Functional Outcomes of Sleep Questionnaire (FOSQ) AND FOSQ-10

          Functional Outcomes of Sleep Questionnaire (FOSQ)

DEVELOPER NAME

TE Weaver, PhD, FAAN, RN et al is the developer of this scale which was published in 1997

objective of questionnaire

This is the first self-report measure designed to assess the impact of disorders of excessive sleepiness (DOES) on multiple activities of everyday living and the extent to which these abilities are improved by effective treatment. 

NUMBER OF ITEMS, DOMAINS AND CATEGORIES

This scale has 30 items and has five factor subscales i.e. consisting of 30 questions related to the effects of fatigue on daily activities. Five domains of day-to-day life that are examined are

·         activity levels

·         vigilance

·         intimacy and sexual relationships

·         general productivity

·         Social outcomes.

The questionnaire is indicated for both research and clinical purposes (screening, assessing treatment outcomes, etc.).

SCALING

It is a likert scale whose scaling of items is from zero to four.

LANGUAGES

This scale was originally developed in English language which was later translated in many other languages such as Turkish, Penansulvanian, Spanish, Swedish, French, Mexican,  Norwegian version 

PSCHOMATRIC ANALYSIS

Three samples were used in the development and psychometric analyses of the FOSQ:

Sample 1 (n = 153) consisted of individuals seeking medical attention for a sleep problem and persons of similar age and gender having no sleep disorder;

samples 2 (n = 24) and 3 (n = 51) were composed of patients from two medical centers diagnosed with obstructive sleep apnea (OSA).

Factor analysis of the FOSQ yielded five factors: activity level, vigilance, intimacy and sexual relationships, general productivity, and social outcome.

Internal reliability was excellent for both the subscales (alpha = 0.86 to alpha = 0.91) and the total scale (alpha = 0.95).

Test-retest reliability of the FOSQ yielded coefficients ranging from r = 0.81 to r = 0.90 for the five subscales and r = 0.90 for the total measure

. The FOSQ successfully discriminated between normal subjects and those seeking medical attention for a sleep problem

the FOSQ can be used to determine how disorders of excessive sleepiness affect patients' abilities to conduct normal activities and the extent to which these abilities are improved by effective treatment of DOES.

LIMITATIONS:

It’s a long questionnaire, a shorter version; FOSQ 10 came after this which have same reliability and internal consistency.

SCORING INSTRUCTIONS OF FOSQ

SUBSCALES                                                                        QUESTIONS             ITEM #         

General productivity                                                   8 questions                  1-4, 8-11

Social outcome                                                            2 questions                  12, 13

Activity level                                                              9 questions                  5, 14-16, 22-26

Vigilance                                                                  7 questions                     6, 7, 17-21

Intimate relationships and sexual activity             4 questions                        27-30

A response score of 0 for an item should be coed as N/A or missing response. Thus, potential range of scores for any item is 1-4. Calculate the mean of the answered items with responses equal to or greater than 1 for each subscale. This is the weighted mean item total or subscale score.

For example if a subscale has six questions and one question has missing response and one with N/A response. Then you would not include those two questions why you added the responses and you would divide by four instead of six when calculating the mean. This prevents a score biased due to missing answers or skipped questions because an individual doesn’t engage in a particular activity due to reasons other than disorders of excessive sleepiness.

The potential range of scores for each subscale is 1-4.

FOR TOTAL SCORE

To obtain total score, take all the subscale scores and calculate the mean of these scores and then multiply that mean by five. Multiply by five regardless of number of subscales scores used in computation of the mean.

For example, if you a subscale score for all subscales, then you multiply the mean of those scores by 5; f you have subscale scores for only 4 of the 5 subscales. Then you would also multiply the mean by five.

The potential range of scores for the total score is 5-20

Functional Outcomes of Sleep Questionnaire (FOSQ)

Some people have difficulty performing everyday activities when they feel tired or sleepy.  The purpose of this questionnaire is to find out if you generally have difficulty carrying out certain activities because you are too sleepy or tired.  In this questionnaire, when the words "sleepy" or "tired" are used, it means the feeling that you can't keep your eyes open, your head is droopy, that you want to "nod off", or that you feel the urge to take a nap.  These words do not refer to the tired or fatigued feeling you may have after you have exercised.

Directions: Please put a check in the box for your answer to each question.  Select only one answer for each question.  Please try to be as accurate as possible. 

(0)I don't do this activity for other reasons

(4)No difficulty

(3)a little difficulty

(2)moderate difficulty

(1)extreme difficulty

1. Do you have difficulty concentrating on the things you do because you are sleepy or tired?

2. Do you generally have difficulty remembering things, because you are sleepy or tired

3. Do you have difficulty finishing a meal because you become sleepy or tired?

4. Do you have difficulty working on a hobby (for example, sewing, collecting, gardening) because you are sleepy or tired?

5. Do you have difficulty doing work around the house (for example, cleaning house, doing laundry, taking out the trash, repair work) because you are sleepy or tired?

6. Do you have difficulty operating a motor vehicle for short distances (less than 100 miles) because you become sleepy or tired?

7. Do you have difficulty operating a motor vehicle for long distances (greater than 100 miles) because you become sleepy or tired?

8. Do you have difficulty getting things done because you are too sleepy or tired to drive or take public transportation?

9. Do you have difficulty taking care of financial affairs and doing paperwork (for example, writing checks, paying bills, keeping financial records, filling out tax forms, etc.) because you are sleepy or tired?

10. Do you have difficulty performing employed or volunteer work because you are sleepy or tired?

11. Do you have difficulty maintaining a telephone conversation, because you become sleepy or tired?

12. Do you have difficulty visiting with your family or friends in your home because you become sleepy or tired?

13. Do you have difficulty visiting with your family or friends in their home because you become sleepy or tired?

14. Do you have difficulty doing things for your family or friends because you are too sleepy or tired?

(4)No

(3)Yes, a little

(2)Yes, moderately

(1)Yes, extremely

15. Has your relationship with family, friends or work colleagues been affected because you are sleepy or tired?

16.In what way has your relationship been affected?

(0) I don't do this activity for other reasons

(4) No difficulty

(3) little difficulty

(2) moderate difficulty

(1)  extreme difficulty

16. Do you have difficulty exercising or participating in a sporting activity because you are too sleepy or tired?

17. Do you have difficulty watching a movie or videotape because you become sleepy or tired?

18. Do you have difficulty enjoying the theater or a lecture because you become sleepy or tired?

19. Do you have difficulty enjoying a concert because you become sleepy or tired?

20. Do you have difficulty watching TV because you are sleepy or tired?

21. Do you have difficulty participating in religious services, meetings or a group or club, because you are sleepy or tired?

22. Do you have difficulty being as active as you want to be in the evening because you are sleepy or tired?

23. Do you have difficulty being as active as you want to be in the morning because you are sleepy or tired?

24. Do you have difficulty being as active as you want to be in theafternoon because you are sleepy or tired?

25.  Do you have difficulty keeping pace with others your own age because you are sleepy or tired?

(1)Very low

(2)Low

(3)Medium

(4)High

26. How would you rate your general level of activity?

(0)I don't do this for other reasons

(4)No difficulty

(3)a little difficulty

(2)moderate difficulty

(1)extreme difficulty

27. Has your intimate or sexual relationship been affected because you are sleepy or tired?

(0)I don't engage in sexual activity for other reasons

(4)No

(3a little

(2)moderately

(1)Yes, extreme

28. Has your desire for intimacy or sex been affected because you are sleepy or tired?

29. Has your ability to become sexually aroused been affected because you are sleepy or tired?

30. Has your ability to have an orgasm been affected because you are sleepy or tired?

FOSQ-10 (2009)

DEVELOPER NAME

Eileen R Chasens and colleagues, Sarah J Ratcliffe, Terri E Weaver created a shorter, 10-item version of the scale in order to allow for rapid and efficient administration.

objective of questionnaire

 It is a shorter version of the original instrument (FOSQ). The main objective to develop shorter version that it may be more easily implemented in clinical.

NUMBER OF ITEMS, DOMAINS AND CATEGORIES

Of the 30 original FOSQ items, 10 questions representing each of the 5 subscales were selected if they had a normal distribution of responses and the largest pre- to post-treatment effect size

SCALING

 FOSQ-10 consists of 10 questions rated on a scale of 1 to 4 (1=extreme difficulty and 4=no difficulty). A total score and 5 subscale (vigilance, general productivity, social outcome, intimacy, and activity level) scores are calculated from the responses. Worst subscale score is 1 (maximum difficulty) and the best score is 4 (no difficulty). 

PSCHOMATRIC ANALYSIS

FOSQ 10 has similar validity and reliability as the FOSQ a with an  internal consistency of  α = 0.87.

With similar psychometric performances, the FOSQ-10 provides a simple means to assess functional status both in clinical arena and large scale health assessments with minimizing information loss. Prior to treatment, the Total score of the FOSQ-10 was robustly associated with the FOSQ-30

 although the short form has fewer questions obtaining less information, the strong correlation indicates that similar conclusions can be drawn when using the short form as would be the case if the longer form were employed.

 Applying the criteria suggested by Nunnally and Bernstein, the internal consistency of the short form surpasses the threshold of 0.70 for application of the measure in both research and clinical practice. 

The range of pre-treatment and post-treatment scores obtained for the Total score of the short form indicates that, like the original instrument, it has the ability to detect a wide range of functional limitations.

 The two versions of the FOSQ were able to reach the same statistical conclusion regarding differences between normal controls and patients with OSA.

SCORING INSTRUCTIONS OF FOSQ

Worst subscale score is 1 (maximum difficulty) and the best score is 4 (no difficulty).

                                                            FOSQ-10

Q1. Do you have difficulty concentrating on the things you do because you are sleepy or tired?

1. Yes, extreme                       2. Yes, moderate        3. Yes, a little              4. No

Q2. Do you generally have difficulty remembering things because you are sleepy or tired?

1. Yes, extreme                       2. Yes, moderate        3. Yes, a little              4. No

Q3. Do you have difficulty operating a motor vehicle for short distances (less than 100 miles) because you become sleepy?

1. Yes, extreme                       2. Yes, moderate         3. Yes, a little              4. No

Q4. Do you have difficulty operating a motor vehicle for long distances (greater than 100 miles) because you become sleepy?

1. Yes, extreme                       2. Yes, moderate         3. Yes, a little              4. No

Q5. Do you have difficulty visiting your family or friends in their home because you become sleepy or tired?

1. Yes, extreme                       2. Yes, moderate         3. Yes, a little              4. No

Q6. Has your relationship with family, friends or work colleagues been affected because you are sleepy or tired?

1. Yes, extreme                       2. Yes, moderate        3. Yes, a little              4. No

Q7. Do you have difficulty watching a movie or video because you become sleepy or tired?

1. Yes, extreme                       2. Yes, moderate        3. Yes, a little              4. No

Q8. Do you have difficulty being as active as you want to be in the evening because you are sleepy or tired?

1. Yes, extreme                       2. Yes, moderate        3. Yes, a little              4. No

Q9. Do you have difficulty being as active as you want to be in the morning because you are sleepy or tired?

1. Yes, extreme                       2. Yes, moderate        3. Yes, a little             4. No

Q10. Has your mood been affected because you are sleepy or tired?

1. Yes, extreme                       2. Yes, moderate         3. Yes, a little               4. No