Description:

Z6051 Mayo Bowel Function Questionnaire (MBFQ) NCT00726622 Laparoscopic-Assisted Resection or Open Resection in Treating Patients With Stage IIA, Stage IIIA, or Stage IIIB Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AEB4B3D-5518-0337-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4AEB4B3D-5518-0337-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/26/15
Uploaded on:

June 26, 2015

DOI:
No DOI assigned. To request one please log in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Z6051 Mayo Bowel Function Questionnaire (MBFQ) NCT00726622

No Instruction available.

  1. StudyEvent: Z6051 Mayo Bowel Function Questionnaire (MBFQ)
    1. No Instruction available.
Header Module
Visit
Patient Bowel Function
Overall, would you say that you had problems with your bowel function in the past week?
In the past week, have you had a problem causing you to get up at night to have a bowel movement?
In the past week, have you had a problem causing you to have a bowel movement within 30 minutes of a prior bowel movement?
In the past week, have you had a problem causing you to lose control of your bowel movements?
In the past week, have you had to wear protective clothing or a pad in case you lost control of a bowel movement?
In the past week, have you had a problem causing you to be unable to tell the difference between a stool and gas?
In the past week, have you had a problem causing you to have stools that are liquid?
In the past week, have you found that once you feel the urge to have a bowel movement, you must do so within 15 minutes to avoid an accident?
Do you have any other problems or comments you would like to make about your bowel function over the past week
Was there any thing that confused or bothered you about the previous questions?
In the past week, have you had cramping with a bowel movement?
Is your cramping (If yes,)
In the past week, have you had blood in your bowel movement?
Check the description that best describes the amount of blood in your bowel movement
In the past week, how much have problems with bowel movements affected your normal activities?
How would you describe your overall Quality of Life?

Similar models