AAFP Chronic Pain Toolkit
AMERICAN ACADEMY OF FAMILY PHYSICIANS
15
HOP 20012003
Work Productivity and Activity
Impairment Questionnaire
Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility
of a work productivity and activity impairment instrument.
PharamcoEconomics 1993; 4(5):353-65
Chronic Pain
Management
Toolkit
The following questions ask about the effect of your health problems on your ability to work and perform regular
activities. “Health problems” are defined as any physical or emotional problem or symptom. Please fill in the blanks
or check the appropriate box, as indicated.
1. Are you currently employed (working for pay)?
If NO, check “NO” and skip to question 6.
Yes
No
2. During the past seven days, not including today, how many hours did you miss from work because
of your health problems?
Include hours you missed on sick days, times you went in late, left early, etc., because of your
health problems. Do not include time you missed to participate in this study. _____ HOURS
3. During the past seven days, not including today, how many hours did you miss from work because
of any other reason, such as vacation, holidays, time off to participate in this study? _____ HOURS
4. During the past seven days, not including today, how many hours did you actually work?
(If “0”, skip to question 6.) _____ HOURS
5. During the past seven days, not including today, how much did your health problems 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. If health problems affected your work
only a little, choose a low number. Choose a high number if health problems affected your work a great deal.
Consider only how much health problems affected productivity while you were working.
Health problems had no Health problems completely prevented
effect on my daily activities me from doing my daily activities
0 1
2 3 4 5 6 7 8 9 10
6. During the past seven days, not including today, how much did your health problems affect your ability to do your
regular, daily, non-work activities?
“Regular activities” are defined as 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. If health problems affected your activities only
a little, choose a low number. Choose a high number if health problems affected your activities a great deal.
Consider only how much health problems affected your ability to do your regular, daily, non-work activities.
Health problems had no Health problems completely prevented
effect on my daily activities me from doing my daily activities
0 1
2 3 4 5 6 7 8 9 10
