The Healthcare Resource Utilization and Costs of Acute/Subacute Herpes Zoster in a Set
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ORIGINAL RESEARCH ARTICLE / Pharmacoeconomics 2007; 25 (5): Supplementary Material1170-7690/07/002-0001/$44.95/0
© 2007 Adis Data Information BV. All rights reserved.
The Work Productivity and Activity Impairment Questionnaire for Patients with Gastroesophageal Reflux Disease (WPAI GERD)
Responsiveness to Change and English Language Validation
Peter Wahlqvist,1 Gordon H. Guyatt,2 David Armstrong,2 Alessio Degl’ Innocenti,1 Diane Heels-Ansdell,2 Samer El-Dika,3 Ingela Wiklund,1 Carlo A. Fallone,4 Lisa Tanser,5 Sander Veldhuyzen van Zanten,6 Peggy Austin,2 Alan N. Barkun,4 Naoki Chiba,2 and Holger J. Schunemann2,3,7
- AstraZeneca R&D, Mölndal, Sweden
- McMaster University, Hamilton, Ontario, Canada
- University at Buffalo, State University of New York, Buffalo, New York, USA
- McGill University Health Center, Montreal, Quebec, Canada
- AstraZeneca Canada, Mississauga, Ontario, Canada
- University of Alberta, Edmonton, Canada
- INFORMA/CLARITY Research Group, Italian National Cancer Institute, Regina Elena, Rome, Italy
Supplementary Material
This supplementary material contains the questionnaire referred to in the full version of this article, which can be found at
Work Productivity and Activity Impairment Questionnaire:
Gastro-Esophageal Reflux Disease (WPAI-GERD)
The following questions ask about the effect of your reflux symptoms on your ability to work and perform regular daily activities. Please fill in the appropriate box or the blanks or mark on the scales as indicated.
We use the term reflux symptoms to mean heartburn or acid regurgitation. Heartburn is defined as a burning feeling rising from your stomach or lower chest up towards your neck. Acid regurgitation is defined as acid tasting liquid returning to your throat or mouth.
1) Are you currently employed (working for pay)? NO YES
If NO, check “NO” and skip to question 7.
The next questions refer to the past seven days, not including today.
2.a) / During the past seven days, how many days did you work? Count each day you worked as a working day, even if you only worked for part of the day.0 1 2 3 4 5 6 7 WORKING DAYS
2.b) / How many of those days did you have reflux symptoms while working?Include days when you had reflux symptoms at any time while working.
0 1 2 3 4 5 6 7 WORKING DAYS WITH
REFLUX SYMPTOMS
3) During the past seven days, how many hours did you miss from work because of problems associated with your reflux symptoms? Include hours you missed on sick days, times you went in late, left early, etc., because of problems associated with reflux symptoms. Do not include time you missed to participate in this study.
_____ HOURS
4) During the past seven days, how many hours did you miss from work because of any other reason, such as holidays, bank holidays, time off to participate in this study?
_____HOURS
5) During the past seven days, how many hours did you actually work?
_____HOURS
(If "0", skip to question 7)
6) During the past seven days, how much did your reflux symptoms on average affect your productivity while you were working?
Think about days you were limited in the amount or kind of work you could do, days you accomplished less than you would like, or days you could not do your work as carefully as usual because of your reflux symptoms.
Please answer indicating how much your normal productivity was affected by putting a cross (X) on the scale. For example, if your normal productivity was not affected at all by your reflux symptoms, put a X at 0%; if your productivity was reduced by half, put a X at 50%; if you were completely unable to perform your work, put a X at 100%.
Productivity (PUT A CROSS (X) ON THE SCALE)Unable
not affectedto work
0%10%20%30%40%50%60%70%80%90%100%
7) During the past seven days, how much did your reflux symptoms on average affect your productivity while doing your regular daily activities, other than work at a job?
By regular daily activities, we mean the usual activities you do, such as work around the house, shopping, childcare, exercising, studying, etc. Think about times you were limited in the amount or kind of activities you could do and times you accomplished less than you would like because of your reflux symptoms.
Please answer indicating how much your normal productivity was affected by putting a cross (X) on the scale. For example, if your normal productivity was not affected at all by your reflux symptoms, put a X at 0%; if your productivity was reduced by half, put a X at 50%; if you were completely unable to perform your daily activities, put a X at 100%.
Productivity (PUT A CROSS (X) ON THE SCALE)Unable to do
not affecteddaily activities
0%10%20%30%40%50%60%70%80%90%100%