Leicester Cough Questionnaire


                        
        
            Survey.StylesManager.applyTheme("defaultV2");
        



                
                    var json = {
  "logoPosition": "right",
  "pages": [
    {
      "name": "page1",
      "elements": [
        {
          "type": "rating",
          "name": "question1",
          "title": "In the last 2 weeks, have you had chest or stomach pains as a result of your cough?",
          "rateMax": 7,
          "minRateDescription": "All of the time",
          "maxRateDescription": "None of the time"
        },
        {
          "type": "rating",
          "name": "question2",
          "title": "In the last 2 weeks, have you been bothered by sputum (phlegm) production when you cough?",
          "rateMax": 7,
          "minRateDescription": "All of the time",
          "maxRateDescription": "None of the time"
        },
        {
          "type": "rating",
          "name": "question3",
          "title": "In the last 2 weeks, have you been tired because of your cough?",
          "rateMax": 7,
          "minRateDescription": "All of the time",
          "maxRateDescription": "None of the time"
        },
        {
          "type": "rating",
          "name": "question4",
          "title": "In the last 2 weeks, have you felt in control of your cough?",
          "rateMax": 7,
          "minRateDescription": "All of the time",
          "maxRateDescription": "None of the time"
        },
        {
          "type": "boolean",
          "name": "question5",
          "title": "In the last 2 weeks, has your coughing been bad enough to cause you social distress?"
        },
        {
          "type": "panel",
          "name": "panel1",
          "elements": [
            {
              "type": "rating",
              "name": "question6",
              "title": "How often during the last 2 weeks have you felt embarassed by your coughing?",
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            },
            {
              "type": "rating",
              "name": "question7",
              "title": "In the last 2 weeks, my cough has made me feel anxious",
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            },
            {
              "type": "rating",
              "name": "question8",
              "title": "In the last 2 weeks, my cough has interfered with my job, or other daily tasks",
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            },
            {
              "type": "rating",
              "name": "question9",
              "title": "In the last 2 weeks, I felt that my cough interfered with the overall enjoyment of my life",
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            },
            {
              "type": "rating",
              "name": "question10",
              "title": "In the last 2 weeks, have you been concerned that other people think something is wrong with you, because of your cough?",
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            },
            {
              "type": "rating",
              "name": "question11",
              "title": "In the last 2 weeks, my cough has interrupted conversation or phone calls",
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            },
            {
              "type": "rating",
              "name": "question12",
              "title": "In the last 2 weeks, my cough has annoyed my partner, family, or friends",
              "rateMax": 7,
              "minRateDescription": "All of the time",
              "maxRateDescription": "None of the time"
            }
          ],
          "visible": false,
          "visibleIf": "{question5} = true",
          "title": "Social Distress"
        },
        {
          "type": "rating",
          "name": "question13",
          "title": "In the last 2 weeks, exposure to paints or fumes has made me cough",
          "rateMax": 7,
          "minRateDescription": "All of the time",
          "maxRateDescription": "None of the time"
        },
        {
          "type": "rating",
          "name": "question14",
          "title": "In the last 2 weeks, how many times a day have you had coughing bouts?",
          "rateMax": 7,
          "minRateDescription": "Continously",
          "maxRateDescription": "None "
        },
        {
          "type": "rating",
          "name": "question15",
          "title": "In the last 2 weeks, have you had a lot of energy?",
          "rateMax": 7,
          "minRateDescription": "All of the time",
          "maxRateDescription": "None of the time"
        },
        {
          "type": "boolean",
          "name": "question16",
          "visibleIf": "{question1} <= 3 and {question2} <= 3 and {question14} <= 3 and {question15} >= 5",
          "title": "In the last 2 weeks, has your coughing been accompanied by wheezing as well?"
        }
      ]
    }
  ]
};

                    window.survey = new Survey.Model(json);
                
        
            survey.onComplete.add(function(sender) {
            document.querySelector('#surveyResult').textContent =
            "Result JSON:\n" + JSON.stringify(sender.data, null, 3);
            });
        
        
            ReactDOM.render(
            <SurveyReact.Survey model={survey}  />, document.getElementById("surveyElement"));
        

                    
<!DOCTYPE html>
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<head>
    <title>Leicester Cough Questionnaire, Reactjs Survey Library Example</title>
    
<meta name="viewport" content="width=device-width" />
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