Introduction: Assessment of symptoms regarding quality, strength and localisation is a part of the medical consultation. After that these informations need to be documented in the medical files. This process can be substantially ameliorated with a patient questionnaire, which assessess the symptoms and disabilities in a structured way. We developed a simple graphic questionaire (pationnaire), clearly structured, easy to understand and simple to fill out. The aim of this study was to test the construct validity of the ‚pationnaire’ with personal interviews (the agreement of symptoms and disabilities), and the ability and time to fill it out without help.

Study design: Monocentric analytical study measuring the agreement.

Persons/patients and methods: The persons/patients were randomly selected by the interviewer. They signed an informed consent approved by the local ethical commitee. After a short introduction about the ‚pationnaire’ and its aims, people filled out one directly without help. The time to completion was measured. The person/patient was then personally interviewed about items within the ‚pationnaire’ to assess their correlation with their symptoms and disabilities, and uncover any sources of misunderstanding or misinterpretation.

At the end of the interview every person/patient was asked for a statement about their understanding, formulations, difficulties with the ‚pationnaire’, missing questions and general impression.

Results: 78 persons/patients (50 women, 28 men) were included. Their average age was 46.3 years (range 12–93 years). 97% (76) could fill out the ‚pationnaire’ without help, 2 needed help and further explanations. Average time for completion was 9.9 min (range 3–45 mins) – the longest time being taken by those who needed help. Complete agreement between the questionaire and the perceived symptoms/disabilities was found in 94% (n=73), it was partial in 3.8% (n=3), and„no agreement“ occurred in 2.2% (n=2, persons, both of whom needed support). The understanding was rated very good in 98% and difficult in 2% (both elderly persons > 80 years). The formulation ’my symptoms are’ was preferred by everybody compared to ’which symptoms do you have’. In general the overall rating was good or very good for all persons, although older people with co-morbidities needed help.