Symptom check-in · The Woods Counselling Co.

The Woods Counselling Co.

Symptom check-in

Two short questionnaires you can repeat over time. Your scores are saved on this device so you can see how things change, and you can download or print them to bring to your session.

The Spider

An impact scale for the multisystemic symptoms of people with joint hypermobility. It has been validated in adolescents and adults aged 13 to 65 with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome, and takes about 10 minutes.

Who this is helpful for

Researched in: hypermobility spectrum disorder (HSD), hypermobile Ehlers-Danlos syndrome (hEDS) and symptomatic joint hypermobility, including people still waiting for a diagnosis. It has been validated for ages 13 to 65.

Symptoms it covers, in eight areas:

  • Neuromusculoskeletal: joint instability, subluxations or dislocations, muscle weakness or spasms, balance and body-position problems, tingling or numbness.
  • Pain: joint pain, widespread pain, headaches or migraines, and pain from touch or pressure that wouldn’t hurt most people.
  • Fatigue and sleep: physical and mental exhaustion after small efforts, and trouble falling or staying asleep.
  • Cardiac dysautonomia: racing heart, faintness or near-fainting on standing, in heat, after meals or after activity, as in POTS and other orthostatic intolerance.
  • Gastrointestinal: bloating, abdominal pain, diarrhoea or constipation, nausea, reflux and swallowing difficulty.
  • Urogenital: bladder urgency, leaking, difficulty emptying, genital discomfort and repeated suspected urinary infections.
  • Anxiety: worry, restlessness, a sense of dread, and fear of movement because of injury, pain or fatigue.
  • Depression: low mood, hopelessness about your health, and loss of interest or pleasure.

You can fill it in with any diagnosis, but the research comparisons only apply to people with hypermobility. It shows how much symptoms affect daily life; it doesn’t diagnose HSD, hEDS or any other condition.

Think about the past one month. For each symptom, choose how much it has affected your daily life, including work or school, social activities, hobbies and everyday tasks. There are no right or wrong answers.

Part two (optional): how much has each area affected you?

Looking back over your answers, rate your own sense of how much each area has affected your quality of life this month. 0 is no impact, 100 is the greatest impact. This is shown alongside your calculated scores.

0 of 31 answered

These questionnaires track symptoms over time. They do not diagnose any condition. If you are worried about a symptom, or something changes suddenly, contact your doctor. In an emergency, call 911.

About the evidence

The Spider (version 7) is shown and scored exactly as published: each item 0, 0, 25, 50, 75 or 100; question 15 scores 20 per situation; question 25 scores 0, 33.3, 66.6 or 100; each area is the average of its items. In over 11,000 adults, every area correlated moderately to strongly with an established questionnaire for the same symptoms (r = 0.62 to 0.80) and separated people with and without symptomatic hypermobility. Test–retest reliability and the smallest meaningful change have not been published yet, so changes over time should be read as a guide.

COMPASS-31 is shown and scored with the published algorithm: item points summed per area, then weighted (orthostatic intolerance ×4.0, vasomotor ×0.8333, secretomotor ×2.1428571, gastrointestinal ×0.8928571, bladder ×1.111, pupillomotor ×0.333) for a total of 0 to 100. A 2025 Rasch analysis recommends reading the six areas separately rather than relying on the total alone.

References: Simmonds JV, Kazkaz H, Lowe P, Ninis N, Tang E, Ewer E, De Wandele I. The Spider v7 © 2023. Ewer ER, De Pauw R, Kazkaz H, et al. The Spider: validation in adults. Clin Rheumatol 2024;43:3005–3017. Ewer E, Kazkaz H, Ninis N, et al. The Spider: initial validation in adolescents. J Pediatr Clin Pract 2024;12:200098. Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31. Mayo Clin Proc 2012;87(12):1196–1201. © Mayo Foundation for Medical Education and Research. Self-reported symptom burden in POTS: a narrative review. Auton Neurosci 2022. Treister R, O’Neil K, Downs HM, Oaklander AL. Validation of COMPASS-31 in patients with and without small fiber polyneuropathy. Eur J Neurol 2015;22(7):1124–1130. Ahn JH, et al. Validation of the Korean COMPASS-31 in Parkinson’s disease. PLoS One 2021.