Certainly! Here are clear instructions on how to complete the Physical Limitation domain of the Kansas City Cardiomyopathy Questionnaire (KCCQ):
The Physical Limitation domain assesses the extent to which your heart failure symptoms have limited your ability to perform various physical activities over the past 2 weeks. It consists of 6 questions, each asking about a specific activity.
For each question, please choose the response option that best describes how much your heart failure symptoms (such as fatigue, shortness of breath, or chest pain) have limited your ability to perform that activity during the past 2 weeks.
The response options are:
Extremely limited
Quite a bit limited
Moderately limited
Slightly limited
Not at all limited
Limited for other reasons or did not do the activity
Questions:
Dressing yourself
Showering/bathing
Walking 1 block on level ground
Doing yardwork, housework, or carrying groceries
Climbing a flight of stairs without stopping
Hurrying or jogging (as if to catch a bus)
For each question, circle the number that corresponds to your chosen response option. For example, if your heart failure symptoms have extremely limited your ability to dress yourself, circle "1" for question 1.
If you have not performed an activity for reasons other than your heart failure symptoms (e.g., you did not do yardwork because you live in an apartment), or if other factors have limited your ability to perform an activity (e.g., joint pain or back problems), choose response option "6" (Limited for other reasons or did not do the activity).
Please answer all 6 questions to the best of your ability, based on your experiences over the past 2 weeks. If you are unsure about how to answer a particular question, please choose the response option that you feel best describes your situation.
Once you have completed all 6 questions, please return the questionnaire to your healthcare provider or follow any additional instructions they have provided.
Remember, there are no right or wrong answers. The purpose of this questionnaire is to help your healthcare team understand how your heart failure symptoms are affecting your daily life and to guide your treatment plan. If you have any questions or concerns about the questionnaire or your heart failure symptoms, please don't hesitate to discuss them with your healthcare provider.
