Why we chose this test
This scale has been used in several published papers and we think it is easy to use and accurate. It attempts to quantify each individual’s subjective experience and it has good re-test reliability, meaning that it consistently measures the level of debility and correlates well with other measures like the SF36 scales
We have chosen to record best and worst days in addition to the traditional scoring in order to paint a more accurate picture of the patient’s life. Two patients with an overall Bell’s score of 30 may in fact lead completely different lives. One might never go over 30 and sometimes sink to 10, whereas another might never go below 30 but occasionally rise to 50. We need to capture this in case it makes a difference in the effectiveness of any treatment and also because it may coincide with other changes in data and therefore help with diagnosis and management.
Example of questions in test
You can find a full copy of Bell’s scale on ‘My Record – Bell’s scale ‘ when you are logged in and an excerpt below to give you an idea. You can also print it off here
40 Moderate symptoms at rest. Moderate to severe symptoms with exercise or activity; overall activity level reduced to 50%-70% of expected. Not confined to house. Unable to perform strenuous duties; able to perform light duty or desk work 3-4 hours a day, but requires rest periods.
30 Moderate to severe symptoms at rest. Severe symptoms with any exercise; overall activity level reduced to 50% of expected. Usually confined to house. Unable to perform any strenuous tasks. Able to perform desk work 2-3 hours a day, but requires rest periods.
20 Moderate to severe symptoms at rest. Severe symptoms with any exercise; overall activity level reduced to 30%-50% of expected. Unable to leave house except rarely; confined to bed most of day; unable to concentrate for more than 1 hour a day.
Examples of graphs generated
1) MY PROGRESS GRAPH
A pwME’s progress along Bell’s Scale on ‘Treatment A’
2) COMPARE TREATMENT GRAPH
Please use Bell’s scale to score how you have felt over the past month. We are asking people to record 3 measures : 1) how they felt on their worst day 2) how they felt on their best day 3) how they felt most of the time. Ideally, we would like you to submit these readings every month, but just as often as you can is fine.
You should not spend too much time scrutinising in detail what it says at each level. Just pick the description that best fits how you feel. Where it refers to ‘work’ this does not necessarily mean official paid work in a place away from your home. It can be taken as meaning carrying out a family or social role etc. When it refers to the number of hours you can ‘work’, this can mean the total number of hours over the day rather than the consecutive number of hours.
What we are trying to capture is your movement up or down the scale and therefore it is irrelevant if perhaps your idea of 40 is someone else’s idea of 30.
If you think you may have difficulty remembering your best and worst days, then perhaps when you are having a particularly good or bad day, you can jot down your score in a diary. You should not have too much difficulty remembering your ‘mostly’ score as this just answers the question “ how have you been feeling lately”?
Best and worst day scores will reflect how you spent most of that day, ignoring brief ups and downs during the day and ignoring the consequences of a good day.