Wellsbourne Healthcare Community Interest Company

Your local GP surgery in East Brighton

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Moving Beyond Pain – Monitoring Form

Thank you for taking a few minutes to answer these questions. Your answers will help us understand how ‘Moving Beyond Pain’ is working, and whether it is helping you to manage your pain at all. We will be asking you to answer the same questions at the start and end of the programme. There are no right or wrong answers. Please answer as accurately as you can. Everything you tell us is completely confidential. We will never use your name or anything else that might identify you, without your express permission.

Moving Beyond Pain – Monitoring Form
Pain Self-Efficacy Questionnaire (PSEQ)
Please rate how confident you are that you can do the following things at present, despite the pain. To indicate your answer, tick one of the options on the scale under each item from 0 to 6, where 0 means ‘Not at all confident’ and 6 means ‘Completely confident’
I can enjoy things despite the pain *
I can do most of the household chores (e.g. tidying-up, washing dishes, etc.), despite the pain. *
I can socialise with my friends or family members as often as I used to do, despite the pain. *
I can cope with my pain in most situations *
I can do some form of work, despite the pain. (‘work’ includes housework, paid and unpaid work)
I can still do many of the things I enjoy doing, such as hobbies or leisure activity, despite pain. *
I can cope with my pain without medication *
I can still accomplish most of my goals in life, despite the pain *
I can live a normal lifestyle, despite the pain *
I can gradually become more active, despite the pain *
Short Active Lives Questionnaire
In the past 7 days, have you done a continuous walk lasting at least 10 minutes? *
How much time, in hours and minutes, did you usually spend walking on each day that you did the activity?
Was the effort you put into walking usually enough to raise your breathing rate?
Mental Wellbeing Questionnaire