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K-BILD Questionnaire

32 Formulários  
<div class="rich-text-field-label"><p>KING'S BRIEF INTERSTITIAL LUNG DISEASE QUESTIONNAIRE (K-BILD)</p> <p>Please answer the following questions as precise as possible:</p> <p>&nbsp;</p></div>
Descrição

<div class="rich-text-field-label"><p>KING'S BRIEF INTERSTITIAL LUNG DISEASE QUESTIONNAIRE (K-BILD)</p> <p>Please answer the following questions as precise as possible:</p> <p>&nbsp;</p></div>

Date of completion
Descrição

kbild_date

Tipo de dados

date

K-BILD Questionnaire
Descrição

K-BILD Questionnaire

1. In the last 2 weeks, I have been breathless climbing stairs or walking up an incline or hill.
Descrição

kbild_breathlessclimb

Tipo de dados

text

2. In the last 2 weeks, because of my lung condition, my chest has felt tight.
Descrição

kbild_chestfeeltight

Tipo de dados

text

3. In the last 2 weeks have you worried about the seriousness of your lung complaint?
Descrição

kbild_worrylungcomplain

Tipo de dados

text

4. In the last 2 weeks have you avoided doing things that make you breathless?
Descrição

kbild_avoidbreathless

Tipo de dados

text

5. In the last 2 weeks have you felt in control of your lung condition?
Descrição

kbild_feltcontrolungcond

Tipo de dados

text

6. In the last 2 weeks, has your lung complaint made you feel fed up or down in the dumps?
Descrição

kbild_discouraged

Tipo de dados

text

7. In the last 2 weeks, I have felt the urge to breathe, also known as 'air hunger'.
Descrição

kbild_airhunger

Tipo de dados

text

8. In the last 2 weeks, my lung condition has made me feel anxious.
Descrição

kbild_anxiousduelungcond

Tipo de dados

text

9. In the last 2 weeks, how often have you experienced 'wheeze' or whistling sounds from your chest?
Descrição

kbild_wheezing

Tipo de dados

text

10. In the last 2 weeks, how much of the time have you felt your lung disease is getting worse?
Descrição

kbild_nrdiseaseworse

Tipo de dados

text

11. In the last 2 weeks has your lung condition interfered with your job or other daily tasks?
Descrição

kbild_interferedjob

Tipo de dados

text

12. In the last 2 weeks have you expected your lung complaint get worse?
Descrição

kbild_expectationworse

Tipo de dados

text

13. In the last 2 weeks, how much has your lung condition limited you carrying things, for example, groceries?
Descrição

kbild_limitationlungcond

Tipo de dados

text

14. In the last 2 weeks, has your lung condition made you think more about the end of your life?
Descrição

kbild_thinkendoflife

Tipo de dados

text

15. Are you financially worse off because of your lung condition?
Descrição

kbild_financialstatus

Tipo de dados

text

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Similar models

K-BILD Questionnaire

32 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
kbild_date
Item
Date of completion
date
Item
1. In the last 2 weeks, I have been breathless climbing stairs or walking up an incline or hill.
text
kbild_breathlessclimb
Code List
1. In the last 2 weeks, I have been breathless climbing stairs or walking up an incline or hill.
CL Item
Every time (every_time)
CL Item
Most times (most_time)
CL Item
Several times (several_times)
CL Item
Some times (some_times)
CL Item
Occasionally (occasionally)
CL Item
Rarely (rarely)
CL Item
Never (never)
Item
2. In the last 2 weeks, because of my lung condition, my chest has felt tight.
text
kbild_chestfeeltight
Code List
2. In the last 2 weeks, because of my lung condition, my chest has felt tight.
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
3. In the last 2 weeks have you worried about the seriousness of your lung complaint?
text
kbild_worrylungcomplain
Code List
3. In the last 2 weeks have you worried about the seriousness of your lung complaint?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
4. In the last 2 weeks have you avoided doing things that make you breathless?
text
kbild_avoidbreathless
Code List
4. In the last 2 weeks have you avoided doing things that make you breathless?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
5. In the last 2 weeks have you felt in control of your lung condition?
text
kbild_feltcontrolungcond
Code List
5. In the last 2 weeks have you felt in control of your lung condition?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
6. In the last 2 weeks, has your lung complaint made you feel fed up or down in the dumps?
text
kbild_discouraged
Code List
6. In the last 2 weeks, has your lung complaint made you feel fed up or down in the dumps?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
7. In the last 2 weeks, I have felt the urge to breathe, also known as 'air hunger'.
text
kbild_airhunger
Code List
7. In the last 2 weeks, I have felt the urge to breathe, also known as 'air hunger'.
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
8. In the last 2 weeks, my lung condition has made me feel anxious.
text
kbild_anxiousduelungcond
Code List
8. In the last 2 weeks, my lung condition has made me feel anxious.
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
9. In the last 2 weeks, how often have you experienced 'wheeze' or whistling sounds from your chest?
text
kbild_wheezing
Code List
9. In the last 2 weeks, how often have you experienced 'wheeze' or whistling sounds from your chest?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
10. In the last 2 weeks, how much of the time have you felt your lung disease is getting worse?
text
kbild_nrdiseaseworse
Code List
10. In the last 2 weeks, how much of the time have you felt your lung disease is getting worse?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
11. In the last 2 weeks has your lung condition interfered with your job or other daily tasks?
text
kbild_interferedjob
Code List
11. In the last 2 weeks has your lung condition interfered with your job or other daily tasks?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
12. In the last 2 weeks have you expected your lung complaint get worse?
text
kbild_expectationworse
Code List
12. In the last 2 weeks have you expected your lung complaint get worse?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
13. In the last 2 weeks, how much has your lung condition limited you carrying things, for example, groceries?
text
kbild_limitationlungcond
Code List
13. In the last 2 weeks, how much has your lung condition limited you carrying things, for example, groceries?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
14. In the last 2 weeks, has your lung condition made you think more about the end of your life?
text
kbild_thinkendoflife
Code List
14. In the last 2 weeks, has your lung condition made you think more about the end of your life?
CL Item
All of the time (all_of_time)
CL Item
Most of the time (most_of_time)
CL Item
A good bit of the time (good_bit_time)
CL Item
Some of the time (some_time)
CL Item
A little of the time (little_time)
CL Item
Hardly any of the time (hardly_any_time)
CL Item
None of the time (none_time)
Item
15. Are you financially worse off because of your lung condition?
text
kbild_financialstatus
Code List
15. Are you financially worse off because of your lung condition?
CL Item
A significant amount (significant_amount)
CL Item
A large amount (large_amount)
CL Item
A considerable amount (considerable_amount)
CL Item
A reasonable amount (reasonable_amount)
CL Item
A small amount (small_amount)
CL Item
Hardly at all (hardly_at_all)
CL Item
Not at all (not_at_all)
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