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FACE-QTM - PATIENT-PERCEIVED AGE VISUAL ANALOGUE SCALE - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Age Appraisal-Visual Analog Scale_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ PATIENT‐PERCEIVED AGE VISUAL ANALOGUE SCALE
We would like to know how old you think you look. How many years younger or older do you think you look compared with your actual age? Please circle one number below:
-15 -14 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5 +6 +7 +8 +9 +10 +11 +12 +13 +14 +15
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Panchapakesan V, Klassen AF, Cano SJ, Scott AM, Pusic AL. Development and Psychometric Evaluation of the FACE‐Q Aging Appraisal Scale and Patient‐Perceived Age Visual Analog Scale. Aesthetic Facial Surgery. 2013 Nov 1;33(8):1099‐109.
I look my age
I look 15 years
older
I look 15 years younger
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FACE-QTM - AGING APPRAISAL - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Aging Appearance Appraisal SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ AGING APPRAISAL For each statement, circle only one answer. These statements ask about how you look right now. We would like to know how you feel about the age your face looks. Please indicate how much you agree or disagree with each statement.
Definitely
disagree
Somewhat
disagree
Somewhat
agree
Definitely
agree
a. I look so old that I don’t recognize myself. 1 2 3 4
b. When I look in the mirror, I don’t look like
myself. 1 2 3 4
c. I am bothered by how old I look. 1 2 3 4
d. I look older than I want to look. 1 2 3 4
e. I am worried by how old I am starting to
look. 1 2 3 4
f. In recent photos, I look older than I want to. 1 2 3 4
g. When I see my reflection, I am reminded of
how old I look. 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Panchapakesan V, Klassen AF, Cano SJ, Scott AM, Pusic AL. Development and Psychometric Evaluation of the FACE‐Q Aging Appraisal Scale and Patient‐Perceived Age Visual Analog Scale. Aesthetic Facial Surgery. 2013 Nov 1;33(8):1099‐109.
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information. REVIE
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FACE-QTM - AGING APPRAISAL - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Aging Appearance Appraisal SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ AGING APPRAISAL CONVERSION TABLE Instructions: Ensure the data are rescored as follows: “Definitely disagree” = 4; “Somewhat disagree” = 3; “Somewhat agree” = 2; “Definitely agree” = 1. Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale summed score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100) 7 0
8 7
9 15
10 21
11 26
12 30
13 35
14 38
15 42
16 46
17 50
18 53
19 56
20 60
21 63
22 66
23 70
24 73
25 77
26 83
27 90
28 100
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FACE-QTM - APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Appearance-Related Psychosocial Distress SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS For each statement circle only one answer. These are statements people might use to describe themselves. With your appearance in mind, how much do you disagree or agree with each statement:
Definitely
disagree
Somewhat
disagree
Somewhat
agree
Definitely
agree
a. I feel unhappy about how I look. 1 2 3 4
b. I feel stressed about how I look. 1 2 3 4
c. I feel down about how I look. 1 2 3 4
d. I feel anxious when people look at me. 1 2 3 4
e. I worry that I don’t look normal. 1 2 3 4
f. I worry that I am ugly. 1 2 3 4
g. I tend to avoid being around people. 1 2 3 4
h. I have little interest in doing things. 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Klassen AF, Cano SJ, Alderman A, East C, Badia L, Baker SB, Robson S, Pusic AL. Self‐report scales to measure expectations and appearance‐related psychosocial distress in patients seeking cosmetic treatments. Aesth Plast Surg. 2016 May 24. [Epub ahead of print]
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
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FACE-QTM - APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Appearance-Related Psychosocial Distress SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ APPEARANCE-RELATED PSYCHOSOCIAL DISTRESS CONVERSION TABLE
Instructions: Higher scores reflect more appearance‐related psychosocial distress. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw summed scale score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100)
8 0
9 3
10 13
11 20
12 26
13 31
14 35
15 39
16 42
17 45
18 47
19 50
20 52
21 54
22 57
23 59
24 61
25 64
26 67
27 70
28 73
29 77
30 82
31 90
32 100
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FACE-QTM - EARLY LIFE IMPACT OF TREATMENT - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Early Life Impact of Treatment SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ EARLY LIFE IMPACT OF TREATMENT For each question, circle only one answer. These questions ask about recovery from your surgery or procedure. With your most recent facial surgery or procedure in mind, in the past 2 days, how often have you:
Not at all
Some of the
time Most of the
time
a. Felt regret about the surgery or procedure? 1 2 3
b. Felt more anxious than usual? 1 2 3
c. Had trouble sleeping? 1 2 3
d. Wondered if the surgery or procedure was worthwhile?
1 2 3
e. Felt more tired than usual? 1 2 3
f. Avoided certain head movements (e.g. bending your head down)?
1 2 3
g. Not done your usual day‐to‐day activities (e.g. going to work, running errands)?
1 2 3
h. Avoided certain facial movements (e.g. laughing, squinting)?
1 2 3
i. Had difficulty drinking? 1 2 3
j. Had difficulty eating? 1 2 3
k. Avoided social situations? 1 2 3
l. Avoided intimacy (e.g. kissing or hugging)? 1 2 3
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Klassen AF, Cano SJ, Schwitzer J, Scott A, Pusic AL. FACE‐Q scales for health‐related quality of life, early life impact and satisfaction with outcomes and decision to have treatment: development and validation. Plast Reconstr Surg. 2015;135(2):375‐86
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
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FACE-QTM - EARLY LIFE IMPACT OF TREATMENT - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Early Life Impact of Treatment SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ EARLY LIFE IMPACT OF TREATMENT CONVERSION TABLE Instructions: Ensure the data are rescored as follows: “Not at all” = 3; “Some of the time” = 2; “Most of the time” = 1. Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100) 12 0
13 7
14 16
15 22
16 26
17 30
18 34
19 37
20 40
21 43
22 46
23 49
24 51
25 54
26 56
27 58
28 61
29 64
30 66
31 70
32 73
33 77
34 82
35 90
36 100
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1 FACE-QTM – EXPECTATIONS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Expectations SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM – EXPECTATIONS
For each statement circle only one answer. These are statements people might use to describe how their life will change after a cosmetic procedure. With your appearance in mind, how much do you disagree or agree with each statement:
Definitely
disagree
Somewhat
disagree
Somewhat
agree
Definitely
agree
a. I will look fantastic. 1 2 3 4
b. People will tell me how great I look. 1 2 3 4
c. People close to me will be proud of how I look. 1 2 3 4
d. I will be transformed. 1 2 3 4
e. Good things will happen to me. 1 2 3 4
f. I will feel like I fit in. 1 2 3 4
g. My close relationships will improve. 1 2 3 4
h. New people will want to get to know me. 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Klassen AF, Cano SJ, Alderman A, East C, Badia L, Baker SB, Robson S, Pusic AL. Self‐report scales to measure expectations and appearance‐related psychosocial distress in patients seeking cosmetic treatments. Aesth Plast Surg. 2016 May 24. [Epub ahead of print]
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
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2 FACE-QTM – EXPECTATIONS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Expectations SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM – EXPECTATIONS CONVERSION TABLE
Instructions: Higher scores reflect higher (more unrealistic) expectations. If missing data is less than
50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to
convert the raw summed scale score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100)
8 0
9 11
10 18
11 23
12 28
13 32
14 35
15 38
16 40
17 43
18 45
19 47
20 50
21 52
22 54
23 57
24 59
25 62
26 65
27 69
28 73
29 77
30 83
31 90
32 100
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FACE-QTM - PSYCHOLOGICAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Psychological Function SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ PSYCHOLOGICAL FUNCTION
For each statement, circle only one answer. These are statements people might use to describe themselves. With your facial appearance in mind, in the past week, how much would you agree or disagree with each statement:
Definitely
disagree
Somewhat
disagree
Somewhat
agree
Definitely
agree
a. I like myself. 1 2 3 4
b. I feel positive about myself. 1 2 3 4
c. I feel okay about myself. 1 2 3 4
d. I feel happy. 1 2 3 4
e. I am comfortable with myself. 1 2 3 4
f. I am accepting of myself. 1 2 3 4
g. I feel good about myself. 1 2 3 4
h. I feel confident. 1 2 3 4
i. I feel attractive. 1 2 3 4
j. I feel great about myself. 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Klassen AF, Cano SJ, Schwitzer J, Scott A, Pusic AL. FACE‐Q scales for health‐related quality of life, early life impact and satisfaction with outcomes and decision to have treatment: development and validation. Plast Reconstr Surg. 2015;135(2):375‐86.
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
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FACE-QTM - PSYCHOLOGICAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Psychological Function SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ PSYCHOLOGICAL FUNCTION CONVERSION TABLE
Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s
items, insert the mean of the completed items. Use the Conversion Table below to convert the raw
summed scale score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100)
10 0
11 12
12 16
13 20
14 23
15 25
16 27
17 30
18 32
19 34
20 36
21 38
22 40
23 42
24 45
25 47
26 50
27 52
28 55
29 58
30 62
31 65
32 68
33 71
34 74
35 77
36 80
37 84
38 88
39 93
40 100
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FACE-QTM - RECOVERY EARLY SYMPTOMS - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Recovery Early Symptoms_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ RECOVERY EARLY SYMPTOMS
For each question, circle only one answer. These questions ask about recovery from your surgery or procedure. With your face in mind, in the past 2 days, how much have you been bothered by:
Not at all A little Moderately Extremely
a. Swelling? 1 2 3 4
b. Tenderness? 1 2 3 4
c. Discomfort? 1 2 3 4
d. Feeling bruised? 1 2 3 4
e. Feeling sore? 1 2 3 4
f. Feeling that your face is tight? 1 2 3 4
g. Pain? 1 2 3 4
h. Numbness (loss of feeling)? 1 2 3 4
i. Stinging? 1 2 3 4
j. Tingling? 1 2 3 4
k. Throbbing? 1 2 3 4
l. Burning? 1 2 3 4
m. Feeling tired? 1 2 3 4
n. Itching? 1 2 3 4
o. Feeling lightheaded? 1 2 3 4
p. Headaches? 1 2 3 4
q. Feeling feverish? 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Klassen AF, Cano SJ, Schwitzer J, Scott A, Pusic AL. FACE‐Q scales for health‐related quality of life, early life impact and satisfaction with outcomes and decision to have treatment: development and validation. Plast Reconstr Surg. 2015;135(2):375‐86.
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
SCORING: This checklist of symptoms can be scored by adding items to obtain the total number of adverse effects experienced.
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FACE-QTM - SATISFACTION WITH DECISION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Decision SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ SATISFACTION WITH DECISION
For each statement, circle only one answer. We would like to know how you feel about your decision to have your most recent procedure. Please indicate how much you agree or disagree with each statement.
Definitely
disagree
Somewhat
disagree
Somewhat
agree
Definitely
agree
a. It was worth the time and effort. 1 2 3 4
b. It was money well spent. 1 2 3 4
c. It was just what I wanted. 1 2 3 4
d. It was just what I needed. 1 2 3 4
e. It made me look how I want to look. 1 2 3 4
f. It changed my life for the better. 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved. Psychometric Paper: Klassen AF, Cano SJ, Schwitzer J, Scott A, Pusic AL. FACE‐Q scales for health‐related quality of life, early life impact and satisfaction with outcomes and decision to have treatment: development and validation. Plast Reconstr Surg. 2015;135(2):375‐86
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
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FACE-QTM - SATISFACTION WITH DECISION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Decision SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ SATISFACTION WITH DECISION CONVERSION TABLE
Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale summed score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100) 6 0 7 15 8 21 9 26 10 30 11 34 12 38 13 41 14 44 15 48 16 51 17 55 18 59 19 64 20 69 21 75 22 82 23 90 24 100
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FACE-QTM - SATISFACTION WITH OUTCOME - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Outcome SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ SATISFACTION WITH OUTCOME
For each statement, circle only one answer. We would like to know how you feel about your most recent procedure. Please indicate how much you agree or disagree with each statement.
Definitely
disagree
Somewhat
disagree
Somewhat
agree
Definitely
agree
a. I am pleased with the result. 1 2 3 4
b. The result turned out great. 1 2 3 4
c. The result was just as I expected. 1 2 3 4
d. I am surprised at how good I look in the
mirror. 1 2 3 4
e. The result is fantastic. 1 2 3 4
f. The result is miraculous. 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Klassen AF, Cano SJ, Schwitzer J, Scott A, Pusic AL. FACE‐Q scales for health‐related quality of life, early life impact and satisfaction with outcomes and decision to have treatment: development and validation. Plast Reconstr Surg. 2015;135(2):375‐86.
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
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FACE-QTM - SATISFACTION WITH OUTCOME - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Satisfaction with Outcome SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ SATISFACTION WITH OUTCOME CONVERSION TABLE
Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s items, insert the mean of the completed items. Use the Conversion Table below to convert the raw scale summed score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100)
6 0
7 19
8 24
9 28
10 31
11 35
12 38
13 41
14 45
15 48
16 52
17 55
18 59
19 63
20 68
21 73
22 79
23 87
24 100 REVIE
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FACE-QTM - SOCIAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Social Function SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ SOCIAL FUNCTION
For each statement, circle only one answer. These are statements people might use to describe themselves. With your facial appearance in mind, in the past week, how much would you agree or disagree with the each statement:
Definitely
disagree
Somewhat
disagree
Somewhat
agree
Definitely
agree
a. I make a good first impression. 1 2 3 4
b. I feel confident when I meet a new person. 1 2 3 4
c. I am comfortable meeting new people. 1 2 3 4
d. It is easy for me to make new friends. 1 2 3 4
e. I feel confident when I participate in group
situations (e.g. meetings). 1 2 3 4
f. I feel confident in new social situations (e.g.
parties). 1 2 3 4
g. I am relaxed around people that I don’t know
well. 1 2 3 4
h. I feel confident when I walk into a room full of
people I don’t know. 1 2 3 4
FACE‐QTM ©2013 Memorial Sloan‐Kettering Cancer Center. All rights reserved.
Psychometric Paper: Klassen AF, Cano SJ, Schwitzer J, Scott A, Pusic AL. FACE‐Q scales for health‐related quality of life, early life impact and satisfaction with outcomes and decision to have treatment: development and validation. Plast Reconstr Surg. 2015;135(2):375‐86.
Electronic versions of FACE‐Q scales with scoring are available for Excel and REDCap (http://projectredcap.org/). Contact [email protected] for more information.
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FACE-QTM - SOCIAL FUNCTION - Canada-United Kingdom-United States/English – Original version FACE-Q_QOL - Social Function SCORING_AU2.0_eng-CA-GB-USori.docx
FACE‐QTM ‐ SOCIAL FUNCTION CONVERSION TABLE
Instructions: Higher scores reflect a better outcome. If missing data is less than 50% of the scale’s
items, insert the mean of the completed items. Use the Conversion Table below to convert the raw
scale summed score into a score from 0 (worst) to 100 (best).
SUM SCORE EQUIVALENT RASCH TRANSFORMED SCORE (0‐100)
8 0
9 8
10 14
11 19
12 24
13 28
14 31
15 35
16 38
17 41
18 44
19 46
20 49
21 52
22 55
23 58
24 62
25 66
26 70
27 73
28 77
29 81
30 86
31 92
32 100
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