CompleteMSIS

Multiple Sclerosis Impact Scale (MSIS)

The following questions ask for your views about the impact of Multiple Sclerosis on your day to day life DURING THE PAST 2 WEEKS

For each statement please select the option from the dropdown that best describes your situation.

The choices are

Not at all
A little
Moderately
Quite a bit
Extremely

Thank you

Name *

First

Last

1. Do physically demanding Tasks? *

2. Grip things tightly (eg Taps) *

3. Carry things *

4. Problems with balance *

5. Difficulty moving around indoors *

6. Being clumsy *

7. Stiffness *

8. Heavy arms or legs *

9. Tremor of your arms or legs *

10. Spasms in your limbs *

11. Your body not doing what you want it to do *

12. Having to depend on others to do things for you *

13. Limitations in your social and leisure activities at home *

14. Being stuck at home more than you would like *

15. Difficulties in using your hands in everyday tasks *

16. Having to cut down on the amount of time you spent on work on other daily activites *

17. Problems using transport (eg. Car, bus, train, taxi, etc.) *

18. Taking longer to do things *

19. Difficulty doing things *

20. Needing to go to the toiler urgently *

21. Feeling unwell? *

22. Problems sleeping? *

23. Feeling mentally fatigued? *

24. Worries relating to your MS? *

25. Feeling anxious and tense? *

26. Feeling irritable, impatient and short tempered? *

27. Problems concentrating? *

28. Lack of confidence? *

29. Feeling depressed? *

Donations are really important to the continued running of the Ryan MS Therapy Centre, particularly as we receive no government funding.