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.How much has MS affected your walking and 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.How much has your hand function and dexterity (e.g. hand tremors and hand coordination) been affected by your MS?
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.How have you been impacted by 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.How much has any bodily pain (e.g. achiness and tenderness) impacted you?
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.How have any sensory symptoms such as numbness, tingling or burning affected you?
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.Have bladder control symptoms (e.g. urinary urgency, frequency or hesitancy) affected you?
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.What impact has fatigue had on you?
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.How has MS affected your 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.How much have you been affected by 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.How much is MS impacting your cognitive functioning (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.Are you experiencing depression (e.g. low mood or depressed thoughts) and how is this impacting you?
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.Are you feeling anxious (e.g. feelings of stress or panic attacks) & how does this affect you?
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.