ID

31090

Description

LOW BACK PAIN DATA COLLECTION REFERENCE GUIDE Version 2.0.3 Revised August 24th, 2017 www.ichom.org Conditions: Lumbar Disc Herniation | Lumbar Stenosis | Lumbar Spondylolisthesis | Degenerative Scoliosis | Adult Idiopathic Scoliosis | Degenerative Disc Disorder | Other Degenerative Lumbar Disorders | Mechanical, Acute, and Chronic Lumbar Back Pain and Back-Related Leg Pain Conditions Not Covered: Individuals < 18 Years of Age | Spinal Infection | Spinal Tumor | Spinal Fractures | Traumatic Dislocation | Congenital Scoliosis Documented as >20 Degrees, Moderate, Large, or Severe Treatment Approaches: Conservative Therapy (e.g. physical therapy, chiropractic, drug therapy, injections, etc.) | Surgical Therapy (e.g. spinal fusion, decompression, or discectomy) This ODM-file contains Case Mix Variables to be assessed at baseline, with use of the following Scores: ODI - Oswestry Disability Index Version 2.1a: The ODI is free for all health care organizations, but a license is needed for use (therefore not included in this version of the standard set). Please visit eprovide: https://eprovide.mapi-trust.org/ NPRS - Numerical Pain Rating Scale: The NPRS is free for all health care organizations, and a license is not needed. EQ-5D-3L - EuroQol‐5D descriptive system (EQ-­5D‐3L) and visual analogue scale (EQ-­VAS): The EQ-5D-3L is free for non-profits and academic research, but a license is needed for use (therefore not included in this version of the standard set). https://euroqol.org/support/how-to-obtain-eq-5d/

Link

www.ichom.org

Keywords

Versions (4)
  1. 7/20/18 7/20/18 - Sarah Riepenhausen
  2. 8/23/18 8/23/18 - Sarah Riepenhausen
  3. 8/31/18 8/31/18 - Sarah Riepenhausen
  4. 4/30/20 4/30/20 - Sarah Riepenhausen
Copyright Holder

ICHOM

Uploaded on

July 20, 2018

DOI

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License

Creative Commons BY-NC 3.0
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ICHOM Low Back Pain

English

ICHOM Low Back Pain - Case Mix Variables

1 forms  
Patient ID
Description

Patient ID

Alias
UMLS CUI-1
C1269815
Indicate the patient's medical record number.
Description

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution. INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical RESPONSE OPTIONS: According to institution

Data type

integer

Alias
UMLS CUI [1]
C1269815
Demographic Factors
Description

Demographic Factors

Alias
UMLS CUI-1
C1704791
What is your date of birth?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C0001779
UMLS CUI [2]
C0421451
DD/MM/YYYY
Please indicate your sex at birth
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1]
C0079399
Please indicate highest level of schooling completed
Description

The level of schooling is defined in each country as per ISCED [International Standard Classification] INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0013658
Baseline functional Status
Description

Baseline functional Status

Alias
UMLS CUI-1
C0598463
UMLS CUI-2
C1442488
What is your work status?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0014003
UMLS CUI [1,2]
C0449438
Are you currently on sick leave from work?
Description

INCLUSION CRITERIA: If answered 'Unable to work due to a condition other than back or leg pain' or 'Unable to work due to back or leg pain' to work status (WORK) TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1]
C0242807
Since when?
Description

INCLUSION CRITERIA: All patients If answered 'yes' to currently being on sick leave (SICKLEAVE) TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0449238
UMLS CUI [1,2]
C0242807
Oswestry Disability Index - Total Score
Description

For use of ODI a licence is needed. Therefore only a single item for the total score for ODI is given here, while in the original ICHOM the separate questions of the score appear (ODI_Q01 to ODI_Q10). INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported

Data type

integer

Alias
UMLS CUI [1,1]
C4288568
UMLS CUI [1,2]
C2964552
On a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain imaginable, please indicate your average back pain over the last 7 days
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported RESPONSE OPTIONS: Ordinal values from 0 to 10, with 'No pain' marked at '0' and 'Worst pain imaginable' marked at '10'

Data type

integer

Alias
UMLS CUI [1,1]
C1518471
UMLS CUI [1,2]
C0004604
On a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain imaginable, please indicate your average leg pain over the last 7 days
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported RESPONSE OPTIONS: Ordinal values from 0 to 10, with 'No pain' marked at '0' and 'Worst pain imaginable' marked at '10'

Data type

integer

Alias
UMLS CUI [1,1]
C1518471
UMLS CUI [1,2]
C0023222
EQ-5D-3L Score
Description

For use of EQ-5D-3L a licence is needed. Therefore only two items for the EQ-5D-3L are given here, while in the original ICHOM the separate questions of the score appear (EQ5D_Q01 to EQ5D_Q06). This item is for the calculated Score of the 5 questions. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported

Data type

float

Alias
UMLS CUI [1,1]
C1880594
UMLS CUI [1,2]
C0449820
EQ-5D-3L VAS
Description

For use of EQ-5D-3L a licence is needed. Therefore only two items for the EQ-5D-3L are given here, while in the original ICHOM the separate questions of the score appear (EQ5D_Q01 to EQ5D_Q06). This item is for the result of the VAS. INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: VAS

Data type

float

Alias
UMLS CUI [1]
C3639380
Baseline Clinical Factors
Description

Baseline Clinical Factors

Alias
UMLS CUI-1
C1442488
UMLS CUI-2
C0449440
UMLS CUI-3
C0035648
Do you smoke?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient reported TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1]
C1519386
Have you been told by a doctor that you have any of the following? 0 = I have no other diseases
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C1298908
Have you been told by a doctor that you have any of the following? 1 = Heart disease (For example angina, heart attack, or heart failure)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0018799
Have you been told by a doctor that you have any of the following? 2 = High blood pressure
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0020538
Have you been told by a doctor that you have any of the following? 3 = Leg pain when walking due to poor circulation
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0085096
UMLS CUI [1,2]
C0009488
Have you been told by a doctor that you have any of the following? 4 = Lung disease (For example asthma, chronic bronchitis, or emphysema)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0024115
Have you been told by a doctor that you have any of the following? 5 = Diabetes
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0011849
Have you been told by a doctor that you have any of the following? 6 = Kidney disease
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0022658
Have you been told by a doctor that you have any of the following? 7 = Liver Disease
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0023895
Have you been told by a doctor that you have any of the following? 8 = Problems caused by stroke
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0038454
Have you been told by a doctor that you have any of the following? 9 = Disease of the nervous system (For example Parkinson’s disease or Multiple Sclerosis)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0027765
Have you been told by a doctor that you have any of the following? 10 = Cancer (within the last 5 years)
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0006826
Have you been told by a doctor that you have any of the following? 11 = Depression
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0011581
Have you been told by a doctor that you have any of the following? 12 = Arthritis
Description

Based upon the Self-administered Comorbidity Questionnaire (Sangha et al, 2003) INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient-reported TYPE: Multiple answer, Separate multiple entries with ";"

Data type

boolean

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C0003864
How long have you had your current back pain?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient reported TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0004604
UMLS CUI [1,2]
C0449238
How long have you had pain radiating to your leg(s)?
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient reported TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0023222
UMLS CUI [1,2]
C0449238
Indicate the patient's height
Description

Height and weight are used to calculate BMI INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical RESPONSE OPTIONS: Numerical value of height in cm or in

Data type

float

Alias
UMLS CUI [1]
C0005890
Indicate units of height
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C1519795
Indicate the patient's weight
Description

Height and weight are used to calculate BMI INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical RESPONSE OPTIONS: Numerical value of weight in kg or lbs

Data type

float

Alias
UMLS CUI [1]
C0005910
Indicate units of weight
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0005910
UMLS CUI [1,2]
C1519795
Diagnostic classification (according to Glassman criteria): Symptoms - Select one
Description

Back pain dominant, acute: Primary complaint is LBP. Symptoms ≤3 months Leg pain dominant, acute: Primary complaint is leg pain. Symptoms ≤3 months Back pain = Leg pain, acute: Patient reports 50 +/- 10% of each. Symptoms ≤3 months Back pain dominant, chronic: Primary complaint is LBP. Symptoms >3 months Leg pain dominant, chronic: Primary complaint is leg pain. Symptoms >3 months Back pain = leg pain, chronic: Patient reports 50 +/- 10% of each. Symptoms >3 months Neurogenic claudication: Numbness, weakness, or pain to the buttocks or legs, exacerbated by walking or standing, relieved by sitting Cauda equina syndrome: Dominant complaint is motor weakness, incontinence or Cauda equina syndrome, with or without associated complaints of pain INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0683327
UMLS CUI [1,2]
C1457887
Diagnostic classification (according to Glassman criteria): Structural pathology - Select one
Description

Not defined: No study ordered, or no study interpretation available for determination of structural pathology Age appropriate: Structural changes are consistent with normal aging and not a clinically relevant source of symptoms Disc pathology with normal disc height: Disc pathology without significant loss of disc height, includes disc herniation, internal disc desiccation and annual tear Disc space collapse: Disc pathology with mechanical disc space collapse with or without associated disc space pathology Spondylolisthesis/Spondylolysis: Any listhesis, including degenerative and isthmic spondylolisthesis Scoliosis/Kyphosis: Lumbar spine deformity including localized scoliosis or kyphosis Facet pathology: Significant face arthrosis or degeneration, including synovial cysts INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0683327
UMLS CUI [1,2]
C0037933
Diagnostic classification (according to Glassman criteria): Compressive pathology - Select one
Description

Not defined: No study ordered, or no study interpretation available for determination of compressive pathology None: No clinically relevant compressive pathology Central: Compression in the central canala region (between the lateral margins of the dura) from any etiology Lateral: Compression in the lateral recess or foraminal regions (lateral to the lateral margins of the dura) from any etiology Combined: Compression in the central canal and latera recess/foraminal regions from any etiology Recurrent: Recurrent compression following previous surgical treatment at the same level, either in a central canala and/or recess/foraminal regions INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C0683327
UMLS CUI [1,2]
C0037926
UMLS CUI [2,1]
C0683327
UMLS CUI [2,2]
C0037941
UMLS CUI [2,3]
C0332459
Answer the following questions only if the patient is receiving spinal procedures (surgery or injections) Indicate the morbidity state of the patient
Description

ASA1: no disturbance ASA2:mild/moderate ASA3: severe ASA4: life-threatening ASA5: moribund INCLUSION CRITERIA: Surgically treated patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1]
C1531480
Indicate the reason for surgery
Description

INCLUSION CRITERIA: Surgically treated patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

integer

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C0543467
Prior Treatment
Description

Prior Treatment

Alias
UMLS CUI-1
C1514463
Do you take any of the following? Over the counter or non-prescription pain medication
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient reported TYPE: Single Answer Only needs to be answered once.

Data type

integer

Alias
UMLS CUI [1,1]
C2709201
UMLS CUI [1,2]
C0242937
UMLS CUI [1,3]
C0549178
Prescription pain medication (opioid or narcotic medications)
Description

INCLUSION CRITERIA: All patients TIMING: Baseline REPORTING SOURCE: Patient reported TYPE: Single Answer Only needs to be answered once.

Data type

integer

Alias
UMLS CUI [1,1]
C0027409
UMLS CUI [1,2]
C0549178
Indicate if the patient has had previous procedural back interventions
Description

INCLUSION CRITERIA: Surgically treated patients TIMING: Baseline REPORTING SOURCE: Clinical TYPE: Single Answer

Data type

text

Alias
UMLS CUI [1,1]
C0744961
UMLS CUI [1,2]
C0741419
Indicate when the patient had previous procedural back interventions
Description

INCLUSION CRITERIA: Surgically treated patients; If patient has had previous procedural back interventions (INTERVENT) TIMING: Baseline REPORTING SOURCE: Clinical Variable ID: In the Variable ID the numeral will have to be modified, up to 10 possible entries.

Data type

partialDate

Measurement units
  • MM/YYYY
Alias
UMLS CUI [1,1]
C0744961
UMLS CUI [1,2]
C0741419
UMLS CUI [1,3]
C0011008
MM/YYYY
Indicate the type of the previous procedural back interventions
Description

INCLUSION CRITERIA: Surgically treated patients; If patient has had previous procedural back interventions (INTERVENT) TIMING: Baseline REPORTING SOURCE: Clinical Variable ID: In the Variable ID the numeral will have to be modified, up to 10 possible entries. TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0744961
UMLS CUI [1,2]
C0741419
UMLS CUI [1,3]
C0184661
Indicate the levels of the previous procedural back interventions
Description

INCLUSION CRITERIA: Surgically treated patients; If patient has had previous procedural back interventions (INTERVENT) TIMING: Baseline REPORTING SOURCE: Clinical Variable ID: In the Variable ID the numeral will have to be modified, up to 10 possible entries. TYPE: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0744961
UMLS CUI [1,2]
C0741419
UMLS CUI [1,3]
C0037949
UMLS CUI [1,4]
C2946261
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Similar models

ICHOM Low Back Pain - Case Mix Variables

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient ID
C1269815 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number.
integer
C1269815 (UMLS CUI [1])
Item Group
Demographic Factors
C1704791 (UMLS CUI-1)
AGE
Item
What is your date of birth?
date
C0001779 (UMLS CUI [1])
C0421451 (UMLS CUI [2])
Item
Please indicate your sex at birth
integer
C0079399 (UMLS CUI [1])
Sex
Code List
Please indicate your sex at birth
CL Item
Male (1)
CL Item
Female (2)
CL Item
Undisclosed (999)
Item
Please indicate highest level of schooling completed
integer
C0013658 (UMLS CUI [1])
Educational level
Code List
Please indicate highest level of schooling completed
CL Item
None (0)
CL Item
Primary (1)
CL Item
Secondary (2)
CL Item
Tertiary (3)
Item Group
Baseline functional Status
C0598463 (UMLS CUI-1)
C1442488 (UMLS CUI-2)
Item
What is your work status?
integer
C0014003 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
Work status
Code List
What is your work status?
CL Item
Unable to work due to a condition other than back or leg pain (0)
CL Item
Unable to work due to back or leg pain (1)
CL Item
Not working by choice (student, retired, homemaker) (2)
CL Item
Seeking employment (I consider myself able to work but cannot find a job)  (3)
CL Item
Working part-time (4)
CL Item
Working full-time (5)
Item
Are you currently on sick leave from work?
integer
C0242807 (UMLS CUI [1])
Sick leave
Code List
Are you currently on sick leave from work?
CL Item
No (0)
CL Item
Yes, full time for my back problems (1)
CL Item
Yes, part time for my back problems (2)
CL Item
Yes, due to another disease (3)
Item
Since when?
integer
C0449238 (UMLS CUI [1,1])
C0242807 (UMLS CUI [1,2])
Duration of sick leave
Code List
Since when?
CL Item
1 week or less (1)
CL Item
1-4 weeks (2)
CL Item
1-3 months (3)
CL Item
3-6 months (4)
CL Item
6-9 months (5)
CL Item
9-12 months (6)
CL Item
1-2 years (7)
CL Item
More than 2 years (8)
ODI Total Score
Item
Oswestry Disability Index - Total Score
integer
C4288568 (UMLS CUI [1,1])
C2964552 (UMLS CUI [1,2])
Question 1 of NPRS
Item
On a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain imaginable, please indicate your average back pain over the last 7 days
integer
C1518471 (UMLS CUI [1,1])
C0004604 (UMLS CUI [1,2])
Question 2 of NPRS
Item
On a scale of 0 to 10, with 0 being no pain at all and 10 being the worst pain imaginable, please indicate your average leg pain over the last 7 days
integer
C1518471 (UMLS CUI [1,1])
C0023222 (UMLS CUI [1,2])
EQ-5D-3L Score
Item
EQ-5D-3L Score
float
C1880594 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
EQ-5D-3L VAS
Item
EQ-5D-3L VAS
float
C3639380 (UMLS CUI [1])
Item Group
Baseline Clinical Factors
C1442488 (UMLS CUI-1)
C0449440 (UMLS CUI-2)
C0035648 (UMLS CUI-3)
Item
Do you smoke?
integer
C1519386 (UMLS CUI [1])
Smoking status
Code List
Do you smoke?
CL Item
No (0)
CL Item
Yes (1)
Comorbidities - No
Item
Have you been told by a doctor that you have any of the following? 0 = I have no other diseases
boolean
C0009488 (UMLS CUI [1,1])
C1298908 (UMLS CUI [1,2])
Comorbidities - Heart Disease
Item
Have you been told by a doctor that you have any of the following? 1 = Heart disease (For example angina, heart attack, or heart failure)
boolean
C0009488 (UMLS CUI [1,1])
C0018799 (UMLS CUI [1,2])
Comorbidities - Hypertension
Item
Have you been told by a doctor that you have any of the following? 2 = High blood pressure
boolean
C0009488 (UMLS CUI [1,1])
C0020538 (UMLS CUI [1,2])
Comorbidities - peripheral vascular disease
Item
Have you been told by a doctor that you have any of the following? 3 = Leg pain when walking due to poor circulation
boolean
C0085096 (UMLS CUI [1,1])
C0009488 (UMLS CUI [1,2])
Comorbidities - Lung disease
Item
Have you been told by a doctor that you have any of the following? 4 = Lung disease (For example asthma, chronic bronchitis, or emphysema)
boolean
C0009488 (UMLS CUI [1,1])
C0024115 (UMLS CUI [1,2])
Comorbidities - Diabetes
Item
Have you been told by a doctor that you have any of the following? 5 = Diabetes
boolean
C0009488 (UMLS CUI [1,1])
C0011849 (UMLS CUI [1,2])
Comorbidities - Kidney Disease
Item
Have you been told by a doctor that you have any of the following? 6 = Kidney disease
boolean
C0009488 (UMLS CUI [1,1])
C0022658 (UMLS CUI [1,2])
Comorbidities - Liver Disease
Item
Have you been told by a doctor that you have any of the following? 7 = Liver Disease
boolean
C0009488 (UMLS CUI [1,1])
C0023895 (UMLS CUI [1,2])
Comorbidities - Stroke
Item
Have you been told by a doctor that you have any of the following? 8 = Problems caused by stroke
boolean
C0009488 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
Comorbidities - Disease of the nervous system
Item
Have you been told by a doctor that you have any of the following? 9 = Disease of the nervous system (For example Parkinson’s disease or Multiple Sclerosis)
boolean
C0009488 (UMLS CUI [1,1])
C0027765 (UMLS CUI [1,2])
Comorbidities - Cancer
Item
Have you been told by a doctor that you have any of the following? 10 = Cancer (within the last 5 years)
boolean
C0009488 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
Comorbidities - Depression
Item
Have you been told by a doctor that you have any of the following? 11 = Depression
boolean
C0009488 (UMLS CUI [1,1])
C0011581 (UMLS CUI [1,2])
Comorbidities - Arthritis
Item
Have you been told by a doctor that you have any of the following? 12 = Arthritis
boolean
C0009488 (UMLS CUI [1,1])
C0003864 (UMLS CUI [1,2])
Item
How long have you had your current back pain?
integer
C0004604 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Duration of back pain
Code List
How long have you had your current back pain?
CL Item
I don't have back pain (0)
CL Item
Less than 3 months  (1)
CL Item
3-12 months (2)
CL Item
1-2 years (3)
CL Item
More than 2 years (4)
Item
How long have you had pain radiating to your leg(s)?
integer
C0023222 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Duration of leg pain
Code List
How long have you had pain radiating to your leg(s)?
CL Item
I don’t have pain radiating to my leg(s)  (0)
CL Item
Less than 3 months (1)
CL Item
3-12 months (2)
CL Item
1-2 years (3)
CL Item
More than 2 years (4)
Height
Item
Indicate the patient's height
float
C0005890 (UMLS CUI [1])
Item
Indicate units of height
integer
C0005890 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Height units
Code List
Indicate units of height
CL Item
centimeters (1)
CL Item
inches (2)
Weight
Item
Indicate the patient's weight
float
C0005910 (UMLS CUI [1])
Item
Indicate units of weight
integer
C0005910 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Weight units
Code List
Indicate units of weight
CL Item
kilograms (1)
CL Item
pounds (2)
Item
Diagnostic classification (according to Glassman criteria): Symptoms - Select one
integer
C0683327 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
Diagnostic classification (according to Glassman criteria): Symptoms
Code List
Diagnostic classification (according to Glassman criteria): Symptoms - Select one
CL Item
Back pain dominant, acute (1)
CL Item
Leg pain dominant, acute (2)
CL Item
Back pain = Leg pain, acute (3)
CL Item
Back pain dominant, chronic (4)
CL Item
Leg pain dominant, chronic (5)
CL Item
Back pain = leg pain, chronic (6)
CL Item
Neurogenic claudication (7)
CL Item
Cauda equina syndrome (8)
Item
Diagnostic classification (according to Glassman criteria): Structural pathology - Select one
integer
C0683327 (UMLS CUI [1,1])
C0037933 (UMLS CUI [1,2])
Diagnostic classification (according to Glassman criteria): Structural pathology
Code List
Diagnostic classification (according to Glassman criteria): Structural pathology - Select one
CL Item
Not defined (1)
CL Item
Age appropriate (2)
CL Item
Disc pathology with normal disc height (3)
CL Item
Disc space collapse (4)
CL Item
Spondylolisthesis/ Spondylolysis (5)
CL Item
Scoliosis/Kyphosis (6)
CL Item
Facet pathology (7)
Item
Diagnostic classification (according to Glassman criteria): Compressive pathology - Select one
integer
C0683327 (UMLS CUI [1,1])
C0037926 (UMLS CUI [1,2])
C0683327 (UMLS CUI [2,1])
C0037941 (UMLS CUI [2,2])
C0332459 (UMLS CUI [2,3])
Diagnostic classification (according to Glassman criteria): Compressive pathology
Code List
Diagnostic classification (according to Glassman criteria): Compressive pathology - Select one
CL Item
Not defined (1)
CL Item
None (2)
CL Item
Central (3)
CL Item
Lateral (4)
CL Item
Combined (5)
CL Item
Recurrent (6)
Item
Answer the following questions only if the patient is receiving spinal procedures (surgery or injections) Indicate the morbidity state of the patient
integer
C1531480 (UMLS CUI [1])
ASA rating
Code List
Answer the following questions only if the patient is receiving spinal procedures (surgery or injections) Indicate the morbidity state of the patient
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
Unknown (999)
Item
Indicate the reason for surgery
integer
C3146298 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
Surgical indication
Code List
Indicate the reason for surgery
CL Item
Paramedian disc herniation (1)
CL Item
Central disc herniation (2)
CL Item
Central spinal stenosis with degen. listhesis (3)
CL Item
Central spinal stenosis without degen. listhesis (4)
CL Item
Lateral spinal stenosis (5)
CL Item
Spondylolysis/Spondylolisthesis, isthmic (6)
CL Item
Segmental pain (with or without degen. listhesis) (7)
CL Item
Postoperative instability (8)
CL Item
Degen. scoliosis (9)
CL Item
Other (999)
Item Group
Prior Treatment
C1514463 (UMLS CUI-1)
Item
Do you take any of the following? Over the counter or non-prescription pain medication
integer
C2709201 (UMLS CUI [1,1])
C0242937 (UMLS CUI [1,2])
C0549178 (UMLS CUI [1,3])
Need for continuous analgesic use (non-narcotics)
Code List
Do you take any of the following? Over the counter or non-prescription pain medication
CL Item
No (0)
CL Item
Yes, regularly (1)
CL Item
Yes, sometimes (2)
Item
Prescription pain medication (opioid or narcotic medications)
integer
C0027409 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Need for continuous analgesic use (narcotics)
Code List
Prescription pain medication (opioid or narcotic medications)
CL Item
No (0)
CL Item
Yes, regularly (1)
CL Item
Yes, sometimes (2)
Item
Indicate if the patient has had previous procedural back interventions
text
C0744961 (UMLS CUI [1,1])
C0741419 (UMLS CUI [1,2])
Prior back surgery
Code List
Indicate if the patient has had previous procedural back interventions
CL Item
No (0)
CL Item
Yes (1)
Prior interventions dates*
Item
Indicate when the patient had previous procedural back interventions
partialDate
C0744961 (UMLS CUI [1,1])
C0741419 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Indicate the type of the previous procedural back interventions
integer
C0744961 (UMLS CUI [1,1])
C0741419 (UMLS CUI [1,2])
C0184661 (UMLS CUI [1,3])
Prior interventions types*
Code List
Indicate the type of the previous procedural back interventions
CL Item
Discectomy (1)
CL Item
Decompression (2)
CL Item
Fusion (3)
Item
Indicate the levels of the previous procedural back interventions
integer
C0744961 (UMLS CUI [1,1])
C0741419 (UMLS CUI [1,2])
C0037949 (UMLS CUI [1,3])
C2946261 (UMLS CUI [1,4])
Prior interventions levels*
Code List
Indicate the levels of the previous procedural back interventions
CL Item
T12-L1 (1)
CL Item
L1-L2 (2)
CL Item
L2-L3 (3)
CL Item
L3-L4 (4)
CL Item
L4-L5 (5)
CL Item
L5-S1 (6)
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