arth

[p. 95]

U.S Health Interview Survey: Arthritis Supplement

PSU ____

Segment ____

Serial No. ____

Sample ____
B-

Name of sample person ____

Person No. ____

Name of interviewer ____

Code ____

1[] Responded for self or Person number of respondent ____

Footnotes:

[p.96]

Earlier in the interview you told me about ... arthritis (rheumatism...). This is a matter of special interest to the US Public Health Service, and I have some additional questions about it.

Starting time
[] a.m ____
[] p.m ____

1a. During the past 12 months, have you had any STIFFNESS in your joints when first getting out of bed in the morning?

1[] Yes
2[] No (2)

b. What time of day does this stiffness usually go away?

[] a.m ____
[] p.m ____
[] Never

c. During the past 12 months, have your WRISTS been stiff when first getting out of bed in the morning?

1[] Yes
2[] No

2a. During the past 12 months, have you had PAIN in your joints when moving them?

1[] Yes
2[] No(3)

b. During that period, have your WRISTS been painful when you moved them?

1[] Yes
2[] No

3a. (During the past 12 months) have you had SWELLING in any joints except in the ankles or feet?

1[] Yes
2[] No (4)

b. During that period, have you had any swelling in your WRISTS?

1[] Yes
2[] No

4a. (During the past 12 months) have you had PAIN or SORENESS when you touch or press on your joints?

1[] Yes
2[] No (5)

b. During that period, have you had any pain or soreness when you touched or pressed on your WRISTS?

1[] Yes
2[] No

If "Yes" in questions 1c, 2b, 3b, or 4b ask:
5. Which wrist is bothered or affected by arthritis?

1[] Right
2[] Left
3[] Both

6a. During the past 12 months, have any of the joints in your FINGERS been bothered or affected by arthritis?

1[] Yes
2[] No (7)

b. Please look at this picture of a hand. (HAND CARD D TO RESPONDENT). Tell me what colors on this card match the joints of your RIGHT hand that are bothered or affected by arthritis.

[] 1 red
[] 2 blue
[] 3 yellow
[] 4 gray
[] None

d. Are you right-handed or left-handed?

1[] Right
2[] Left
3[] Both

Footnotes:

[p.97]

7a. During the past 12 months, have your ELBOWS been bothered or affected in any way by arthritis?

[] Yes
1[] No (8)

b. Which elbow is affected?

2[] Right
3[] Left
4[] Both

8a. During the past 12 months, have your KNEES been affected in any way by arthritis?

[] Yes
1[] No (9)

b. Which knee is affected?

2[] Right
3[] Left
4[] Both

9a. Do you presently have pain, swelling, or stiffness in any joint as a result of an old accident or injury?

1[] Yes
2[] No (10)

b. Did this accident or injury happen during the past 12 months or before that time?

1[] During past 12 months (10)
2[] More that 12 months ago

c. Which joints were hurt in this accident or injury?

[] Neck
[] Upper back
[] Middle back
[] Lower back

Ankle

[] Right
[] Left

Elbow

[] Right
[] Left

Foot

[] Right
[] Left

Hand

[] Right
[] Left

Hip

[] Right
[] Left

Knee

[] Right
[] Left

Shoulder

[] Right
[] Left

Wrist

[] Right
[] Left

10. Who was the FIRST person to tell you that you had arthritis?

1[] Medical doctor
2[] Chiropractor
3[] Friend
4[] Relative
[] Other (specify) ________

11. When did a doctor first tell you that you had arthritis?

0[] Less than 12 months ago
8[] Doctor never said it was arthritis
Years ____
9[] Doctor never seen

12. When did your arthritis bother you the most-during that past 12 months, when you first noticed it, or at some other time?

1[] During the past 12 months
2[] When first noticed it
3[] Some other time

13. Have you ever been treated by any of the following people for your ARTHRITIS-

a. a foot doctor (chiropodist or podiatrist)?

1[] Yes
2[] No

b. a physical therapist?

1[] Yes
2[] No

c. an occupational therapist?

1[] Yes
2[] No

14a. Have you ever seen a social worker for your arthritis?

[] Yes
1[] No (15)

b. Was the social worker from a hospital?

2[] Yes
3[] No

[p.98]

15. Have you EVER used (any of the following) for your arthritis-

a. Any splints or casts?

[] Yes
1[] No (b)

Are you now using .....for your arthritis?

2[] Yes
3[] No (b)

Where are the splints or casts worn? (Specify) _________

b. Braces of any kind?

[] Yes
1[] No (c)

Are you now using ....for your arthritis?

2[] Yes
3[] No (c)

Where are the braces worn? (specify) ________

c. Diathermy or paraffin?

[] Yes
1[] No (d)

Are you now using .... for your arthritis?

2[] Yes
3[] No

d. Hot packs, hot baths, or a heating pad?

[] Yes
1[] No (e)

Are you now using ... for your arthritis?

2[] Yes
3[] No

e. Cold packs or ice treatment?

[] Yes
1[] No (f)

Are you now using .... for your arthritis?

2[] Yes
3[] No

f. Rest recommended by a doctor?

[] Yes
1[] No (g)

Are you now using ....for your arthritis?

2[] Yes
3[] No

g. Exercises recommended by a doctor or physical therapist?

[] Yes
1[] No (16)

Are you now using ....for your arthritis?

2[] Yes
3[] No

16a. Are you now taking aspirin, anacin, or bufferin for your arthritis?

1[] Yes
2[] No (17)

b. Do you take it every day?

1[] Yes
2[] No (17)

c. About how many do you usually take each day?

Number per day ________

d. Do you usually take the same amount every day?

1[] Yes
2[] No

e. How long have you been taking aspirin every day?

0[] Less than one month
Months ____
Years ____

17a. Are you presently taking any injections or shots for your arthritis?

1[] Yes
2[] No (18)

b. Are any of these injections "gold" shots?

1[] Yes
2[] No

[p.99]

18a. Are you presently taking any (other) drugs or medicines that were recommended by a medical doctor for your arthritis?

1[] Yes
2[] No (19)

b. What are the names of these medicines?

1[] Butazolidin, Sterazolidin, Tandearil
2[] Aristocort, Cortisone, Decadron, Medrol, Prednisone
4[] Darvon, Soma, Tylenol
[] Other (Specify) ____

19a. Have you EVER used any remedies or medicines for your arthritis either on your own or that were recommended by someone Other than a medical doctor?

1[] Yes
2[] No (20)

b. What kind of remedies or medicines did you use? (Enter name or description of remedies or medicines in column (a) of Table II below).

Table II

[upto 7 remedies entries in the original document not presented here. With each entry 2 sets of questions are asked- b and c]

a. Remedies or medicines ________

b. Have you used .... at any time during the past 12 months?

1[] Yes
2[] No

c. Did you ever talk to a medical doctor about using.....?

1[] Yes
2[] No

c. Anything else?

[] Yes (Reask 19b)
[] No

Footnotes:

[p. 100]

Some people need help because of arthritis-
20. Do you use the help of another person or special aid-

a. When getting in or out of an automobile?

[] Yes
1[] No (b)