Item
1 OBSERVE: Is the participant able to do a tandem stand (balance unaided for five seconds)?
integer
C3840592 (UMLS CUI [1])
Code List
1 OBSERVE: Is the participant able to do a tandem stand (balance unaided for five seconds)?
Item
2 OBSERVE: Does the participant use an assistive device for walking?
integer
C3874140 (UMLS CUI [1])
Code List
2 OBSERVE: Does the participant use an assistive device for walking?
Item
What type of device?
integer
C3874140 (UMLS CUI [1])
Code List
What type of device?
CL Item
standard cane (1)
CL Item
crutches (1 or 2) (6)
device for walking type other
Item
Other, specify:
text
C3874140 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Item
3 OBSERVE: Does the participant use a lower extremity orthosis (plastic or metal leg brace at or above the ankle)?
integer
C0029365 (UMLS CUI [1,1])
C0023216 (UMLS CUI [1,2])
Code List
3 OBSERVE: Does the participant use a lower extremity orthosis (plastic or metal leg brace at or above the ankle)?
Item
4 OBSERVE: Is the participant missing any limb?
integer
C1719258 (UMLS CUI [1])
Code List
4 OBSERVE: Is the participant missing any limb?
Item
Which limb(s)? Left arm
integer
C1719258 (UMLS CUI [1,1])
C1140618 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
Code List
Which limb(s)? Left arm
Item
Which limb(s)? Right arm
integer
C1719258 (UMLS CUI [1,1])
C1140618 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
Code List
Which limb(s)? Right arm
Item
Which limb(s)? Left leg
integer
C1719258 (UMLS CUI [1,1])
C0023216 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
Code List
Which limb(s)? Left leg
Item
Which limb(s)? Right leg
integer
C1719258 (UMLS CUI [1,1])
C0023216 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
Code List
Which limb(s)? Right leg
Item
5 OBSERVE: Does the participant use prosthesis (artificial limb)?
integer
C0175649 (UMLS CUI [1])
Code List
5 OBSERVE: Does the participant use prosthesis (artificial limb)?
Item
Which limb(s)? Left arm
integer
C0175649 (UMLS CUI [1,1])
C1140618 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
Code List
Which limb(s)? Left arm
Item
Which limb(s)? Right arm
integer
C0175649 (UMLS CUI [1,1])
C1140618 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
Code List
Which limb(s)? Right arm
Item
Which limb(s)? Left leg
integer
C0175649 (UMLS CUI [1,1])
C0023216 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
Code List
Which limb(s)? Left leg
Item
Which limb(s)? Right leg
integer
C0175649 (UMLS CUI [1,1])
C0023216 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
Code List
Which limb(s)? Right leg
Item
6 OBSERVE: Is the participant able to walk 15 feet?
integer
C0559964 (UMLS CUI [1])
Code List
6 OBSERVE: Is the participant able to walk 15 feet?
assissive device on walk
Item
Participant uses assissive device on walk
boolean
C3874140 (UMLS CUI [1,1])
C0080331 (UMLS CUI [1,2])
time to walk 15 feet
Item
7 Time, in seconds, to walk 15 feet
integer
C0080331 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
number of steps taken
Item
8 Number of steps taken:
integer
C1651669 (UMLS CUI [1])
Item
9 OBSERVE: Can the participant lift his/her arm to the table independently? Left arm
integer
C1299583 (UMLS CUI [1,1])
C0206244 (UMLS CUI [1,2])
C1140618 (UMLS CUI [1,3])
C0205091 (UMLS CUI [1,4])
Code List
9 OBSERVE: Can the participant lift his/her arm to the table independently? Left arm
Item
9 OBSERVE: Can the participant lift his/her arm to the table independently? Right arm
integer
C1299583 (UMLS CUI [1,1])
C0206244 (UMLS CUI [1,2])
C1140618 (UMLS CUI [1,3])
C0205090 (UMLS CUI [1,4])
Code List
9 OBSERVE: Can the participant lift his/her arm to the table independently? Right arm
Item
10 ASK: Have you had a recent worsening of pain or of arthritis in your wrist, or do you have tendonitis?
integer
C0853946 (UMLS CUI [1,1])
C0409210 (UMLS CUI [1,2])
C0039503 (UMLS CUI [2])
Code List
10 ASK: Have you had a recent worsening of pain or of arthritis in your wrist, or do you have tendonitis?
Item
11 ASK: Have you had any surgery on your hands or arms during the last 13 weeks?
integer
C0543467 (UMLS CUI [1,1])
C0018563 (UMLS CUI [1,2])
Code List
11 ASK: Have you had any surgery on your hands or arms during the last 13 weeks?
grip strength test
Item
12 Was grip strength test done?
boolean
C0430765 (UMLS CUI [1])
Item
13 Code which hand is being tested. (Begin with dominant hand
text
C0018563 (UMLS CUI [1,1])
C0441987 (UMLS CUI [1,2])
Code List
13 Code which hand is being tested. (Begin with dominant hand
CL Item
unable/discontinued (unable/discontinued)
first try
Item
14 1st try
float
C0180572 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
second try
Item
15 2nd try
float
C0180572 (UMLS CUI [1,1])
C0205436 (UMLS CUI [1,2])
third try
Item
16 3rd try
float
C0180572 (UMLS CUI [1,1])
C0205437 (UMLS CUI [1,2])
Item
17 Code which hand is being tested.
text
C1140618 (UMLS CUI [1])
Code List
17 Code which hand is being tested.
CL Item
unable/discontinued (unable/discontinued)
first try opposite hand
Item
18 1st try
float
C0180572 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
second try opposite hand
Item
19 2nd try
float
C0180572 (UMLS CUI [1,1])
C0205436 (UMLS CUI [1,2])
third try opposite hand
Item
20 3rd try
float
C0180572 (UMLS CUI [1,1])
C0205437 (UMLS CUI [1,2])
stand up from chair
Item
21 ASK: Do you think it would be safe for you to try to stand up from a chair without using your arms?
boolean
C4055533 (UMLS CUI [1])
stand arm from chair without using arms
Item
22 ASK: Do you think you could try to stand up from a chair without using your arms?
boolean
C4055533 (UMLS CUI [1])
Item
23 Reason task was not performed:
text
C0445106 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Code List
23 Reason task was not performed:
CL Item
Not attempted - safety reasons (Not attempted - safety reasons)
CL Item
Not attempted - chair bound (Not attempted - chair bound)
CL Item
Not attempted - other reason (Not attempted - other reason)
CL Item
Specify (Specify)
reason task not performed other
Item
Specify:
text
C0445106 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
number of attempts to rise
Item
24 Number of attempts to rise. [NOTE: Attempts include rocking and weight shifting. If participant stands on first attempt, code 1.)
integer
C3163850 (UMLS CUI [1,1])
C4055533 (UMLS CUI [1,2])
CL Item
Attempted, but unable (Attempted, but unable)
CL Item
Rises using arms (Rises using arms)
CL Item
Rises without using arms (Rises without using arms)
stand up from chair repeatedly
Item
26 ASK: Do you think it would be safe for you to try to stand up from a chair, without using your arms, five times quickly?
boolean
C4055533 (UMLS CUI [1,1])
C0563334 (UMLS CUI [1,2])
Item
27 Reason task was not performed:
text
C0445106 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Code List
27 Reason task was not performed:
CL Item
Not attempted - safety reasons (Not attempted - safety reasons)
CL Item
Not attempted - chair bound (Not attempted - chair bound)
CL Item
Not attempted - other reason (Not attempted - other reason)
CL Item
Specify (Specify)
other reason task not performed
Item
Specify:
text
C0445106 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
heart rate prior to task
Item
28 Heart rate (30 second) prior to chair stands:
integer
C0018810 (UMLS CUI [1,1])
C0332152 (UMLS CUI [1,2])
number of chair rises
Item
29 Number of completed chair rises:
integer
C4055533 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
heart rate after task
Item
30 Heart rate (30 second) immediately following chair stands:
integer
C0018810 (UMLS CUI [1,1])
C1548614 (UMLS CUI [1,2])
number of seconds
Item
31 Number of seconds:
integer
C0457385 (UMLS CUI [1])
chair height
Item
32 Chair height (Centimeters from floor to lowest point)
integer
C0489786 (UMLS CUI [1,1])
C0179847 (UMLS CUI [1,2])
Item
33 Hand done first (begin with dominant hand):
text
C0451161 (UMLS CUI [1,1])
C0449722 (UMLS CUI [1,2])
Code List
33 Hand done first (begin with dominant hand):
CL Item
Not done (Not done)
number of taps right hand
Item
34 Number of taps in 15 seconds: RIGHT HAND
integer
C0451161 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C1288948 (UMLS CUI [1,3])
number of taps left hand
Item
34 Number of taps in 15 seconds: LEFT HAND
integer
C0451161 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C1288949 (UMLS CUI [1,3])
Item
35 Is the participant able to pick up key?
text
C0565700 (UMLS CUI [1])
Code List
35 Is the participant able to pick up key?
CL Item
yes - as instructed (yes - as instructed)
CL Item
yes - slid key off table (yes - slid key off table)
CL Item
yes - picked key up, then dropped it (yes - picked key up, then dropped it)
CL Item
not assessed (not assessed)
Item
36 Is participant able to put key in lock?
text
C4055528 (UMLS CUI [1])
Code List
36 Is participant able to put key in lock?
Item
37 Is participant able to open lock?
text
C4055528 (UMLS CUI [1])
Code List
37 Is participant able to open lock?
time to complete task
Item
38 Time in seconds to complete task:
integer
C0040223 (UMLS CUI [1,1])
C0039333 (UMLS CUI [1,2])
Item
39 Is participant able to open a standard medication container?
integer
C0565737 (UMLS CUI [1])
Code List
39 Is participant able to open a standard medication container?
Item
40 Is the participant able to put on shirt?
integer
C2963321 (UMLS CUI [1])
Code List
40 Is the participant able to put on shirt?
Item
41 Is the participant able to button shirt?
integer
C2963275 (UMLS CUI [1])
Code List
41 Is the participant able to button shirt?
time needed to put on and button shirt
Item
42 Time needed to put on and button shirt (gently discontinue after four minutes)
integer
C0453917 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Item
43 Is participant able to lift his/her leg while standing to 90 degrees at hip and knee? LEFT LEG
integer
C0565671 (UMLS CUI [1,1])
C1140621 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
Code List
43 Is participant able to lift his/her leg while standing to 90 degrees at hip and knee? LEFT LEG
Item
43 Is participant able to lift his/her leg while standing to 90 degrees at hip and knee? RIGHT LEG
integer
C0565671 (UMLS CUI [1,1])
C1140621 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
Code List
43 Is participant able to lift his/her leg while standing to 90 degrees at hip and knee? RIGHT LEG