, PT employment ; 3, Off sick ; 4, Caring for children ; 5, Caring for an adult ; 6, FT education ; 7, PT education ; 8, Unemployed ; 9, Retired ; 10, Furloughed ; 11, Laid off due to outbreak
psq_shift_work		radio	q) Prior to COVID did your work involve shift work?	0, Never ; 1, Rarely ; 2, Sometimes ; 3, Usually ; 4, Always ; 5, Don't know
psq_shift_night		radio	q) Prior to COVID did your work involve night shifts?	0, Never ; 1, Rarely ; 2, Sometimes ; 3, Usually ; 4, Always ; 5, Don't know
psq_feel_lonely		radio	Do you feel lonely?	1, Very lonely ; 2, Lonely at times ; 3, Never lonely
psq_bereavement		yesno	q) Have you experienced a close bereavement due to COVID-19?	1, Yes ; 0, No
psq_bereave_relation		text	q) Relationship in the bereavement
psq_furlough_yn		yesno	Have you ever been furloughed?	1, Yes ; 0, No
psq_furlough_when		checkbox	When were you furloughed? (Select all that apply)	1, Before you were admitted to hospital with COVID-19 ; 2, Since you were discharged from hospital after COVID-19
psq_furlough_months		text	For how long have you been/were you furloughed in total?
psq_ability_work		yesno	q) Has your illness affected your ability to do your usual work?	1, Yes ; 0, No
psq_lack_companion	r) Regarding loneliness and mental health, please complete the following:	radio	How often do you feel that you lack companionship?	0, Hardly ever ; 1, Some of the time ; 2, Often
psq_left_out		radio	How often do you feel left out?	0, Hardly ever ; 1, Some of the time ; 2, Often
psq_isolated		radio	How often do you feel isolated from others?	0, Hardly ever ; 1, Some of the time ; 2, Often
psq_lonely		radio	How often do you feel lonely?	0, Hardly ever ; 1, Some of the time ; 2, Often
psq_satisfied_life		radio	s) Overall, how satisfied are you with your life nowadays, where 0 means 'not at all' and 10 means 'completely'?	0, 0 ; 1, 1 ; 2, 2 ; 3, 3 ; 4, 4 ; 5, 5 ; 6, 6 ; 7, 7 ; 8, 8 ; 9, 9 ; 10, 10
psq_not_mentioned		yesno	s) Are you experiencing any new problems that we haven't mentioned?	1, Yes ; 0, No
psq_new_problems		notes	s) Please specify new problem(s) that we have not mentioned
psq_help_info		notes	s) What information would have been helpful to receive at discharge?
psq_feverish		radio	t1) Have you felt feverish recently?	1, Yes ; 0, No ; 2, Not sure
psq_feverish_time		radio	t2) Roughly when did you last feel feverish?	1, Within the last 7 days ; 2, Between 1 to 2 weeks ago ; 3, Between 2 to 4 weeks ago ; 4, Between 1 to 2 months ago ; 5, Between 2 to 3 months ago
psq_feverish_reason		radio	t3) What was the cause of your most recent feverish illness?	1, COVID-19 ; 2, Other respiratory infection (cough/cold/sore throat) ; 3, Somach infection (diarrhoea/vomiting) ; 4, Urinary infection ; 5, TB ; 6, Other ; 7, Unknown ; 8, Prefer not to say
psq_feverish_reason_other		notes	t4) Please specify the cause of your most recent feverish illness
psq_tinnitus_since	u) Regarding hearing and balance disturbance:	radio	u) Since your COVID-19 illness - Have you had noises (such as ringing or buzzing) in your head or in one or both ears that lasts for more than 5 minutes at a time?	5, Yes, most or all of the time ; 4, Yes, a lot of the time ; 3, Yes, some of the time ; 2, No, not in the past year ; 1, No, never ; 0, Do not know/Prefer not to answer
psq_tinnitus_before		radio	u) Before your COVID-19 illness - Have you had noises (such as ringing or buzzing) in your head or in one or both ears that lasts for more than 5 minutes at a time?	5, Yes, most or all of the time ; 4, Yes, a lot of the time ; 3, Yes, some of the time ; 2, No, not in the past year ; 1, No, never ; 0, Do not know/Prefer not to answer
psq_balance_q1_since	u) Since your COVID-19 illness	radio	a) Attacks of dizziness in which things seem to spin around you?	0, No ; 1, Yes
psq_balance_q2_since		radio	b) Attacks of dizziness in which you seem to move?	0, No ; 1, Yes
psq_balance_q1_before	u) Before your COVID-19 illness	radio	a) Attacks of dizziness in which things seem to spin around you?	0, No ; 1, Yes
psq_balance_q2_before		radio	b) Attacks of dizziness in which you seem to move?	0, No ; 1, Yes
psq_vac_first_yn	v) Vaccination	radio	Have you received a SARS-CoV-2 (Coronavirus) vaccine first dose?	1, Yes ; 0, No ; 2, Not known
psq_vac_first_date_yn		radio	Is date of SARS-CoV-2 (Coronavirus) vaccine first dose known?	1, Yes ; 0, No ; 2, Not known
psq_vac_first_date		text	Date of SARS-CoV-2 (Coronavirus) vaccine first dose
psq_vac_first_type_yn		yesno	Do you know which SARS-CoV-2 (Coronavirus) vaccine first dose you received?	1, Yes ; 0, No
psq_vac_first_type		radio	SARS-CoV-2 (Coronavirus) vaccine first dose received	1, Oxford/AstraZeneca ; 2, Pfizer/Bio-N-Tec ; 3, Moderna ; 4, Other
psq_vac_first_type_other		text	SARS-CoV-2 (Coronavirus) vaccine first dose received - Other
psq_vac_sec_yn		radio	Have you received a SARS-CoV-2 (Coronavirus) vaccine second dose?	1, Yes ; 0, No ; 2, Not known
psq_vac_sec_date_yn		radio	Is date of SARS-CoV-2 (Coronavirus) vaccine second dose known?	1, Yes ; 0, No ; 2, Not known
psq_vac_sec_date		text	Date of SARS-CoV-2 (Coronavirus) vaccine second dose
psq_vac_sec_type_yn		yesno	Do you know which SARS-CoV-2 (Coronavirus) vaccine second dose you received?	1, Yes ; 0, No
psq_vac_sec_type		radio	SARS-CoV-2 (Coronavirus) vaccine second dose received	1, Oxford/AstraZeneca ; 2, Pfizer/Bio-N-Tec ; 3, Moderna ; 4, Other
psq_vac_sec_type_other		text	SARS-CoV-2 (Coronavirus) vaccine second dose received - Other