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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)


For each "Yes" answer, ask:
What kind of help is this - a person or some kind of aid?

2[] Person
3[] Aid


b. When going up or down stairs?

[] Yes
1[] No (c)


For each "Yes" answer, ask:
What kind of help is this - a person or some kind of aid?

2[] Person
3[] Aid


c. When getting in or out of a tub or shower?

[] Yes
1[] No (d)


For each "Yes" answer, ask:
What kind of help is this - a person or some kind of aid?

2[] Person
3[] Aid


Do you use the help of another person or special aid
d. In order to completely dress yourself?

[] Yes
1[] No (e)


For each "Yes" answer, ask:
What kind of help is this - a person or some kind of aid?

2[] Person
3[] Aid


e. In order to feed yourself a complete meal?

[] Yes
1[] No (f)


For each "Yes" answer, ask:
What kind of help is this - a person or some kind of aid?

2[] Person
3[] Aid


f. When rolling onto your side in bed?

[] Yes
1[] No (21)


For each "Yes" answer, ask:
What kind of help is this - a person or some kind of aid?

2[] Person
3[] Aid


21a. Does your ARTHRITIS cause you to sit or lie down to rest at any time during the day?

1[] Yes
2[] No (e)


b. At what time do you usually sit or lie down to rest?

Time
[] a.m ____
[] p.m ____


c. Do you rest some every day?

1[] Yes
2[] No (e)


d. How long do you usually rest each day?

Hours ____
Minutes ____


e. What time do you Usually get up in the morning?

Time
[] a.m ____

Footnotes:

[p.101]


22a. Are you PRESENTLY seeing anyone for your arthritis?

1[] Yes (c)
2[] No (b)


b. Could you tell me why you aren't presently seeing anyone for your arthritis?

1[] Arthritis not severe enough (23)
2[] No one can do anything for it (23)
[] Other (Record response verbatim) ________ (23)


c. Who are you seeing? ________ [Check all categories in Table III that apply. Then ask the appropriate questions for each category marked]

d. Are you now seeing anyone else for your arthritis? ________ [Check all categories in Table III that apply. Then ask the appropriate questions for each category marked]

TABLE III

Type of person

[] Medical doctor
[] Medical doctor
[] Other (Specify) ____


[Upto there sets of entries [One set includes: Questions 1-7] in the original document not presented here. 2 entries for medical doctor and 1 entry for "other"].


1. What is the name and address of the doctor you see?

Name ____
Address ________


2. Why did you decide to go to this .... for your arthritis?

1[] He's a family doctor
2[] Referred by doctor
3[] Referred by someone else
4[] He's an arthritis specialist
[] Other (specify) ________



[Question 3 is asked for 2 medical doctor entries and not for "Other" entry in Type of person above]

3a. Is the doctor a general practitioner or a specialist?

1[] General practitioner (4)
[] Specialist


b. What kind of specialist is he? ________


4. When was the LAST time you saw .... for your arthritis?

1[] Past 2 weeks
Weeks ____
Months ____


5. Where did you see the .... , at his office, your home, or some other place?

1[] Doctor's office
2[] Home (next column)
[] Other (specify) ________


6. About how long did it take you to get to the ....?

Minutes ____
Hours ____


7. How did you get to and from the ....?

1[] Bus or subway
2[] Taxi
3[] Private car
[] Other (specify) ____

[p.102]


23a. Have you ever had any special job training because of your arthritis?

1[] Yes
2[] No (24)


b. Where did you receive this training?
Name of place ____


24a. Have you ever changed or left a job because of your arthritis?

1[] Yes (c)
2[] No


b. Have you worked at any time since you had arthritis- (For females add: not counting work around the house)?

1[] Yes
2[] No (25)


c. In general has your own income decreased because of your arthritis?

1[] yes
2[] No


25a. Have you ever heard of the Arthritis Foundation?

1[] Yes
2[] No (STOP)
3[] Don't know (STOP)


b. How did you first learn about the Arthritis Foundation?

Describe ________


c. Have you ever received any personal help, treatment, referral, or other information from the Arthritis Foundation?

1[] Yes
2[] No (STOP)


d. What did the Arthritis Foundation do for you?

Describe ____


Ending time

[] a.m ____
[] p.m ____