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Survey Instrument Library

This is a list of instruments that have been identified as being used in VA research and clinical settings for Long COVID and should not be viewed as an endorsement by LC-PBRN. For specific guidance please refer to available clinic guides for considerations of in-clinic use.

Symptom Domain

Clinical Recommendations on Survey Instruments for Long COVID

Symptom Domain: General

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

30 Second Sit to Stand

<5

NA

measures lower extremity strength

NA

EQ-5D-5L

<5

5

Provides a single measurement of health status based on mobility, self-care, usual activity, pain,
 and anxiety/depression.

yes

Accountable Health Communities Screening Tool

10-20 

10-26

Determining needs available through community services including housing instability, food
 insecurity, transportation problems, utility help needs, interpersonal safety, etc.

 

Post COVID Functional Status (PCFS)

<5

1

Current impact of COVID-19 on every day life

no

VA Well-Being Survey

<5

3

How Veterans are doing in their daily lives

no

COVID-19 Yorkshire Rehabilitation Scale (C-19-YRS)/Modified COVID-19
Yorkshire Rehabilitation Scale (C19-YRSm)

20-30

17-22

assess presence and severity of Long COVID symptoms as well as functional disablilty

no

Long-Term Symptom Questionnaire

15-20

20

Impact of long-term health conditions on daily life

no

PROMIS Scale v1.2- Global Health

10

10

Overall evaluation of a patient's physical and mental health.

yes

SARS CoV 2 Symptom Questionnaire

<5

21

assesses for presence of COVID-19 like symptoms

no

Veterans Rand 12-Item Health Survey (VR 12)

10

12

Measures physical well-being, physical symptoms, psychlogical symptioms as well as overall
quality of life.

no

Functional Independence Measure (FIM)

30-45

18

Measures disability through measuring activties of daily living (ADLS)

no

WHO Disabilitiy Assessment Schedule 2.0 (WHODAS 2.0)

5-20

12-36

Standardized method for measuring health and disability across cultures

no

AM-PAC Daily Activity Outpatient Routine Short Form

5

10

Measures a patient's ability to perform functional activities required in most daily routines.

no

Flu Related Symptoms Questionnaire

10

42

assesses common virus-related symptoms

no

Maryland Assessment of Recovery Scale (MARS-12)

5

12

Assess the recovery of patients with serious mental illness

no

Texas Functional Living Scale (TFLS)

15-20

15

Measures a patient's ability to perform activities of daily living related to time, money,
communication and memory

no

McGill Global Quality of Life (GQOL)

10-15

17

Measures physical well-being, physical symptoms, psychlogical symptioms as well as overall
quality of life.

no

Million Veterans Program COVID-19 Survey

65

54

Collects information on symptoms, diagnosis, hospitalization and other factors specific to
COVID-19

no

Symptom Burden Questionnaire (University of Birmingham)

20

131

measures symptom burden in adults with Long COVID.

no

Long-Term Conditions Questionnaire (LTCQ)

5-10

20

measures the impact of long term health conditions on quality of life

no

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Symptom Domain: Objective Exam

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

30 Second Sit to Stand (30STS)

<5

NA

measures lower extremity strength

NA

2 Minute Step Test (2MST)

<5

NA

measures aerobic capacity

NA

2 Minute Walk Test (2MWT)

 <5

NA

measures aerobic capacity

NA

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Symptom Domain: Activity Tolerance

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

2 Minute Walk Test (2MWT)

 <5

NA

measures aerobic capacity

NA

Exercise Vital Sign (EVS) Questionnaire

<5

2-3

calculates a person's total exercise per week

no

6 Minute Walk Test

 6

NA

measures aerobic capacity

NA

Life Space Assessment (LSA)

<5

5

measures mobility

no

AM-PAC Activity Measure for Post-Acute Care - "6 Clicks"

5

6

assesses activity limitations following an acute hospitalization

no

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Anosmia

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

Anglicized Olfactory Disroder Questionnaire (eODQ)

5-10

24

impact of olfactory disorders on quality of life

no

Smell Identification Test (UPSIT)

10

40

tests the function of the olfactory system

no

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Symptom Domain: ANS Dysregulation

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

Migraine Disability Assessment (MIDAS)

5

5-7

measures the impact of migraines on quality of life

yes

Orhtostatic Hypotension Questionnaire (OHQ)

5-10

10

assesses the symptom burden of neurogenic orthostatic hypotension

no

Insomnia Severiy Index (ISI)

<5

5

measures the severity of insomnia symtpoms over the prior two weeks

no

STOP-Bang Obstructive Sleep Apnea Questionnaire

<5

8

assesses risk of obstructive sleep apnea

no

COMPASS 31

10-15

31

assesses autonomic symptom severity

yes

Neurobehavioral Symptom Inventory (NSI)

5-10

22

measures symptoms after a traumatic brain injury (TBI)

no

10-Minute Stand Test (Active Stand Test)

20

NA

used to diagnose PoTS

NA

Orthostatic Blood Pressure

10 

NA

detects low blood pressure when standing

NA

Pupil reactivity

<5

NA

part of neurological exam - helps detect problems with the brain, autonomic nervous system

NA

Heart Rate Variability with deep breathing

<5

NA

assesses cardiovegal function and autonomic nervous system activity

NA

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Symptom Domain: Chest Pain

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

ECG

5-10

NA

assesses heart activity and for cardiac symptoms

NA

Submax treadmill test

6-12

NA

assesses cardiorespiratory fitness and functional capacity

NA

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Symptom Domain: Cognitive Impairment

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

Multidimensional Inventory of Subjective Cognitive Impairment

5-10

10

measures cognitive dysfunction in fibromyalgia

no

Long-Term Symptoms Questionnaire

15-20

20

Impact of long-term health conditions on daily life

no

AM-PAC Applied Cognitive Outpatient Routine Short Form

5-10

19

assesses cognitive function not well-represented in other measures like reading, daily routines
 and problem solving

no

Mini-Mental State Examination (MMSE)

5-10

11

assesses cognitive impairment

no

Montreal Cognitive Assessment (MoCA)

10

11

screening tool for cognitive dysfunction

no

Six-Item Cognitive Impairment Test (6CIT)

5

6

identifies cognitive impairment

no

Saint Louis University Mental Status Exam (SLUMS)

5-10

11

screening tool for mild neurocognitive disorder and dementia

no

Neurobehavioral Symptom Inventory (NSI)

5-10

22

measures symptoms after a traumatic brain injury (TBI)

no

Telephone Interview for Cognitive Status (TICS)

10

11

screening tool for cognitive impairment and dementia. It can be given to patients with severe visual
 and/or motor impairments and does not require face-to-face administration

no

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Symptom Domain: Cough

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

Cough Severity Index

5

10

measures the impact of cough on quality of life

no

Leicester Cough Questionnaire

5-10

19

measures the impact of cough on quality of life

no

Cough Symptom Score

<5

2

assesses cough severity during daytime and nighttime

no

Flu Related Symptoms Questionnaire

10

42

assesses common virus-related symptoms

no

Cough Specific Quality of Life Questionnare (CQLQ)

5-10

28

measures the impact of cough on quality of life

no

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Symptom Domain: Dysgeusia

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

Anglicized Olfactory Disorder Questionnaire (eODQ)

5-10

24

impact of olfactory disorders on quality of life

yes

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Symptom Domain: Dyspnea

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

30 Second Sit to Stand (30STS)

<5

NA

measures lower extremity strength

NA

Modified Medical Research Council Dyspnea Scale (mMRC)

<5

1

assess functional diability related to dyspnea

no

2 Minute Walk Test (2MWT)

<5

NA

measures aerobic capacity

NA

Long-Term Symptom Questionnaire

15-20

20

Impact of long-term health conditions on daily life

no

PROMIS-Dyspnea Severity - 10a

5-10

10

measures dyspnea/SOB severity

no

6 Minute Walk Test

6

NA

measures aerobic capacity

NA

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Symptom Domain: Fatigue

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

30 Second Sit to Stand

<5

NA

measures lower extremity strength

NA

Modified Medical Research Council Dyspnea Scale (mMRC)

<5

1

assess functional diability related to dyspnea

no

2 Minute Step Test (2MST)

<5

NA

measures aerobic capacity

NA

2 Minute Walk Test (2MWT)

<5

NA

measures aerobic capacity

NA

Long-Term Symptom Questionnaire

15-20

20

Impact of long-term health conditions on daily life

no

DePaul Symptom Questionnaire - Post Exertionl Malaise (DSQ-PEM)

5

10

assess post-exertional malaise

yes

6 Minute Walk Test

6

NA

measures aerobic capacity

NA

Epworth Sleepiness Scale

<5

8

measures daytime sleepiness

no

Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)

10-15 

40

assesses fatigue and its effect on daily activities

yes

Fatigue Severity Scale (FSS)

<5 

9

measures fatigue severity and impacts on daily life

yes

McGill Global Quality of Life (GQOL)

10-15 

17

Measures physical well-being, physical symptoms, psychlogical symptioms as well as overall
 quality of life.

no

Canadian Occupational Performance Measure (COPM)

10-45

9

assesses perceived performance of self-care, productivity and leisure

no

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Symptom Domain: Headache

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

Headache Impact Test (HIT-6)

5

6

assesses the impact of headaches on daily life

no

Migraine Disability Assessment (MIDAS)

5

5-7

measures the impact of migraines on quality of life

yes

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Symptom Domain: Mental Health

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

EQ-5D-5L

<5

5

Provides a singe measurement of health status based on mobility, self-care, usual activity, pain,
 and anxiety/depression.

yes

General Anxiety Disorder-7 (GAD-7)

5

7

screening for the presence of anxiety disorder

yes

Patient Health Questionnaire (PHQ-9)

5

9

screening tool for depression as well as monitoring of depression and response to treatment

no

Patient Health Questionnaire (PHQ-4)

<5

4

screening tool for depression and anxiety

no

Subjective Units of Distress

<5

1

measures intensity of anxiety/distress/nervousness

no

Long-Term Symptom Questionnaire

15-20

20

Impact of long-term health conditions on daily life

no

Sheehan Disability Scale (SDS)

<5

3

measures functional impairment in work, family and social life

no

Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)

<5

5

screening for probable PTSD

no

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Symptom Domain: Pain

Instrument

Time to Administer (minutes)

Instrument Length (# of items)

Description

Available in VA REDCap

Pain, Enjoyment of Life and General Activity (PEG) Scale

<5

3

assesses impact of pain on daily life

yes

Headache Impact Test (HIT-6)

5

6

assesses the impact of headaches on daily life

no

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Clinical Recommendations on Survey Instruments for Long COVID:

Cognitive Impairment:

https://www.va.gov/covidtraining/docs/longCOVID/LongCOVID-Clinic-Guide-Nervous-System-09172024.pdf

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