Work Productivity and Activity Impairment Questionnaire: Nausea & Vomiting

(WPAI:NV)
The following questions ask about the effect of nausea or vomiting on your ability to work and perform regular
activities. Please fill in the blanks or circle a number, as indicated
1) Are you currently employed (working for pay)?
!" #$%
If NO, check NO and go to question 6.
The ne&t questions are about the past seven days, not including today.
') (uring the past seven days) how many hours did you miss from work because of problems associated with
your nausea and vomiting? Include hours you missed due to sick days, times when you went in late, left
early, etc. because of your nausea and omiting. !o not include time off to "artici"ate in this study.
*"+,%
-) (uring the past seven days) how many hours did you miss from work for any other reason) such as
holidays or time off to participate in this study?
*"+,%
.) (uring the past seven days) how many hours did you actually work?
*"+,% #If $, go to question 6.%
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5) (uring the past seven days) how much did your nausea or vomiting affect your productivity while you were
working?
&hink about days when you were limited in the amount or kind of work you could do, days when you
accom"lished less than you would like, or days when you could not do your work as carefully as usual. If
your nausea or omiting affected your work only a little, choose a low number. 'hoose a high number if
your nausea or omiting affected your work a great deal.
6onsider only how much nausea or vomiting affected
productivity while you were working.
!ausea or
vomiting had no
effect on my
work
!ausea or vomiting
completely
prevented me from
working
7 1 ' - . 5 8 9 : ; 17
61,6<$ A !+=>$,
8) (uring the past seven days) how much did your nausea or vomiting affect your ability to do your regular
daily activities) other than work at a ?ob?
(y regular actiities, we mean the usual actiities you do, such as work around the house, sho""ing,
childcare, e)ercising, and studying, etc. &hink about times when you were limited in the amount or kind of
actiities you could do and times when you accom"lished less than you would like. If your nausea or
omiting affected your actiities only a little, choose a low number. 'hoose a high number if your nausea
or omiting affected your actiities a great deal.
6onsider only how much nausea or vomiting affected your ability
to do your regular daily activities) other than work at a ?ob.
!ausea or
vomiting had no
effect on my daily
activities
!ausea or vomiting
completely
prevented me from
doing my daily
activities
7 1 ' - . 5 8 9 : ; 17
61,6<$ A !+=>$,
'