ID

41587

Description

The TOPICS – Short Form 2017 including Casemix forms were developed by the TOPICS-MDS team in collaboration with the Nederlandse Vereniging voor Klinische Geriatrie (NvKG – Dutch Association for Clinical Geriatrics) to use as a Patient Reported Outcome Measure (PROM) in the Dutch outpatient and clinical daily practice. In this version the casemix variables were left out of the Dutch version (with permission by the TOPICS-MDS team), as they are currently not available for the English version. The short forms (including casemix variables for various situations and follow-up in Dutch) can be found on https://topics-mds.eu/topics-short-form/ as pdfs. More information on the public data repository TOPICS-MDS can be found at https://topics-mds.eu/. English Instructions (Dutch Version below): Your experiences as a care receiver are valuable. This list contains questions about your physical and mental health and quality of life. Your answers will be used in research to improve care for the elderly. The more information there is about care for elderly people, the more this can be taken into consideration. Therefore, your experiences are also valuable for other elderly people. Instructions for this questionnaire: - Completing this questionnaire will take approximately 10 minutes. - If you find it difficult to understand or answer the questions, ask your partner, a family member or a friend to help you. - Read each question through completely before selecting an answer. - When you are done, please check that you have not forgotten any questions. Nederlandse Aanwijzingen: Uw ervaringen zijn waardevol. In deze lijst staan vragen over uw lichamelijke en geestelijke gezondheid en kwaliteit van leven. Uw antwoorden worden gebruikt om de zorg voor ouderen in kaart te brengen. Want hoe meer er bekend is over zorg voor ouderen, hoe beter er rekening mee gehouden kan worden. Uw ervaringen zijn dus waardevol, ook voor andere ouderen. Aanwijzingen bij deze vragenlijst: - Het invullen van de vragenlijst kost u ongeveer 10 minuten. - Als u het moeilijk vindt om de vragen te begrijpen of in te vullen, vraag dan hulp aan uw partner, een familielid of vriend. - Lees elke vraag eerst helemaal door voordat u een antwoord kiest. - Bent u klaar, kijk dan of u geen vragen vergeten bent.

Link

https://topics-mds.eu/topics-short-form/

Keywords

Versions (2)
  1. 11/13/20 11/13/20 -
  2. 11/18/20 11/18/20 -
Copyright Holder

Radboud University Medical Center, Department of Geriatric Medicine

Uploaded on

November 18, 2020

DOI

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License

Creative Commons BY-NC 4.0
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TOPICS-MDS

English Dutch

TOPICS Short Form 2017

1 forms  
  1. StudyEvent: ODM
    1. TOPICS Short Form 2017
.
Description

.

Alias
UMLS CUI-1
C1320722
Project - hospital ID:
Description

Project - hospital ID

Data type

text

Alias
UMLS CUI [1,1]
C1709701
UMLS CUI [1,2]
C0019994
UMLS CUI [1,3]
C1300638
Serial number:
Description

Serial number

Data type

text

Alias
UMLS CUI [1]
C2348188
General health
Description

General health

Alias
UMLS CUI-1
C0424575
On a scale of 0 to 10: how do you rate your health in general? 0 indicates ‘completely unhealthy’ and 10 ‘completely healthy’. Please choose the answer that best fits your situation.
Description

General health

Data type

integer

Alias
UMLS CUI [1]
C0424575
Pain/discomfort
Description

Pain/discomfort

Alias
UMLS CUI-1
C2737161
Do you experience pain or discomfort at this moment?
Description

Current Pain/discomfort

Data type

integer

Alias
UMLS CUI [1,1]
C2737161
UMLS CUI [1,2]
C0521116
Brain functions
Description

Brain functions

Alias
UMLS CUI-1
C0678908
Do you have complaints about your memory?
Description

Complaints about memory

Data type

integer

Alias
UMLS CUI [1,1]
C0025260
UMLS CUI [1,2]
C0277786
Tasks and activities of daily life
Description

Tasks and activities of daily life

Alias
UMLS CUI-1
C0001288
Can you, fully independently, dress yourself?
Description

Dress independently

Data type

integer

Alias
UMLS CUI [1]
C0429966
Can you, fully independently, stand up from sitting in a chair?
Description

Stand up independently

Data type

integer

Alias
UMLS CUI [1,1]
C4055533
UMLS CUI [1,2]
C1299583
Can you, fully independently, wash and dry your whole body?
Description

Wash and dry yourself independently

Data type

integer

Alias
UMLS CUI [1,1]
C4055522
UMLS CUI [1,2]
C1299583
Can you, fully independently, go up and down the stairs?
Description

Walk stairs independently

Data type

integer

Alias
UMLS CUI [1,1]
C0560077
UMLS CUI [1,2]
C1299583
UMLS CUI [2,1]
C0560081
UMLS CUI [2,2]
C1299583
Can you, fully independently, walk outdoors (if necessary with a cane or wheel rollator)?
Description

Walk outdoors independently

Data type

integer

Alias
UMLS CUI [1,1]
C4055526
UMLS CUI [1,2]
C1299583
UMLS CUI [2]
C3844079
Can you, fully independently, take care of your feet and toenails?
Description

Foot and toenail care independently

Data type

integer

Alias
UMLS CUI [1,1]
C0150240
UMLS CUI [1,2]
C1299583
UMLS CUI [2,1]
C0749563
UMLS CUI [2,2]
C1299583
Can you, fully independently, do “light” household activities (for example, dusting and tidying up)?
Description

Light household activities independently

Data type

integer

Alias
UMLS CUI [1,1]
C4055557
UMLS CUI [1,2]
C1299583
UMLS CUI [2]
C0563970
UMLS CUI [3]
C0564042
Can you, fully independently, do the shopping?
Description

Do shopping independently

Data type

integer

Alias
UMLS CUI [1,1]
C4055547
UMLS CUI [1,2]
C1299583
Can you, fully independently, take your medicines?
Description

Take medicine independently

Data type

integer

Alias
UMLS CUI [1,1]
C4075001
UMLS CUI [1,2]
C1299583
Can you, fully independently, use your own or public transportation?
Description

Use own or public transportation independently

Data type

integer

Alias
UMLS CUI [1,1]
C0871194
UMLS CUI [1,2]
C1299583
UMLS CUI [2,1]
C4274917
UMLS CUI [2,2]
C1299583
Feelings past 4 weeks
Description

Feelings past 4 weeks

Alias
UMLS CUI-1
C3828653
UMLS CUI-2
C1527305
How much of the time in the past 4 weeks have you felt calm and peaceful?
Description

Calm and peaceful feeling past 4 weeks

Data type

integer

Alias
UMLS CUI [1,1]
C3829745
UMLS CUI [1,2]
C3828653
How much of the time in the past 4 weeks have you felt downhearted and blue?
Description

Downhearted and blue feeling past 4 weeks

Data type

integer

Alias
UMLS CUI [1,1]
C3829743
UMLS CUI [1,2]
C3828653
How much of the time in the past 4 weeks have you been a happy person?
Description

Happy feeling past 4 weeks

Data type

integer

Alias
UMLS CUI [1,1]
C3828653
UMLS CUI [1,2]
C3829752
Social activities
Description

Social activities

Alias
UMLS CUI-1
C4321480
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
Description

Health or emotional problems interfering with social activities

Data type

integer

Alias
UMLS CUI [1]
C3484327
The following question is about your ‘quality of life’. This refers to what you think about your life. For example, whether you are satisfied with your life, whether you have enjoyment in your life and whether your life gives you satisfaction. On a scale of 0 to 10: how do you rate your life at this moment? 0 indicates ‘completely unsatisfied’ and 10 ‘completely satisfied’.
Description

Quality of life

Data type

integer

Alias
UMLS CUI [1]
C2984049
Closure
Description

Closure

Alias
UMLS CUI-1
C1521802
Has someone helped you to complete this questionnaire?
Description

Help with filling in this questionnaire

Data type

integer

Alias
UMLS CUI [1,1]
C3273494
UMLS CUI [1,2]
C3828841
If anyone helped you to complete the list, please specify:
Description

Help with filling in this questionnaire - Specification

Data type

text

Alias
UMLS CUI [1,1]
C3273494
UMLS CUI [1,2]
C3828841
UMLS CUI [1,3]
C2348235
If yes, what did the help consist of? This is the end of the questionnaire. Thank you very much for completing the questionnaire.
Description

Type of help to fill in this questionnaire

Data type

integer

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C3828841
UMLS CUI [1,3]
C3273494
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Similar models

TOPICS Short Form 2017

1 forms
  1. StudyEvent: ODM
    1. TOPICS Short Form 2017
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
.
C1320722 (UMLS CUI-1)
Project - hospital ID
Item
Project - hospital ID:
text
C1709701 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Serial number
Item
Serial number:
text
C2348188 (UMLS CUI [1])
Item Group
General health
C0424575 (UMLS CUI-1)
General health
Item
On a scale of 0 to 10: how do you rate your health in general? 0 indicates ‘completely unhealthy’ and 10 ‘completely healthy’. Please choose the answer that best fits your situation.
integer
C0424575 (UMLS CUI [1])
Item Group
Pain/discomfort
C2737161 (UMLS CUI-1)
Item
Do you experience pain or discomfort at this moment?
integer
C2737161 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Current Pain/discomfort
Code List
Do you experience pain or discomfort at this moment?
CL Item
None (1)
CL Item
Slightly (2)
CL Item
Moderately (3)
CL Item
Severely (4)
CL Item
Extremely (5)
Item Group
Brain functions
C0678908 (UMLS CUI-1)
Item
Do you have complaints about your memory?
integer
C0025260 (UMLS CUI [1,1])
C0277786 (UMLS CUI [1,2])
Complaints about memory
Code List
Do you have complaints about your memory?
CL Item
No (1)
CL Item
Yes (2)
Item Group
Tasks and activities of daily life
C0001288 (UMLS CUI-1)
Item
Can you, fully independently, dress yourself?
integer
C0429966 (UMLS CUI [1])
Dress independently
Code List
Can you, fully independently, dress yourself?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, stand up from sitting in a chair?
integer
C4055533 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress independently
Code List
Can you, fully independently, stand up from sitting in a chair?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, wash and dry your whole body?
integer
C4055522 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress independently
Code List
Can you, fully independently, wash and dry your whole body?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, go up and down the stairs?
integer
C0560077 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C0560081 (UMLS CUI [2,1])
C1299583 (UMLS CUI [2,2])
Dress independently
Code List
Can you, fully independently, go up and down the stairs?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, walk outdoors (if necessary with a cane or wheel rollator)?
integer
C4055526 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C3844079 (UMLS CUI [2])
Dress independently
Code List
Can you, fully independently, walk outdoors (if necessary with a cane or wheel rollator)?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, take care of your feet and toenails?
integer
C0150240 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C0749563 (UMLS CUI [2,1])
C1299583 (UMLS CUI [2,2])
Dress independently
Code List
Can you, fully independently, take care of your feet and toenails?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, do “light” household activities (for example, dusting and tidying up)?
integer
C4055557 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C0563970 (UMLS CUI [2])
C0564042 (UMLS CUI [3])
Dress independently
Code List
Can you, fully independently, do “light” household activities (for example, dusting and tidying up)?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, do the shopping?
integer
C4055547 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress independently
Code List
Can you, fully independently, do the shopping?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, take your medicines?
integer
C4075001 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress independently
Code List
Can you, fully independently, take your medicines?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, use your own or public transportation?
integer
C0871194 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C4274917 (UMLS CUI [2,1])
C1299583 (UMLS CUI [2,2])
Dress independently
Code List
Can you, fully independently, use your own or public transportation?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item Group
Feelings past 4 weeks
C3828653 (UMLS CUI-1)
C1527305 (UMLS CUI-2)
Item
How much of the time in the past 4 weeks have you felt calm and peaceful?
integer
C3829745 (UMLS CUI [1,1])
C3828653 (UMLS CUI [1,2])
Calm and peaceful feeling
Code List
How much of the time in the past 4 weeks have you felt calm and peaceful?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A good bit of the time (3)
CL Item
Some of the time (4)
CL Item
A little of the time (5)
CL Item
None of the time (6)
Item
How much of the time in the past 4 weeks have you felt downhearted and blue?
integer
C3829743 (UMLS CUI [1,1])
C3828653 (UMLS CUI [1,2])
Calm and peaceful feeling
Code List
How much of the time in the past 4 weeks have you felt downhearted and blue?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A good bit of the time (3)
CL Item
Some of the time (4)
CL Item
A little of the time (5)
CL Item
None of the time (6)
Item
How much of the time in the past 4 weeks have you been a happy person?
integer
C3828653 (UMLS CUI [1,1])
C3829752 (UMLS CUI [1,2])
Calm and peaceful feeling
Code List
How much of the time in the past 4 weeks have you been a happy person?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A good bit of the time (3)
CL Item
Some of the time (4)
CL Item
A little of the time (5)
CL Item
None of the time (6)
Item Group
Social activities
C4321480 (UMLS CUI-1)
Item
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
integer
C3484327 (UMLS CUI [1])
Health or emotional problems interfering with social activities
Code List
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
Some of the time (3)
CL Item
A little of the time (4)
CL Item
None of the time (5)
Quality of life
Item
The following question is about your ‘quality of life’. This refers to what you think about your life. For example, whether you are satisfied with your life, whether you have enjoyment in your life and whether your life gives you satisfaction. On a scale of 0 to 10: how do you rate your life at this moment? 0 indicates ‘completely unsatisfied’ and 10 ‘completely satisfied’.
integer
C2984049 (UMLS CUI [1])
Item Group
Closure
C1521802 (UMLS CUI-1)
Item
Has someone helped you to complete this questionnaire?
integer
C3273494 (UMLS CUI [1,1])
C3828841 (UMLS CUI [1,2])
Help with filling in this questionnaire
Code List
Has someone helped you to complete this questionnaire?
CL Item
No, I have completed the list alone (1)
CL Item
Yes, someone helped me to complete the list (for example: your partner, brother, sister, child, grandchild, friend, acquaintance, nurse) (2)
Help with filling in this questionnaire - Specification
Item
If anyone helped you to complete the list, please specify:
text
C3273494 (UMLS CUI [1,1])
C3828841 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
If yes, what did the help consist of? This is the end of the questionnaire. Thank you very much for completing the questionnaire.
integer
C0332307 (UMLS CUI [1,1])
C3828841 (UMLS CUI [1,2])
C3273494 (UMLS CUI [1,3])
Help with filling in this questionnaire
Code List
If yes, what did the help consist of? This is the end of the questionnaire. Thank you very much for completing the questionnaire.
CL Item
Someone else has written down the answers, I have chosen the answers myself (1)
CL Item
Someone else helped me to choose and write down the answers (2)
CL Item
Someone else has chosen and written down the answers for me (3)
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