ID

36797

Description

ICHOM Overactive bladder data collection Version 1.2.2 Revised: April 10th, 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ For Overactive Bladder, the following treatment approaches (or interventions) are covered by our Standard Set. Treatment Approaches : Patient education | Behavioral modification | Pharmacological management | Intradetrusor Botox, PTNS, SNS | Surgery This document contains the Male Follow-up form. It has to be filled in at 3 months (+/-2 weeks) and 6 months (+/- 1 month) after Baseline. Collecting Clinician and Patient-Reported Outcome Measures: ICIQ-OAB, ICIQ-MLUTSsex and ICIQ-FLUTSsex. For all: Free for use in clinical practice, routine outcomes measurement, and clinical research. As permission from the developer is required, only the total score will be included in this version of the standard set. To obtain permission and an offical copy and scoring guide or to inquire about translations see http://www.iciq.net/userpolicy.html OAB-q SF (4-week recall). As a license is needed for use of this questionnaire, only the total score will be included in this version of the standard set. TBS. Free for use without a license. This Standard set was supported by IUGA (international urogynecological association), National Association for Continence, The Canadian Continence Foundation, Continence Foundation of Australia

Lien

http://www.ichom.org/

Mots-clés

Versions (3)
  1. 11/06/2019 11/06/2019 -
  2. 17/06/2019 17/06/2019 -
  3. 30/04/2020 30/04/2020 - Sarah Riepenhausen
Détendeur de droits

ICHOM

Téléchargé le

11 juin 2019

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0
Modèle Commentaires :

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ICHOM Overactive bladder

Anglais

Male Follow-up

1 Formulaires  
  1. StudyEvent: ODM
    1. Male Follow-up
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Indicate the patient's medical record number
Description

Supporting Definition: 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 Type: Numerical Response Options: According to institution

Type de données

integer

Alias
UMLS CUI [1]
C2348585
Time Relative to Baseline
Description

This Item does not exist in the original standard set, instead it is asked to do the following: Please timestamp all variables. Some Standard Set variables are collected at multiple timepoints, and we will ask you to submit these variables in a concatenated VARIABLEID_TIMESTAMP form for future analyses. For example, VARIABLEID_AT (After treatment); VARIABLEID_AS (After surgery); VARIABLEID_UPDATE (Update at least annually), etc.

Type de données

text

Alias
UMLS CUI [1,1]
C0439564
UMLS CUI [1,2]
C1442488
Explanatory variable
Description

Explanatory variable

Alias
UMLS CUI-1
C0681841
What are you currently using to treat your OAB symptoms? Tick all that apply. 0 = Nothing
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C0442735
What are you currently using to treat your OAB symptoms? Tick all that apply. 1 = Behavioral modifications such as changing your fluid intake, bladder training, or Kegel exercises
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C0542299
UMLS CUI [3,1]
C0429791
UMLS CUI [3,2]
C0429791
UMLS CUI [4]
C0150474
UMLS CUI [5]
C0262718
What are you currently using to treat your OAB symptoms? Tick all that apply. 2 = Pelvic floor physical therapy
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C0262718
What are you currently using to treat your OAB symptoms? Tick all that apply. 3 = Medication taken by mouth or from a patch or jelly on the skin
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C0175795
UMLS CUI [3]
C0991556
UMLS CUI [4]
C0991556
What are you currently using to treat your OAB symptoms? Tick all that apply. 4 = Botox injections to the bladder
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2,1]
C0700702
UMLS CUI [2,2]
C0332157
UMLS CUI [2,3]
C0005682
What are you currently using to treat your OAB symptoms? Tick all that apply. 5 = Electrical stimulation
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C0013787
What are you currently using to treat your OAB symptoms? Tick all that apply. 6 = Percutaneous tibial nerve stimulation (PTNS)
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C3805249
What are you currently using to treat your OAB symptoms? Tick all that apply. 7 = Sacral nerve stimulation (SNS)
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C2609267
What are you currently using to treat your OAB symptoms? Tick all that apply. 8 = Surgery
Description

Inclusion Criteria: All patients Timing: Baseline and follow-­up Reporting Source: Patient‐reported Type: Multiple answers

Type de données

boolean

Alias
UMLS CUI [1]
C2827774
UMLS CUI [2]
C0543467
OAB symptom severity and burden
Description

OAB symptom severity and burden

Alias
UMLS CUI-1
C1319166
UMLS CUI-2
C2828008
Questionnaire ICIQ-OAB, total score
Description

As permission is required, the actual 8 questions of this questionnaire are not included in this version of the standard set. The ICHOM OID's are:ICIQ-OAB1 to ICIQ-OAB8 Inclusion Criteria: All patients Timing: Baseline and follow­‐up Reporting Source: Patient‐reported Type: Single answer

Type de données

integer

Alias
UMLS CUI [1,1]
C2711268
UMLS CUI [1,2]
C0878773
UMLS CUI [1,3]
C2964552
Health Related Quality of Life
Description

Health Related Quality of Life

Alias
UMLS CUI-1
C4279947
Questionnaire OAB-q SF, total score
Description

As license is needed for use this questionaire, the actual 8 questions are not included in this version of the standard set. The ICHOM OID's are: OAB-q SF1 to OAB-q SF13 Inclusion Criteria: All patients Timing: Baseline and follow­‐up Reporting Source: Patient‐reported Type: Single answer

Type de données

integer

Alias
UMLS CUI [1,1]
C4279947
UMLS CUI [1,2]
C0878773
UMLS CUI [1,3]
C2964552
Sexual function
Description

Sexual function

Alias
UMLS CUI-1
C0278092
Questionnaire ICIQ-MLUTSsex, total score
Description

As permission is required, the actual 9 questions of the questionnaire are not included in this version of the standard set. The ICHOM OID's are: ICIQ-MLUTSsex1 to ICIQ-MLUTSsex9 Inclusion Criteria: Male patients Timing: Baseline and follow­‐up Reporting Source: Patient‐reported Type: Single answer

Type de données

integer

Alias
UMLS CUI [1,1]
C2711268
UMLS CUI [1,2]
C1706180
UMLS CUI [1,3]
C0278092
UMLS CUI [1,4]
C2964552
Side effects and burden of treatment
Description

Side effects and burden of treatment

Alias
UMLS CUI-1
C0879626
UMLS CUI-2
C0087111
UMLS CUI-3
C2828008
My condition (urinary problems, incontinence) has…
Description

Inclusion Criteria: All patients Timing: Follow-­up Reporting Source: Patient-­reported Type: Single answer

Type de données

integer

Alias
UMLS CUI [1,1]
C0814225
UMLS CUI [1,2]
C0039798
UMLS CUI [1,3]
C0681889
The tolerability of my treatment for OAB is...
Description

Inclusion Criteria: All patients Timing: Follow-­up Reporting Source: Patient-­reported Type: Single answer

Type de données

integer

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C1704410
Treatment satisfaction
Description

Treatment satisfaction

Alias
UMLS CUI-1
C3476649
My overall satisfaction is…
Description

Inclusion Criteria: All patients Timing: Follow‐up Reporting Source: Patient‐reported Type: Single answer

Type de données

integer

Alias
UMLS CUI [1]
C3476649
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Similar models

Male Follow-up

1 Formulaires
  1. StudyEvent: ODM
    1. Male Follow-up
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C2348585 (UMLS CUI [1])
Time Relative to Baseline
Item
Time Relative to Baseline
text
C0439564 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Item Group
Explanatory variable
C0681841 (UMLS CUI-1)
Current treatment: Nothing
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 0 = Nothing
boolean
C2827774 (UMLS CUI [1])
C0442735 (UMLS CUI [2])
Current treatment: Behavioral modifications
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 1 = Behavioral modifications such as changing your fluid intake, bladder training, or Kegel exercises
boolean
C2827774 (UMLS CUI [1])
C0542299 (UMLS CUI [2])
C0429791 (UMLS CUI [3,1])
C0429791 (UMLS CUI [3,2])
C0150474 (UMLS CUI [4])
C0262718 (UMLS CUI [5])
Current treatment: Pelvic floor physical therapy
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 2 = Pelvic floor physical therapy
boolean
C2827774 (UMLS CUI [1])
C0262718 (UMLS CUI [2])
Current treatment: Medication
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 3 = Medication taken by mouth or from a patch or jelly on the skin
boolean
C2827774 (UMLS CUI [1])
C0175795 (UMLS CUI [2])
C0991556 (UMLS CUI [3])
C0991556 (UMLS CUI [4])
Current treatment: Botox injections to the bladder
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 4 = Botox injections to the bladder
boolean
C2827774 (UMLS CUI [1])
C0700702 (UMLS CUI [2,1])
C0332157 (UMLS CUI [2,2])
C0005682 (UMLS CUI [2,3])
Current treatment: Electrical stimulation
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 5 = Electrical stimulation
boolean
C2827774 (UMLS CUI [1])
C0013787 (UMLS CUI [2])
Current treatment: Percutaneous tibial nerve stimulation
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 6 = Percutaneous tibial nerve stimulation (PTNS)
boolean
C2827774 (UMLS CUI [1])
C3805249 (UMLS CUI [2])
Current treatment: Sacral nerve stimulation
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 7 = Sacral nerve stimulation (SNS)
boolean
C2827774 (UMLS CUI [1])
C2609267 (UMLS CUI [2])
Current treatment: Surgery
Item
What are you currently using to treat your OAB symptoms? Tick all that apply. 8 = Surgery
boolean
C2827774 (UMLS CUI [1])
C0543467 (UMLS CUI [2])
Item Group
OAB symptom severity and burden
C1319166 (UMLS CUI-1)
C2828008 (UMLS CUI-2)
Questionnaire ICIQ-OAB, total score
Item
Questionnaire ICIQ-OAB, total score
integer
C2711268 (UMLS CUI [1,1])
C0878773 (UMLS CUI [1,2])
C2964552 (UMLS CUI [1,3])
Item Group
Health Related Quality of Life
C4279947 (UMLS CUI-1)
Questionnaire OAB-q SF, total score
Item
Questionnaire OAB-q SF, total score
integer
C4279947 (UMLS CUI [1,1])
C0878773 (UMLS CUI [1,2])
C2964552 (UMLS CUI [1,3])
Item Group
Sexual function
C0278092 (UMLS CUI-1)
Questionnaire ICIQ-MLUTSsex, total score
Item
Questionnaire ICIQ-MLUTSsex, total score
integer
C2711268 (UMLS CUI [1,1])
C1706180 (UMLS CUI [1,2])
C0278092 (UMLS CUI [1,3])
C2964552 (UMLS CUI [1,4])
Item Group
Side effects and burden of treatment
C0879626 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C2828008 (UMLS CUI-3)
Item
My condition (urinary problems, incontinence) has…
integer
C0814225 (UMLS CUI [1,1])
C0039798 (UMLS CUI [1,2])
C0681889 (UMLS CUI [1,3])
Treatment benefit scale
Code List
My condition (urinary problems, incontinence) has…
CL Item
Greatly improved (1)
C3840786 (UMLS CUI-1)
C0184511 (UMLS CUI-2)
(Comment:en)
CL Item
Improved (2)
C0184511 (UMLS CUI-1)
(Comment:en)
CL Item
Not changed (3)
C0442739 (UMLS CUI-1)
(Comment:en)
CL Item
Worsened during treatment (4)
C3889049 (UMLS CUI-1)
C0347984 (UMLS CUI-2)
C0087111 (UMLS CUI-3)
(Comment:en)
Item
The tolerability of my treatment for OAB is...
integer
C0087111 (UMLS CUI [1,1])
C1704410 (UMLS CUI [1,2])
Treatment tolerance
Code List
The tolerability of my treatment for OAB is...
CL Item
Inadequate (1)
C0205412 (UMLS CUI-1)
(Comment:en)
CL Item
Moderate (2)
C0205081 (UMLS CUI-1)
(Comment:en)
CL Item
Good (3)
C0205170 (UMLS CUI-1)
(Comment:en)
CL Item
Excellent (4)
C1961136 (UMLS CUI-1)
(Comment:en)
Item Group
Treatment satisfaction
C3476649 (UMLS CUI-1)
Item
My overall satisfaction is…
integer
C3476649 (UMLS CUI [1])
Satisfaction with treatment
Code List
My overall satisfaction is…
CL Item
Extremely satisfied (1)
C0205403 (UMLS CUI-1)
C4084799 (UMLS CUI-2)
(Comment:en)
CL Item
Very satisfied (2)
C3840671 (UMLS CUI-1)
(Comment:en)
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