Register for PBC Study

Thank you for participating in our study. Please complete the questions below by November 15.

Information

Email
Name
I attended Workshop Part 1 in June
Yes No
I will attend Workshop Part 2 in November
Yes No

Participant Questionnaire

  1. I was unable to eat what I liked
    Never Rarely Sometimes Most of the time Always
  2. I ate or drank only a small amount, and still felt bloated :
    Never Rarely Sometimes Most of the time Always
  3. I felt unwell when I drank alcohol :
    Never Rarely Sometimes Most of the time Always
  4. I had discomfort in my right side
    Never Rarely Sometimes Most of the time Always
  5. I had dry eyes
    Never Rarely Sometimes Most of the time Always
  6. My mouth was very dry
    Never Rarely Sometimes Most of the time Always
  7. I had aches in the long bones of my arms and legs
    Never Rarely Sometimes Most of the time Always
  8. Itching disturbed my sleep
    Never Rarely Sometimes Most of the time Always
  9. I scratched so much I made my skin raw
    Never Rarely Sometimes Most of the time Always
  10. I felt embarrassed because of the itching
    Never Rarely Sometimes Most of the time Always
  11. I had to force myself to get out of bed
    Never Rarely Sometimes Most of the time Always
  12. I had to have a sleep during the day
    Never Rarely Sometimes Most of the time Always
  13. Fatigue interfered with my daily routine
    Never Rarely Sometimes Most of the time Always
  14. I felt worn out
    Never Rarely Sometimes Most of the time Always
  15. I felt so tired, I had to force myself to do the things I needed to do
    Never Rarely Sometimes Most of the time Always
  16. I felt so tired, I had to go to bed earlier than usual
    Never Rarely Sometimes Most of the time Always
  17. Fatigue just suddenly hit me
    Never Rarely Sometimes Most of the time Always
  18. PBC drained every ounce of energy out of me
    Never Rarely Sometimes Most of the time Always
  19. Some days it took me a long time to do anything
    Never Rarely Sometimes Most of the time Always
  20. If I was busy one day I needed at least another day to recover
    Never Rarely Sometimes Most of the time Always
  21. I had to pace myself for day-to-day things
    Never Rarely Sometimes Most of the time Always
  22. I had to make a lot of effort to remember things
    Never Rarely Sometimes Most of the time Always
  23. I had difficulty remembering things from one day to the next
    Never Rarely Sometimes Most of the time Always
  24. My concentration span was short because of PBC
    Never Rarely Sometimes Most of the time Always
  25. I had difficulty keeping up with conversations
    Never Rarely Sometimes Most of the time Always
  26. I found it difficult to concentrate on anything
    Never Rarely Sometimes Most of the time Always
  27. I found it difficult to remember what I wanted to do
    Never Rarely Sometimes Most of the time Always
  28. My sex life has been affected by having PBC
    Not at all A little Somewhat Quite a bit Very much
  29. I feel I neglect my family because of having PBC
    Not at all A little Somewhat Quite a bit Very much
  30. I feel guilty that I can’t do what I used to do because of having PBC
    Not at all A little Somewhat Quite a bit Very much
  31. I Somewhat feel frustrated that I can’t go out and enjoy myself
    Not at all A little Somewhat Quite a bit Very much
  32. I tend to keep the fact that I have PBC to myself
    Not at all A little Somewhat Quite a bit Very much
  33. I can’t plan holidays because of having PBC
    Not at all A little Somewhat Quite a bit Very much
  34. My social life has almost stopped
    Not at all A little Somewhat Quite a bit Very much
  35. Everything in my life is affected by PBC
    Not at all A little Somewhat Quite a bit Very much
  36. PBC has reduced the quality of my life
    Not at all A little Somewhat Quite a bit Very much
  37. I can still lead a normal life, despite having PBC
    Not at all A little Somewhat Quite a bit Very much
  38. Because of PBC, I get more stressed about things than I used to
    Not at all A little Somewhat Quite a bit Very much
  39. Having PBC gets me down
    Not at all A little Somewhat Quite a bit Very much
  40. I worry about how my PBC will be in the future
    Not at all A little Somewhat Quite a bit Very much