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

PHQ4Survey

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

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

Section 1: General

General

Please rate your ability to do the following activities in the last week by selecting appropriate response below.

Open a tight or new jar. No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Do heavy household chores (e.g. wash walls, floors). No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Carry a shopping bag or briefcase. No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Wash your back. No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Use a knife to cut food. No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis, etc.). No difficulty Mild difficulty Moderate difficulty Severe difficulty Unable During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbours or groups? Not at all Slightly Moderately Quite a bit Extremely During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem? Not limited at all Slightly limited Moderately limited Very limited Unable Arm, shoulder or hand pain. Please rate the severity of the following symptoms in the last week. None Mild Moderate Severe Extreme Tingling (pins and needles) in your arm, shoulder or hand. Please rate the severity of the following symptoms in the last week. None Mild Moderate Severe Extreme During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? No difficulty Mild difficulty Moderate difficulty Severe difficulty So much that I cannot sleep

Work Module

The following questions ask about the impact of your arm, shoulder or hand problem on your ability to work (including homemaking if that is your main work role).

Section 2: Work Module I do not work

Sports / Performing Arts Module

The following questions relate to the impact of your arm, shoulder or hand problem on playing your musical instrument or sport or both. If you play more than one sport or instrument (or play both), please answer with respect to that activity which is most important to you.

I do not play a sport or an instrument.