0 0 1 1 2 2 3.
Australian pelvic floor questionnaire.
The australian pelvic floor questionnaire bladder and bowel domain scores demonstrated moderate positive correlations with the international consultation on incontinence questionnaire short form questionnaire for urinary incontinence r 0 74 p 0 01 and the international consultation on incontinence questionnaire bowel module r 0 69.
Please mark x in the box that best describes your symptoms in the last month.
Page 1 of 2 australian pelvic floor questionnaire please circle your most applicable answer.
Consider your exp patient s name.
The australian pelvic floor questionnaire apfq is a validated multi lingual self completed questionnaire that evaluates and scores all four areas of female pelvic floor dysfunction.
Date of birth.
How many times do you pass urine in the day.
Do you experience urine leakage incontinence related to physical activity such as.
0 up to 7 1 between 8 10 2 between 11 15 3 more than 15 2.
Bladder section q 1 14 score 42 urinary frequency how many times do you pass urine in the day.
Queensland female pelvic floor questionnaire 1 patient.
The self administered australian pelvic floor questionnaire apfq comprehensively integrates four domains to assess bladder bowel prolapse and sexual symptoms their severity their bother and impact on quality of life.
The australian pelvic floor questionaire please circle your most applicable answer.
0 up to 7 1 between 8 10 2 between 11 15 3 more than 15 nocturia how many times do you get up at night to pass urine.
It also advises women to ensure their exercise program is pelvic floor friendly.
Pelvic floor bother questionnaire.
The following is a questionnaire about your pelvic health.
All information is strictly confidential.
Once completed you can compare your scores to that of healthy volunteers and those referred for treatment.
The australian pelvic floor questionnaire apfq is a validated multi lingual self completed questionnaire that evaluates and scores all four areas of female pelvic floor dysfunction.
Takes 5 minutes to complete.
This short screening tool is designed for women to check if at risk of pelvic floor problems.
Consider your experiences during the last month.
It has recently been validated in pregnant and postpartum women and designed to facilitate clinical assessment of pelvic.
