Multiple Sclerosis Impact Scale

In the past two weeks, how much has your MS limited your ability to…

Not at all

A little

Moderately

Quite a bit

Extremely

1.

Do physically demanding tasks?

1

2

3

4

5

2.

Grip things tightly (e.g. turning on taps)?

1

2

3

4

5

3.

Carry things?

1

2

3

4

5

In the past two weeks, how much have you been bothered by…

Not at all

A little

Moderately

Quite a bit

Extremely

4.

Problems with your balance?

1

2

3

4

5

5.

Difficulties moving about indoors?

1

2

3

4

5

6.

Being clumsy?

1

2

3

4

5

7.

Stiffness?

1

2

3

4

5

8.

Heavy arms and/or legs?

1

2

3

4

5

9.

Tremor of your arms or legs?

1

2

3

4

5

10.

Spasms in your limbs?

1

2

3

4

5

11.

Your body not doing what you want it to do?

1

2

3

4

5

12.

Having to depend on others to do things for you?

1

2

3

4

5

Please check that you have answered all the questions before going on to the next page

In the past two weeks, how much have you been bothered by…

Not at all

A little

Moderately

Quite a bit

Extremely

13.

Limitations in your social and leisure activities at home?

1

2

3

4

5

14.

Being stuck at home more than you would like to be?

1

2

3

4

5

15.

Difficulties using your hands in everyday tasks?

1

2

3

4

5

16.

Having to cut down the amount of time you spent on work or other daily activities?

1

2

3

4

5

17.

Problems using transport (e.g. car, bus, train, taxi, etc.)?

1

2

3

4

5

18.

Taking longer to do things?

1

2

3

4

5

19.

Difficulty doing things spontaneously (e.g. going out on the spur of the moment)?

1

2

3

4

5

20.

Needing to go to the toilet urgently?

1

2

3

4

5

21.

Feeling unwell?

1

2

3

4

5

22.

Problems sleeping?

1

2

3

4

5

23.

Feeling mentally fatigued?

1

2

3

4

5

24.

Worries related to your MS?

1

2

3

4

5

25.

Feeling anxious or tense?

1

2

3

4

5

26.

Feeling irritable, impatient, or short tempered?

1

2

3

4

5

27.

Problems concentrating?

1

2

3

4

5

28

Lack of confidence?

1

2

3

4

5

29.

Feeling depressed?

1

2

3

4

5

Please check that you have circled ONE number for EACH question

 2000 Neurological Outcome Measures Unit, 4^th Floor Queen Mary Wing, NHNN, Queen Square, London WC1N 3BG, UK