8/20/2019 Wpai-shp English Us v2

1/2

Work Productivity and Activity Impairment Questionnaire:Specific Health Problem V2! "WPAI:SHP#

The following questions ask about the effect of your PROBLEM on your ability to workand perform regular actiities! Please fill in the blanks or circle a number, as indicated.

"! #re you currently employed $working for pay%& ''''' (O ''' )E*If NO, check “NO” and skip to question 6.

The ne+t questions are about the past seven days, not including today!

-! .uring the past seen days, how many hours did you miss from work because ofproblems associated with your PROBLEM& Include hours you missed on sick days,times you went in late, left early, etc., because of your PO!"#$. %o not includetime you missed to participate in this study.

 &&&&& /O0R*

1! .uring the past seen days, how many hours did you miss from work because ofany other reason, such as acation, holidays, time off to participate in this study&

 '''''/O0R*

2! .uring the past seen days, how many hours did you actually work&

 '''''/O0R* 'If “(”, skip to question 6.)

8/20/2019 Wpai-shp English Us v2

2/2

3! .uring the past seen days, how much did your PROBLEM affect your productiity

while you were working&

*hink about days you were limited in the amount or kind of work you could do, daysyou accomplished less than you would like, or days you could not do your work ascarefully as usual. If PO!"#$ affected your work only a little, choose a lownumber. +hoose a hih number if PO!"#$ affected your work a reat deal.

4onsider only how much PROBLEM affectedproductiity while you were working!

PROBLEM had

no effect on mywork

PROBLEM

completelypreented mefrom working

5 " - 1 2 3 6 7 8 9 "5

4:R4LE # (0MBER

6! .uring the past seen days, how much did your PROBLEM affect your ability to doyour regular daily actiities, other than work at a ;ob&

!y reular acti-ities, we mean the usual acti-ities you do, such as work around thehouse, shoppin, childcare, eercisin, studyin, etc. *hink about times you werelimited in the amount or kind of acti-ities you could do and times you accomplishedless than you would like. If PO!"#$ affected your acti-ities only a little, choose alow number. +hoose a hih number if PO!"#$ affected your acti-ities a reatdeal.

4onsider only how much PROBLEM affected your abilityto do your regular daily actiities, other than work at a ;ob!

PROBLEM had

no effect on mydaily actiities

PROBLEM

completelypreented mefrom doing mydaily actiities

5 " - 1 2 3 6 7 8 9 "5

  4:R4LE # (0MBER

-!5 $0* English%

Reilly MC, Zbrozek AS, Dukes E: The validity and reproducibility o a !ork productivity and activity i"pair"ent "easure#

$har"acoEcono"ics %&&'( )*+:'+'-'.+#/