PDQ-39 Questionnaire

Name*

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Who is your Coach?*

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Your Coach's Email

Due to having Parkinson’s disease, how often during the last month have you....

1. Had difficulty doing the leisure activities which you would like to do?*

2. Had difficulty looking after your home, e.g. DIY, housework, cooking?*

3. Had difficulty carrying bags of shopping?*

4. Had problems walking half a mile?*

5. Had problems walking 100 yards?*

6. Had problems getting around the house as easily as you would like?*

7. Had difficulty getting around in public?*

8. Needed someone else to accompany you when you went out?*

9. Felt frightened or worried about falling over in public?*

10. Been confined to the house more than you would like?*

11. Had difficulty washing yourself?*

12. Had difficulty dressing yourself?*

13. Had problems doing up your shoe laces?*

14. Had problems writing clearly?*

15. Had difficulty cutting up your food?*

16. Had difficulty holding a drink without spilling it?*

17. Felt depressed?*

18. Felt isolated and lonely?*

19. Felt weepy or tearful?*

20. Felt angry or bitter?*

21. Felt anxious?*

22. Felt worried about your future?*

23. Felt you had to conceal your Parkinson's from people?*

24. Avoided situations which involve eating or drinking in public?*

25. Felt embarrassed in public due to having Parkinson's disease?*

26. Felt worried by other people's reaction to you?*

27. Had problems with your close personal relationships?*

28. Lacked support in the ways you need from your spouse or partner?*

Never
Occasionally
Sometimes
Often
Never or cannot do at all
I do not have a spouse or partner

29. Lacked support in the ways you need from your family or close friends?*

30. Unexpectedly fallen asleep during the day?*

31. Had problems with your concentration, e.g. when reading or watching TV?*

32. Felt your memory was bad?*

33. Had distressing dreams or hallucinations?*

34. Had difficulty with your speech?*

35. Felt unable to communicate with people properly?*

36. Felt ignored by people?*

37. Had painful muscle cramps or spasms?*

38. Had aches and pains in your joints or body?*

39. Felt unpleasantly hot or cold?*

Submission Date*

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