EQ5D5LSurvey MOBILITY I have no problems in walking about I have slight problems in walking about I have moderate problems in walking about I have severe problems in walking about I am unable to walk about PERSONAL CARE I have no problems washing or dressing myself I have slight problems washing or dressing myself I have moderate problems washing or dressing myself I have severe problems washing or dressing myself I am unable to wash or dress myself USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities) I have no problems doing my usual activities I have slight problems doing my usual activities I have moderate problems doing my usual activities I have severe problems doing my usual activities I am unable to do my usual activities PAIN / DISCOMFORT I have no pain or discomfort I have slight pain or discomfort I have moderate pain or discomfort I have severe pain or discomfort I have extreme pain or discomfort ANXIETY / DEPRESSION I am not anxious or depressed I am slightly anxious or depressed I am moderately anxious or depressed I am severely anxious or depressed I am extremely anxious or depressed YOUR HEALTH TODAY =

Section 1: First question group 1. Has the scar been painful the past few weeks? (Where: '0' - No, not at all and '10'- Yes, very much) 1 2 3 4 5 6 7 8 9 10 2. Has the scar been itching the past few weeks? (Where: '0' - No, not at all and '10'- Yes, very much) 1 2 3 4 5 6 7 8 9 10 3. Is the scar colour different from the colour of your normal skin at present? (Where: '0' - No, not at all and '10'- Yes, very different) 1 2 3 4 5 6 7 8 9 10 4. Is the stiffness of the scar different from your normal skin at present? (Where: '0' - No, not at all and '10'- Yes, very different) 1 2 3 4 5 6 7 8 9 10 Section 2: Second question group 5. Is the thickness of the scar different from your normal skin at present? (Where: '0' - No, not at all and '10'- Yes, very different) 1 2 3 4 5 6 7 8 9 10 6. Is the scar more irregular than your normal skin at present? (Where: '0' - No, not at all and '10'- Yes, very different) 1 2 3 4 5 6 7 8 9 10 7. What is your overall opinion of the scar compared to normal skin? (Where: '0' - As normal skin and '10'- Yes, very different) 1 2 3 4 5 6 7 8 9 10

Over the last 2 weeks, how often have you been bothered by the following problems?

PHQ4Survey Feeling nervous, anxious or on edge Not at all Several days More than half the days Nearly every day Not being able to stop or control worrying Not at all Several days More than half the days Nearly every day Little interest or pleasure in doing things Not at all Several days More than half the days Nearly every day Feeling down, depressed, or hopeless Not at all Several days More than half the days Nearly every day

FSH BIMS LIFI

Due to my Leg

Your lower limb (leg) may make it difficult to do some things you normally do. This list contains sentences people use to describe themselves when they have such problems. Think of yourself now or over the last few days. If an item describes you mark the box. If not leave the box blank...

I avoid heavy jobs eg. cleaning, lifting more than 5kg or 10lbs, gardening etc Never Sometimes Always I have pain almost all the time Never Sometimes Always I have difficulty with normal home or family duties and chores Never Sometimes Always I sleep less well Never Sometimes Always I need assistance with personal care eg. washing and hygiene Never Sometimes Always My regular daily activities (work, social contact) are affected Never Sometimes Always I am unable to move as fast as I would wish Never Sometimes Always I have difficulty with prolonged or extended standing Never Sometimes Always I have difficulty bending, squatting and/or reaching down Never Sometimes Always I have problems with my balance on uneven surfaces and/or with unaccustomed footwear Never Sometimes Always

PATIENT SPECIFIC INDEX - Think of 5 activities that are important to you and affected by your leg problem. If you can not think of 5, choose from those you marked in the question above. Score each activity on a scale range as follows, you may use half marks if you wish: 0= Best (Never affected / can do normal activity).....10=Worst (Always affected / Cant do activity at all)

Activity 1 Activity 1 Score (Where: '0' - Best (Never affected / Can do activity normally) and '10'- Worst (Always affected / Cant do activity at all)) 0 1 2 3 4 5 6 7 8 9 10 Activity 2 Activity 2 Score (Where: '0' - Best (Never affected / Can do activity normally) and '10'- Worst (Always affected / Cant do activity at all)) 0 1 2 3 4 5 6 7 8 9 10 Activity 3 Activity 3 Score (Where: '0' - Best (Never affected / Can do activity normally) and '10'- Worst (Always affected / Cant do activity at all)) 0 1 2 3 4 5 6 7 8 9 10 Activity 4 Activity 4 Score (Where: '0' - Best (Never affected / Can do activity normally) and '10'- Worst (Always affected / Cant do activity at all)) 0 1 2 3 4 5 6 7 8 9 10 Activity 5 Activity 5 Score (Where: '0' - Best (Never affected / Can do activity normally) and '10'- Worst (Always affected / Cant do activity at all)) 0 1 2 3 4 5 6 7 8 9 10 In all your activities or work, where 100% is what you did before the injury: What is your current % of pre injury duties? (eg Workers not working, sports people not participating=0) In the last few days, as a whole person, due to your LEG, rank your overall status compared to your normal level before the injury? (Where: '0' - Normal / No problem, 5 - Half way and '10’ - Worst possible) 0 1 2 3 4 5 6 7 8 9 10