Diabetic Foot Ulcer Scale: Carer. 1.Because you look after someone with foot ulcer problems, have you: Not at all

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1 Diabetic Foot Ulcer Scale: Carer Instructions These questions ask about the effect that looking after someone with foot ulcer problems has on your daily life and wellbeing. Please read each question carefully and respond by marking the most appropriate answer. Answer each question by circling one number on each line. If you are unsure about how to answer a question, please give the best answer you can. 1.Because you look after someone with foot ulcer problems, have you: a)stopped doing the hobbies and recreational activities that you enjoy b)changed the kinds of hobbies and recreational activities that you enjoy doing Not at all A little bit Moderately Quite a bit A great deal c)not been able to get away for a holiday or a weekend break d)chosen a different kind of holiday or short break than you would have preferred e)had less for yourself f)had to spend extra planning and organizing leisure activities

2 2.Because you look after someone with foot ulcer problems, how often: None A little of the Some Most All of the a)have you felt fatigued or tired b)have you felt drained c)have you had sleeping difficulties d)have you hurt yourself, such as straining your back e)have you neglected your own health f)have you felt that your own health conditions worsened g)have you lost some of your appetite

3 3.Because you look after someone with foot ulcer problems, how often have you: None A little Some Most All of the a)had to change the things you do during the day b)had longer, busier days c)taken on tasks that you wouldn't otherwise do such as cooking and cleaning d)had to spend more plan-ning or organizing your daily life e)felt restricted in your daily life

4 4.Because you look after someone with foot ulcer problems, have you: Not at all Slight-l y Moderately Quite a bit Extreme-l y a)felt frustrated b)felt angry that this is happening to someone you care about c)resented having to look after this person d)felt hopeless that things will ever get better e)felt guilty about feeling angry or frustrated about looking after this person f)been worried about future amputations g)been worried about what would happen if you were no longer able to look after them h)been worried about their wellbeing i)worried that the ulcer may never heal j)felt helpless to make things better k)felt sad about what is happening to the person you look after l)felt that you have no control over your life m)felt angry that this has happened to you n)felt lonely o)felt frightened about the future

5 5.Because you look after someone with foot ulcer problems, how often have you done things that you knew were not good for you such as eating, drinking or smoking too much? None A little Some Most All

6 6.Because you look after someone with foot ulcer problems, how much: Not applicable/ no spouse/ no family None Some Quite a bit A great deal A little a)strain has there been on your relationship with your spouse or partner b)strain has there been on your relationship with other family members 0 0 c)did you argue with your spouse or partner 0 d)have you had to bite your tongue to avoid conflicts 0 e)has there been a decline in your sexual relations 0 f)have you taken on family tasks or responsibilities that you would prefer not to have 0

7 7.Because you look after someone with foot ulcer problems, how much have you felt: Not at all A little bit Moderately Quite a bit A great deal a)that your circle of friends is getting smaller b)that there are restrictions on the kinds of things you do with your friends c)hindered in your social life

8 8.Because you look after someone with foot ulcer problems, how much have you been bothered by: Not at all A little bit Moder-a tely Quite a bit Extremely a)the amount of it takes you to care for the foot ulcer (including dressing changes, waiting for the district nurse and keeping the ulcer clean) b)the appearance, odour or leaking ulcer c)the fact that the person should keep their weight off the ulcer and does not 9.How satisfied were you with the medical care received for the foot ulcer problems? Not at all A little bit Moderately Quite a bit A great deal

9 10.Because you look after someone with foot ulcer problems: Not at all A little bit Moderately Quite a bit A great deal a)have you felt more confident about your ability to manage things b)have you been taking better care of your self in general c)have you felt closer to the person with the foot ulcer d)have you felt less worried e)have you felt more relaxed f)have you felt more aware of how to prevent future foot problems

10 11.Because you look after someone with foot ulcer problems, how much money have you spent out of your own pocket on things such as shoes, taxis, higher phone bills and home modification? None A little bit Some Quite a bit A great deal 12.Because you look after someone with foot ulcer problems, how bothered have you been by the money you have spent out of your own pocket on things such as shoes, taxis, higher phone bills and home modification? Not at all A little bit Moderately Quite a bit Extremely

11 13a.Work: Are you at present in paid employment? Yes (includes being on sick leave), 1 I usually work hours per week No, I am self employed 2 No, I am unemployed 3 No, I am disabled 4 No, I am retired 5 No, describe 6 Answer the following question only if you answered yes to question 13a. 13b.Were you able to work on any day during the past two weeks? No, I have not worked since / / (day/month/year) Yes, In the past two weeks I have missed hours* from work in total hours* from work because of looking after someone with foot ulcer problems. *If you haven t missed any hours, write 0' (zero) 1 2

12 If you are currently working either full or part, please answer the following question. 14.Because you look after someone with foot ulcer problems, how often have you: None of the A little of the Some Most of the All of the a)found it difficult to concentrate on your job b)lost from work because you have had to take care person or take them to a clinic or to hospital c)lost job opportunities or salary d)been less productive at work 15.Please provide the following information about yourself: Initials: Date of Birth (d/m/y): Sex: / / 1 Male 2 Female THANK YOU FOR COMPLETING THIS QUESTIONNAIRE