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

Completed questionnaire

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


How did the symptoms start?

  • At a specific moment (it happened suddenly)
  • Developed gradually
  • I don't know

Did something or someone hit your body and that caused these symptoms?

  • Yes
  • No

For how long have you had these symptoms?

  • 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 changed over time?

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

During which activity or activities do you experience your symptoms most severely?

  • Walking on level ground
  • Walking on uneven ground
  • Walking downstairs
  • Walking upstairs
  • Walking downhill
  • Walking uphill
  • Running
  • Running downhill
  • Running uphill
  • Sprinting
  • Cycling on the flat
  • 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 push the heel on the affected side backward while resisting the movement with your other leg.

Does this cause symptoms you recognize?

  • 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

End of example.