{"id":7066,"date":"2024-11-29T10:57:32","date_gmt":"2024-11-29T09:57:32","guid":{"rendered":"https:\/\/reseau-amylose.org\/jesuissoignant\/?page_id=7066"},"modified":"2024-11-29T11:28:48","modified_gmt":"2024-11-29T10:28:48","slug":"questionnaire-qualite-de-vie-amylose","status":"publish","type":"page","link":"http:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/","title":{"rendered":"Questionnaire Qualit\u00e9 de vie Amylose\u200b"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7066\" class=\"elementor elementor-7066\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fb26030 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"fb26030\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3715840\" data-id=\"3715840\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c084d8c elementor-widget elementor-widget-html\" data-id=\"c084d8c\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n<div style=\"margin-bottom: 20px; background-color: rgb(239, 246, 248);\">\n    <p><strong>Part A : Sympt\u00f4mes<\/strong><br>\n        Les questions suivantes se r\u00e9f\u00e8rent \u00e0 des sympt\u00f4mes. Si vous ne pr\u00e9sentez pas les sympt\u00f4mes suivants, veuillez cocher la case \"NON\". Si vous pr\u00e9sentez les sympt\u00f4mes suivants, veuillez cocher la case \"OUI\" pour chaque sympt\u00f4me associ\u00e9 et indiquez le moment de sa derni\u00e8re manifestation : \"au cours des deux derni\u00e8res ann\u00e9es\", \"il y a plus de deux ans\".<\/p>\n        <p><strong>Part B : Qualit\u00e9 de vie<\/strong><br>\n        Les questions suivantes portent sur les sympt\u00f4mes survenus au cours des quatre derni\u00e8res semaines et sur la mani\u00e8re dont ils ont affect\u00e9 votre qualit\u00e9 de vie. Pour \u00e9valuer l'impact de ces sympt\u00f4mes sur votre qualit\u00e9 de vie, veuillez s\u00e9lectionner l'une des options suivantes pour chaque sympt\u00f4me associ\u00e9 : 0 pas de g\u00eane, 1 g\u00eane l\u00e9g\u00e8re, 2 g\u00eane mod\u00e9r\u00e9e, 3 g\u00eane s\u00e9v\u00e8re.<\/p>\n    <hr>\n<\/div>\n\n<form id=\"cardiacSymptomsForm\" method=\"post\" action=\"submit.php\" style=\"font-size: 1.5rem;\">\n   <div style=\"overflow-x:auto;\">\n        <table id=\"globalScoresOverviewTable\" key=\"globalScoresOverview\" style=\"width: 100%; border-collapse: collapse;\">\n           <thead>\n               <tr>\n                   <th>Amylo-AFFECT<br>Sympt\u00f4mes de l'amylose et qualit\u00e9 de la vie<\/th>\n                   <th>Partie A : Sympt\u00f4mes: Avez-vous souffert de l'un de ces sympt\u00f4mes dans le pass\u00e9 ?<\/th>\n                   <th>Partie B : Qualit\u00e9 de vie : Intensit\u00e9 des sympt\u00f4mes (au cours des 4 derni\u00e8res semaines) ?<\/th>\n                   <th>Num\u00e9ro de la question<\/th>\n               <\/tr>\n           <\/thead>\n           <tbody>\n               <tr id=\"cardiacSymptomsHeader\">\n                   <td colspan=\"4\" style=\"text-align: center; font-weight: bold;\">Sympt\u00f4mes Cardiaques<\/td>\n               <\/tr>\n               <tr>\n                   <td>\u00cates-vous essouffl\u00e9 \u00e0 l\u2019effort ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"symptom1\" value=\"non\" onclick=\"toggleDetails('symptom1_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"symptom1\" value=\"oui\" onclick=\"toggleDetails('symptom1_details1', true)\"> OUI<\/label>\n                       <div id=\"symptom1_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"symptom1_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"symptom1_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality1\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality1\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality1\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality1\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"1\">1<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous la sensation d\u2019\u00e9touffement lorsque vous \u00eates allong\u00e9s ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"symptom2\" value=\"non\" onclick=\"toggleDetails('symptom2_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"symptom2\" value=\"oui\" onclick=\"toggleDetails('symptom2_details1', true)\"> OUI<\/label>\n                       <div id=\"symptom2_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"symptom2_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"symptom2_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality2\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality2\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality2\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality2\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"2\">2<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des difficult\u00e9s \u00e0 monter les escaliers du fait de l\u2019essoufflement ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"symptom3\" value=\"non\" onclick=\"toggleDetails('symptom3_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"symptom3\" value=\"oui\" onclick=\"toggleDetails('symptom3_details1', true)\"> OUI<\/label>\n                       <div id=\"symptom3_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"symptom3_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"symptom3_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality3\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality3\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality3\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality3\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"3\">3<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous les jambes enfl\u00e9es ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"symptom4\" value=\"non\" onclick=\"toggleDetails('symptom4_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"symptom4\" value=\"oui\" onclick=\"toggleDetails('symptom4_details1', true)\"> OUI<\/label>\n                       <div id=\"symptom4_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"symptom4_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"symptom4_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality4\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality4\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality4\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality4\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"4\">4<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous le c\u0153ur qui s\u2019emballe ? Ou, Avez-vous d\u00e9j\u00e0 ressenti des malaises ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"symptom5\" value=\"non\" onclick=\"toggleDetails('symptom5_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"symptom5\" value=\"oui\" onclick=\"toggleDetails('symptom5_details1', true)\"> OUI<\/label>\n                       <div id=\"symptom5_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"symptom5_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"symptom5_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality5\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality5\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality5\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality5\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"5\">5<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous d\u00e9j\u00e0 eu des pertes de connaissance ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"symptom6\" value=\"non\" onclick=\"toggleDetails('symptom6_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"symptom6\" value=\"oui\" onclick=\"toggleDetails('symptom6_details1', true)\"> OUI<\/label>\n                       <div id=\"symptom6_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"symptom6_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"symptom6_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality6\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality6\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality6\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality6\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"6\">6<\/td>\n               <\/tr>\n               <tr id=\"orthostaticSymptoms\">\n                   <td colspan=\"4\" style=\"text-align: center; font-weight: bold;\">Sympt\u00f4mes d\u2019hypotension orthostatique<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des vertiges ou des malaises au lever le matin, lors du passage de la position allong\u00e9e \u00e0 la position assise ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"symptom7\" value=\"non\" onclick=\"toggleDetails('symptom7_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"symptom7\" value=\"oui\" onclick=\"toggleDetails('symptom7_details1', true)\"> OUI<\/label>\n                       <div id=\"symptom7_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"symptom7_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"symptom7_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality7\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality7\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality7\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality7\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"7\">7<\/td>\n               <\/tr>\n               <tr>\n                   <td colspan=\"4\" style=\"text-align: center; font-weight: bold;\">Sympt\u00f4mes neuromusculaires<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des picotements et des engourdissements des doigts et des pieds ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular1\" value=\"non\" onclick=\"toggleDetails('neuromuscular1_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular1\" value=\"oui\" onclick=\"toggleDetails('neuromuscular1_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular1_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular1_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular1_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality8\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality8\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality8\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality8\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"8\">8<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous perdu la sensibilit\u00e9 des mains et des pieds ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular2\" value=\"non\" onclick=\"toggleDetails('neuromuscular2_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular2\" value=\"oui\" onclick=\"toggleDetails('neuromuscular2_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular2_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular2_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular2_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality9\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality9\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality9\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality9\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"9\">9<\/td>\n               <\/tr>\n               <tr>\n                   <td>Les objets vous \u00e9chappent-ils des mains ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular3\" value=\"non\" onclick=\"toggleDetails('neuromuscular3_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular3\" value=\"oui\" onclick=\"toggleDetails('neuromuscular3_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular3_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular3_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular3_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality10\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality10\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality10\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality10\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"10\">10<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des fourmillements ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular4\" value=\"non\" onclick=\"toggleDetails('neuromuscular4_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular4\" value=\"oui\" onclick=\"toggleDetails('neuromuscular4_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular4_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular4_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular4_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality11\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality11\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality11\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality11\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"11\">11<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des d\u00e9mangeaisons ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular5\" value=\"non\" onclick=\"toggleDetails('neuromuscular5_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular5\" value=\"oui\" onclick=\"toggleDetails('neuromuscular5_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular5_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular5_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular5_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality12\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality12\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality12\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality12\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"12\">12<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous une sensation de froid douloureux ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular6\" value=\"non\" onclick=\"toggleDetails('neuromuscular6_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular6\" value=\"oui\" onclick=\"toggleDetails('neuromuscular6_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular6_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular6_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular6_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality13\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality13\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality13\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality13\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"13\">13<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des troubles ou des pertes d\u2019\u00e9quilibre ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular7\" value=\"non\" onclick=\"toggleDetails('neuromuscular7_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular7\" value=\"oui\" onclick=\"toggleDetails('neuromuscular7_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular7_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular7_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular7_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality14\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality14\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality14\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality14\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"14\">14<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des difficult\u00e9s \u00e0 la marche ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular8\" value=\"non\" onclick=\"toggleDetails('neuromuscular8_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular8\" value=\"oui\" onclick=\"toggleDetails('neuromuscular8_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular8_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular8_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular8_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality15\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality15\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality15\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality15\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"15\">15<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des douleurs ou des crampes dans les jambes ou dans les bras ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular9\" value=\"non\" onclick=\"toggleDetails('neuromuscular9_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular9\" value=\"oui\" onclick=\"toggleDetails('neuromuscular9_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular9_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular9_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular9_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality16\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality16\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality16\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality16\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"16\">16<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des douleurs musculaires ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"neuromuscular10\" value=\"non\" onclick=\"toggleDetails('neuromuscular10_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"neuromuscular10\" value=\"oui\" onclick=\"toggleDetails('neuromuscular10_details1', true)\"> OUI<\/label>\n                       <div id=\"neuromuscular10_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"neuromuscular10_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"neuromuscular10_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality17\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality17\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality17\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality17\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"17\">17<\/td>\n               <\/tr>\n               <tr id=\"carpalSymptomsSection\">\n                   <td colspan=\"4\" style=\"text-align: center; font-weight: bold;\">Sympt\u00f4mes canaux carpiens<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des fourmillements dans les doigts la nuit ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"carpalSymptoms\" value=\"non\" onclick=\"toggleDetails('carpalSymptoms_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"carpalSymptoms\" value=\"oui\" onclick=\"toggleDetails('carpalSymptoms_details1', true)\"> OUI<\/label>\n                       <div id=\"carpalSymptoms_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"carpalSymptoms_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"carpalSymptoms_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality18\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality18\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality18\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality18\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"18\">18<\/td>\n               <\/tr>\n               <tr id=\"digestive_gastrointestinal_symptoms\">\n                   <td colspan=\"4\" style=\"text-align: center; font-weight: bold;\">Sympt\u00f4mes digestifs et gastro-intestinaux<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des diarrh\u00e9es ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms1\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms1_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms1\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms1_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms1_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms1_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms1_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality19\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality19\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality19\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality19\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"19\">19<\/td>\n               <\/tr>\n               <tr>\n                   <td>\u00cates-vous constip\u00e9s ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms2\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms2_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms2\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms2_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms2_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms2_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms2_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality20\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality20\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality20\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality20\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"20\">20<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des naus\u00e9es ou des vomissements ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms3\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms3_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms3\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms3_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms3_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms3_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms3_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality21\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality21\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality21\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality21\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"21\">21<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous une perte de go\u00fbt ? (agueusie)<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms4\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms4_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms4\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms4_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms4_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms4_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms4_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality22\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality22\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality22\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality22\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"22\">22<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous la bouche s\u00e8che et p\u00e2teuse ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms5\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms5_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms5\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms5_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms5_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms5_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms5_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality23\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality23\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality23\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality23\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"23\">23<\/td>\n               <\/tr>\n               <tr>\n                   <td>Votre langue a-t-elle grossi ? (macroglossie)<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms6\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms6_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms6\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms6_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms6_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms6_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms6_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality24\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality24\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality24\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality24\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"24\">24<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des difficult\u00e9s de d\u00e9glutition ? (La gorge serr\u00e9e, besoin de m\u00e2cher tr\u00e8s longtemps, vous avez peur d\u2019avaler ou de d\u00e9glutir)<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms7\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms7_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms7\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms7_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms7_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms7_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms7_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality25\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality25\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality25\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality25\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"25\">25<\/td>\n               <\/tr>\n               <tr>\n                   <td>Votre voix a-t-elle chang\u00e9 ? Quelle g\u00eane cela vous procure ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms8\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms8_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms8\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms8_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms8_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms8_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms8_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality26\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality26\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality26\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality26\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"26\">26<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous une baisse de l\u2019audition ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms9\" value=\"non\" onclick=\"toggleDetails('digestiveSymptoms9_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"digestiveSymptoms9\" value=\"oui\" onclick=\"toggleDetails('digestiveSymptoms9_details1', true)\"> OUI<\/label>\n                       <div id=\"digestiveSymptoms9_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms9_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"digestiveSymptoms9_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality27\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality27\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality27\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality27\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"27\">27<\/td>\n               <\/tr>\n               <tr id=\"urinary_genital_issues\">\n                   <td colspan=\"4\" style=\"text-align: center; font-weight: bold;\">Troubles urinaires et g\u00e9nitaux<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des difficult\u00e9s \u00e0 uriner ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"urineDifficulty\" value=\"non\" onclick=\"toggleDetails('urineDifficulty_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"urineDifficulty\" value=\"oui\" onclick=\"toggleDetails('urineDifficulty_details1', true)\"> OUI<\/label>\n                       <div id=\"urineDifficulty_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"urineDifficulty_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"urineDifficulty_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality28\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality28\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality28\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality28\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"28\">28<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des difficult\u00e9s \u00e0 retenir vos urines ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"urineRetentionDifficulty\" value=\"non\" onclick=\"toggleDetails('urineRetentionDifficulty_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"urineRetentionDifficulty\" value=\"oui\" onclick=\"toggleDetails('urineRetentionDifficulty_details1', true)\"> OUI<\/label>\n                       <div id=\"urineRetentionDifficulty_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"urineRetentionDifficulty_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"urineRetentionDifficulty_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality29\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality29\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality29\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality29\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"29\">29<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des difficult\u00e9s \u00e0 retenir vos selles ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"stoolRetentionDifficulty\" value=\"non\" onclick=\"toggleDetails('stoolRetentionDifficulty_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"stoolRetentionDifficulty\" value=\"oui\" onclick=\"toggleDetails('stoolRetentionDifficulty_details1', true)\"> OUI<\/label>\n                       <div id=\"stoolRetentionDifficulty_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"stoolRetentionDifficulty_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"stoolRetentionDifficulty_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality30\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality30\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality30\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality30\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"30\">30<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des troubles sexuels ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"sexualTroubles\" value=\"non\" onclick=\"toggleDetails('sexualTroubles_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"sexualTroubles\" value=\"oui\" onclick=\"toggleDetails('sexualTroubles_details1', true)\"> OUI<\/label>\n                       <div id=\"sexualTroubles_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"sexualTroubles_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"sexualTroubles_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality31\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality31\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality31\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality31\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"31\">31<\/td>\n               <\/tr>\n               <tr id=\"cutaneousInjurySection\">\n                   <td colspan=\"4\" style=\"text-align: center; font-weight: bold;\">Atteinte cutan\u00e9e<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des taches rouges (Ecchymoses) autour des yeux ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"redSpotsEyes\" value=\"non\" onclick=\"toggleDetails('redSpotsEyes_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"redSpotsEyes\" value=\"oui\" onclick=\"toggleDetails('redSpotsEyes_details1', true)\"> OUI<\/label>\n                       <div id=\"redSpotsEyes_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"redSpotsEyes_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"redSpotsEyes_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality32\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality32\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality32\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality32\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"32\">32<\/td>\n               <\/tr>\n               <tr>\n                   <td>Avez-vous des taches rouges (Ecchymoses) sur la peau ?<\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"redSpotsSkin\" value=\"non\" onclick=\"toggleDetails('redSpotsSkin_details1', false)\"> NON<\/label>\n                       <label><input type=\"radio\" name=\"redSpotsSkin\" value=\"oui\" onclick=\"toggleDetails('redSpotsSkin_details1', true)\"> OUI<\/label>\n                       <div id=\"redSpotsSkin_details1\" style=\"display: none;\">\n                           <label><input type=\"checkbox\" name=\"redSpotsSkin_details[]\" value=\"2ans\"> Au cours des deux derni\u00e8res ann\u00e9es<\/label>\n                           <label><input type=\"checkbox\" name=\"redSpotsSkin_details[]\" value=\"plus2ans\"> Il y a plus de deux ans<\/label>\n                       <\/div>\n                   <\/td>\n                   <td>\n                       <label><input type=\"radio\" name=\"quality33\" value=\"0\"> 0<\/label>\n                       <label><input type=\"radio\" name=\"quality33\" value=\"1\"> 1<\/label>\n                       <label><input type=\"radio\" name=\"quality33\" value=\"2\"> 2<\/label>\n                       <label><input type=\"radio\" name=\"quality33\" value=\"3\"> 3<\/label>\n                   <\/td>\n                   <td id=\"33\">33<\/td>\n               <\/tr>\n           <\/tbody>\n       <\/table>\n   <\/div>\n    \n   \n\n<\/form>\n\n<div style=\"overflow-x:auto;\">\n    <table id=\"scoresOverviewTable\" style=\"width: 100%; border-collapse: collapse; text-align: left;\">\n        <thead>\n          <tr>\n            <th style=\"border: 1px solid #ccc; padding: 12px; background-color: #f2f2f2;\">Qualit\u00e9 de vie<\/th>\n            <th style=\"border: 1px solid #ccc; padding: 12px; background-color: #f2f2f2;\">Score<\/th>\n          <\/tr>\n        <\/thead>\n        <tbody>\n          <tr>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\">Insuffisance Cardiaque<\/td>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\" id=\"dimension1Score\"><\/td>\n          <\/tr>\n          <tr>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\">Dysautonomie vasculaire<\/td>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\" id=\"dimension2Score\"><\/td>\n          <\/tr>\n          <tr>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\">Neuropathie<\/td>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\" id=\"dimension3Score\"><\/td>\n          <\/tr>\n          <tr>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\">Dysautonomie Gastrointestinale et Urinaire<\/td>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\" id=\"dimension4Score\"><\/td>\n          <\/tr>\n          <tr>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\">Atteintes cutan\u00e9es et muqueuses<\/td>\n            <td style=\"border: 1px solid #ccc; padding: 12px;\" id=\"dimension5Score\"><\/td>\n          <\/tr>\n        <\/tbody>\n      <\/table>\n<\/div>\n<div style=\"margin-top: 20px;\">\n    <hr>\n    <br>\n    <button type=\"submit\" onclick=\"showSelectedValues()\" style=\"background-color: #921212; color: white; padding: 10px 15px; border: none; border-radius: 5px; cursor: pointer; font-size: 16px;\">Calculer le score global<\/button>\n    <div id=\"selectedValues\" style=\"margin-top: 20px; font-weight: bold;\"><\/div>\n\n<\/div>\n<script>\n    (function() {\n        function showSelectedValues() {\n            const selectedItems = [];\n            const checkboxes = document.querySelectorAll('input[type=\"radio\"]:checked');\n            let sum = 0; \/\/ Initialize sum variable\n            checkboxes.forEach((radio) => {\n                selectedItems.push(radio.value);\n                sum += parseInt(radio.value); \/\/ Add the value to sum\n            });\n\n            \/\/ Calculate the specific sum for dimension 1\n            const dimension1Sum = \n                parseInt(document.querySelector('input[name=\"quality1\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality2\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality3\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality4\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality15\"]:checked')?.value || 0);\n\n            \/\/ Calculate the specific sum for dimension 2\n            const dimension2Sum = \n                parseInt(document.querySelector('input[name=\"quality5\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality6\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality7\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality21\"]:checked')?.value || 0);\n\n            \/\/ Calculate the specific sum for dimension 3\n            const dimension3Sum = \n                parseInt(document.querySelector('input[name=\"quality8\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality9\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality10\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality11\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality12\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality13\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality14\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality16\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality17\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality18\"]:checked')?.value || 0);\n\n            \/\/ Calculate the specific sum for dimension 4\n            const dimension4Sum = \n                parseInt(document.querySelector('input[name=\"quality19\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality20\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality27\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality28\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality29\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality30\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality31\"]:checked')?.value || 0);\n\n            \/\/ Calculate the specific sum for dimension 5\n            const dimension5Sum = \n                parseInt(document.querySelector('input[name=\"quality32\"]:checked')?.value || 0) +\n                parseInt(document.querySelector('input[name=\"quality33\"]:checked')?.value || 0);\n\n            \/\/ Update the score in the table\n            document.getElementById('dimension1Score').innerText = dimension1Sum; \n            document.getElementById('dimension2Score').innerText = dimension2Sum; \n            document.getElementById('dimension3Score').innerText = dimension3Sum; \n            document.getElementById('dimension4Score').innerText = dimension4Sum; \n            document.getElementById('dimension5Score').innerText = dimension5Sum; \n            document.getElementById('selectedValues').innerHTML = \"<h4>SCORE GLOBAL de Qualit\u00e9 de Vie: \" + sum + \"\/99<\/h4>\";\n        }\n\n        \/\/ Expose the function to the global scope if needed\n        window.showSelectedValues = showSelectedValues;\n    })();\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Part A : Sympt\u00f4mes Les questions suivantes se r\u00e9f\u00e8rent \u00e0 des sympt\u00f4mes. Si vous ne pr\u00e9sentez pas les sympt\u00f4mes suivants, veuillez cocher la case \u00ab\u00a0NON\u00a0\u00bb. Si vous pr\u00e9sentez les sympt\u00f4mes suivants, veuillez cocher la case \u00ab\u00a0OUI\u00a0\u00bb pour chaque sympt\u00f4me associ\u00e9 et indiquez le moment de sa derni\u00e8re manifestation : \u00ab\u00a0au cours des deux derni\u00e8res ann\u00e9es\u00a0\u00bb, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"class_list":["post-7066","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Questionnaire Qualit\u00e9 de vie Amylose\u200b - R\u00e9seau Amylose<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Questionnaire Qualit\u00e9 de vie Amylose\u200b - R\u00e9seau Amylose\" \/>\n<meta property=\"og:description\" content=\"Part A : Sympt\u00f4mes Les questions suivantes se r\u00e9f\u00e8rent \u00e0 des sympt\u00f4mes. Si vous ne pr\u00e9sentez pas les sympt\u00f4mes suivants, veuillez cocher la case \u00ab\u00a0NON\u00a0\u00bb. Si vous pr\u00e9sentez les sympt\u00f4mes suivants, veuillez cocher la case \u00ab\u00a0OUI\u00a0\u00bb pour chaque sympt\u00f4me associ\u00e9 et indiquez le moment de sa derni\u00e8re manifestation : \u00ab\u00a0au cours des deux derni\u00e8res ann\u00e9es\u00a0\u00bb, [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/\" \/>\n<meta property=\"og:site_name\" content=\"R\u00e9seau Amylose\" \/>\n<meta property=\"article:modified_time\" content=\"2024-11-29T10:28:48+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/\",\"url\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/\",\"name\":\"Questionnaire Qualit\u00e9 de vie Amylose\u200b - R\u00e9seau Amylose\",\"isPartOf\":{\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/#website\"},\"datePublished\":\"2024-11-29T09:57:32+00:00\",\"dateModified\":\"2024-11-29T10:28:48+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Questionnaire Qualit\u00e9 de vie Amylose\u200b\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/#website\",\"url\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/\",\"name\":\"R\u00e9seau Amylose\",\"description\":\"Centre de r\u00e9f\u00e9rence des amyloses cardiaques espace soignant\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/reseau-amylose.org\/jesuissoignant\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Questionnaire Qualit\u00e9 de vie Amylose\u200b - R\u00e9seau Amylose","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/reseau-amylose.org\/jesuissoignant\/questionnaire-qualite-de-vie-amylose\/","og_locale":"fr_FR","og_type":"article","og_title":"Questionnaire Qualit\u00e9 de vie Amylose\u200b - R\u00e9seau Amylose","og_description":"Part A : Sympt\u00f4mes Les questions suivantes se r\u00e9f\u00e8rent \u00e0 des sympt\u00f4mes. 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