This tracker has been created for people living with MS.1 It is a tool that can help you assess how severe your MS symptoms are, and the impact these symptoms are having on your life. It has been designed to cover the wide range of symptoms that can occur with MS.
The questions take approximately 1-2 minutes
The questionnaire can be completed anytime, even when you aren’t experiencing symptoms or when they seem very mild. You may like to do it regularly as a way of monitoring your symptoms.
Consider sharing the results with your doctor
They can quickly assess how your symptoms are impacting you, and make plans to help you manage them.
How to answer
Select the option that best describes how MS has affected each function. For example, if it takes you longer to type or text, you might rate your hand function as “mildly limited”. If you gave up typing you might rate your hand function as “very limited”.
1.To what extent is your MS currently impacting mobility?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
2.To what extent is your MS currently impacting hand function and dexterity (e.g. hand tremors and hand coordination)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
3.To what extent is your MS currently impacting muscle stiffness and spasticity (e.g. muscle cramps or muscle tightening)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
4.To what extent is your MS currently impacting bodily pain (e.g. achiness and tenderness)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
5.To what extent is your MS currently impacting sensory symptoms (e.g. numbness, tingling or burning)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
6.To what extent is your MS currently impacting bladder control symptoms (e.g. urinary urgency, frequency or hesitancy)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
7.To what extent is your MS currently impacting fatigue?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
8.To what extent is your MS currently impacting vision (e.g. blurry vision, double vision)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
9.To what extent is your MS currently impacting dizziness (e.g. feeling off balance, 'spinning' or vertigo)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
10.To what extent is your MS currently impacting cognitive function (e.g. memory, concentration)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
11.To what extent is your MS currently impacting symptoms of depression (e.g. low mood or depressed thoughts)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
12.To what extent is your MS currently impacting symptoms of anxiety (e.g. feelings of stress or panic attacks)?
Not at all
Very mild impact
I make minor adjustments
Mild impact
I make frequent adjustments
Moderate impact
I have reduced my daily activities
Severe impact
I have given up some daily activities
Very severe impact
I’m unable to do many daily activities
Total limitation
I’m unable to do most daily activities
Share your results with your doctor
This tool is helpful to see how your MS symptoms are impacting your life. It is not intended to diagnose symptoms or measure their severity. That is something that your doctor will do.
Print your results and take them to your GP or neurologist appointment so that they can better understand how the symptoms are affecting you.
Reference: 1. Green R, et al. Appl Neuropsychol Adult. 2017;24(2):183-189.