ID

8556

Beschreibung

Z4032 Quality of Life Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=665C50CD-E03C-DFF5-E040-BB89AD43117E

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=665C50CD-E03C-DFF5-E040-BB89AD43117E

Stichworte

Versionen (2)
  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
Hochgeladen am

9. Januar 2015

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0 Legacy
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Quality of Life - Z4032 Lung Cancer Quality of Life - 2858710v1.0

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: Z4032 Lung Cancer Quality of Life
    1. No Instruction available.
Header Module
Beschreibung

Header Module

Visit
Beschreibung

AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C19712
UMLS 2011AA ObjectClass
C1515944
NCI Thesaurus ObjectClass-2
C25716
UMLS 2011AA ObjectClass-2
C0545082
Patient ID (Pt. ID issued during registration or previously issued Patient ID)
Beschreibung

Patient Study ID

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Institution ID
Beschreibung

Institution Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Patient Initials
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution
Beschreibung

Institution Name

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Header
Beschreibung

Header

In general, would you say your health is
Beschreibung

HealthAssessmentStatus

Datentyp

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C25178
UMLS 2011AA ObjectClass
C0018684
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Compared to one year ago, how would you rate your health in general now
Beschreibung

PriorHealthAssessmentStatus

Datentyp

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C25178
UMLS 2011AA ObjectClass-2
C0018684
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Module Question 3
Beschreibung

Module Question 3

Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
Beschreibung

ActiveExercisePhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL192338
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
Beschreibung

ModerateExercisePhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
CL323823
NCI Metathesaurus ObjectClass-2
C0221187
Lifting or carrying groceries
Beschreibung

LiftingExercisePhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
C0206244
Climbing several flights of stairs
Beschreibung

ClimbingStairsPhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
CL299704
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
Climbing one flight of stairs
Beschreibung

AbilityWalkStairsPhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL240714
Bending, kneeling or stooping
Beschreibung

BendDownPhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL241453
Walking more than a mile
Beschreibung

MaximumWalkedPhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL201237
Walking several blocks
Beschreibung

WalkingDistancePhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
CL201235
Walking one block
Beschreibung

WalkingPhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0080331
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
Bathing or dressing yourself
Beschreibung

BathingPhysicalActivityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Metathesaurus ObjectClass
C0150141
Module Question 4
Beschreibung

Module Question 4

Cut down on the amount of time you spent on work or other activities
Beschreibung

ReducedWorkHealthAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0043227
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Accomplished less than you would like
Beschreibung

ReducedProductivityHealthAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0033269
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Were limited in the kind of work or other activities
Beschreibung

LimitedWorkHealthAssessmentInd-2

Datentyp

boolean

Alias
NCI Metathesaurus ObjectClass
CL110648
NCI Metathesaurus ObjectClass-2
C0043227
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Had difficulty performing the work or other activities (for example, it took extra effort)
Beschreibung

DifficultyWorkHealthAssessmentInd-2

Datentyp

boolean

Alias
NCI Metathesaurus ObjectClass
C0043227
NCI Metathesaurus ObjectClass-2
CL308262
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Module Question 5
Beschreibung

Module Question 5

Cut down on the amount of time you spent on work or other activities
Beschreibung

ReducedWorkHealthAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0043227
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Accomplished less than you would like
Beschreibung

ReducedProductivityHealthAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
C0033269
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Did work or other activities less carefully than usual
Beschreibung

ReducedWorkQualityHealthAssessmentInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C25640
UMLS 2011AA ObjectClass
C0392756
NCI Metathesaurus ObjectClass
CL238443
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups
Beschreibung

FamilySocialBehaviorAssessmentStatus

Datentyp

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C25173
UMLS 2011AA ObjectClass
C0015576
NCI Metathesaurus ObjectClass
C0037397
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
How much bodily pain have you had during the past 4 weeks
Beschreibung

BodyPainAssessmentAmount

Datentyp

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C3303
UMLS 2011AA ObjectClass
C0030193
NCI Thesaurus ObjectClass-2
C13041
UMLS 2011AA ObjectClass-2
C1268086
NCI Thesaurus ValueDomain
C25417
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)
Beschreibung

PainPatientWorkAssessmentStatus

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C3303
UMLS 2011AA ObjectClass-2
C0030193
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0043227
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Module Question 9
Beschreibung

Module Question 9

Did you feel full of pep
Beschreibung

PatientVitalityAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0291944
Have you been a very nervous person
Beschreibung

PatientNervousnessAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0027769
Have you felt so down in the dumps that nothing could cheer you up
Beschreibung

PatientDepressionAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C2982
UMLS 2011AA Property-2
C0011570
Have you felt calm and peaceful
Beschreibung

PatientRelaxationAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0035028
Did you have a lot of energy
Beschreibung

PatientEnergyAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C48058
UMLS 2011AA Property-2
C0542479
Have you felt downhearted and blue
Beschreibung

PatientMoodAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0026516
Did you feel worn out
Beschreibung

PatientFatigueAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3036
UMLS 2011AA Property-2
C0015672
Have you been a happy person
Beschreibung

PatientHappinessAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0018592
Did you feel tired
Beschreibung

PatientLethargyAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
C0023380
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)
Beschreibung

SocialBehaviorAssessmentDuration

Datentyp

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus ObjectClass
C0037397
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
Module Question 11
Beschreibung

Module Question 11

I seem to get sick a little easier than other people
Beschreibung

PatientSicknessAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
NCI Metathesaurus Property
C0221423
I am as healthy as anybody I know
Beschreibung

PatientHealthAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25178
UMLS 2011AA Property-2
C0018684
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
I expect my health to get worse
Beschreibung

PatientWorseAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
CL288707
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
My health is excellent
Beschreibung

PatientHealthExcellentAssessmentScale

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Metathesaurus Property
CL286081
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
NCI Thesaurus ValueDomain-2
C25178
UMLS 2011AA ValueDomain-2
C0018684
Footer Module
Beschreibung

Footer Module

Date Form Completed
Beschreibung

Date Form Completed

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
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1 Formulare
  1. StudyEvent: Z4032 Lung Cancer Quality of Life
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header Module
Item
Visit
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19712 (NCI Thesaurus ObjectClass)
C1515944 (UMLS 2011AA ObjectClass)
C25716 (NCI Thesaurus ObjectClass-2)
C0545082 (UMLS 2011AA ObjectClass-2)
CL.1
Code List
Visit
CL Item
Month 12 (Month 12)
CL Item
Month 24 (Month 24)
CL Item
Month 3 (Month 3)
CL Item
Registration (Registration)
C25646 (NCI Thesaurus)
C1514821 (UMLS 2011AA)
Patient Study ID
Item
Patient ID (Pt. ID issued during registration or previously issued Patient ID)
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Number
Item
Institution ID
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Institution Name
Item
Institution
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Item Group
Header
Item
In general, would you say your health is
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus ObjectClass)
C0018684 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.2
Code List
In general, would you say your health is
CL Item
Excellent (Excellent)
CL Item
Very Good (Very good)
CL Item
Good (Good)
C0205170 (NCI Metathesaurus)
CL Item
Fair (Fair)
CL Item
Poor (Poor)
Item
Compared to one year ago, how would you rate your health in general now
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C25178 (NCI Thesaurus ObjectClass-2)
C0018684 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
Compared to one year ago, how would you rate your health in general now
CL Item
Much Better Now Than One Year Ago (Much better now than one year ago)
CL Item
Somewhat Better Now Than One Year Ago (Somewhat better now than one year ago)
CL Item
About The Same As One Year Ago (About the same as one year ago)
CL Item
Somewhat Worse Now Than One Year Ago (Somewhat worse now than one year ago)
CL Item
Much Worse Now Than One Year Ago (Much worse now than one year ago)
Item Group
Module Question 3
Item
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL192338 (NCI Metathesaurus ObjectClass)
CL.4
Code List
Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL323823 (NCI Metathesaurus ObjectClass)
C0221187 (NCI Metathesaurus ObjectClass-2)
CL.5
Code List
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Lifting or carrying groceries
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C0206244 (NCI Metathesaurus ObjectClass)
CL.6
Code List
Lifting or carrying groceries
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Climbing several flights of stairs
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL299704 (NCI Metathesaurus ObjectClass)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL.7
Code List
Climbing several flights of stairs
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Climbing one flight of stairs
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL240714 (NCI Metathesaurus ObjectClass)
CL.8
Code List
Climbing one flight of stairs
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Bending, kneeling or stooping
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL241453 (NCI Metathesaurus ObjectClass)
CL.9
Code List
Bending, kneeling or stooping
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Walking more than a mile
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL201237 (NCI Metathesaurus ObjectClass)
CL.10
Code List
Walking more than a mile
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Walking several blocks
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL201235 (NCI Metathesaurus ObjectClass)
CL.11
Code List
Walking several blocks
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Walking one block
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0080331 (NCI Metathesaurus ObjectClass)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
CL.12
Code List
Walking one block
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item
Bathing or dressing yourself
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C0150141 (NCI Metathesaurus ObjectClass)
CL.13
Code List
Bathing or dressing yourself
CL Item
Yes, Limited A Lot (Yes, limited a lot)
CL Item
Yes, Limited A Little (Yes, limited a little)
CL Item
No, Not Limited At All (No, not limited at all)
Item Group
Module Question 4
ReducedWorkHealthAssessmentInd-2
Item
Cut down on the amount of time you spent on work or other activities
boolean
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ReducedProductivityHealthAssessmentInd-2
Item
Accomplished less than you would like
boolean
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0033269 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
LimitedWorkHealthAssessmentInd-2
Item
Were limited in the kind of work or other activities
boolean
CL110648 (NCI Metathesaurus ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
DifficultyWorkHealthAssessmentInd-2
Item
Had difficulty performing the work or other activities (for example, it took extra effort)
boolean
C0043227 (NCI Metathesaurus ObjectClass)
CL308262 (NCI Metathesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
Module Question 5
ReducedWorkHealthAssessmentInd-2
Item
Cut down on the amount of time you spent on work or other activities
boolean
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0043227 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ReducedProductivityHealthAssessmentInd-2
Item
Accomplished less than you would like
boolean
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
C0033269 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ReducedWorkQualityHealthAssessmentInd-2
Item
Did work or other activities less carefully than usual
boolean
C25640 (NCI Thesaurus ObjectClass)
C0392756 (UMLS 2011AA ObjectClass)
CL238443 (NCI Metathesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25173 (NCI Thesaurus ObjectClass)
C0015576 (UMLS 2011AA ObjectClass)
C0037397 (NCI Metathesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.21
Code List
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
Slightly (Slightly)
CL Item
Moderately (Moderately)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Extremely (Extremely)
Item
How much bodily pain have you had during the past 4 weeks
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3303 (NCI Thesaurus ObjectClass)
C0030193 (UMLS 2011AA ObjectClass)
C13041 (NCI Thesaurus ObjectClass-2)
C1268086 (UMLS 2011AA ObjectClass-2)
C25417 (NCI Thesaurus ValueDomain)
CL.22
Code List
How much bodily pain have you had during the past 4 weeks
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Very Mild (Very mild)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
Very Severe (Very severe)
Item
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C3303 (NCI Thesaurus ObjectClass-2)
C0030193 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0043227 (NCI Metathesaurus Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.23
Code List
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
CL Item
A Little Bit (A little bit)
CL Item
Moderately (Moderately)
CL Item
Quite A Bit (Quite a bit)
C91216 (NCI Thesaurus)
CL Item
Extremely (Extremely)
Item Group
Module Question 9
Item
Did you feel full of pep
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0291944 (NCI Metathesaurus Property)
CL.24
Code List
Did you feel full of pep
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you been a very nervous person
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0027769 (NCI Metathesaurus Property)
CL.25
Code List
Have you been a very nervous person
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you felt so down in the dumps that nothing could cheer you up
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C2982 (NCI Thesaurus Property-2)
C0011570 (UMLS 2011AA Property-2)
CL.26
Code List
Have you felt so down in the dumps that nothing could cheer you up
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you felt calm and peaceful
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0035028 (NCI Metathesaurus Property)
CL.27
Code List
Have you felt calm and peaceful
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Did you have a lot of energy
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C48058 (NCI Thesaurus Property-2)
C0542479 (UMLS 2011AA Property-2)
CL.28
Code List
Did you have a lot of energy
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you felt downhearted and blue
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0026516 (NCI Metathesaurus Property)
CL.29
Code List
Have you felt downhearted and blue
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Did you feel worn out
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3036 (NCI Thesaurus Property-2)
C0015672 (UMLS 2011AA Property-2)
CL.30
Code List
Did you feel worn out
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Have you been a happy person
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0018592 (NCI Metathesaurus Property)
CL.31
Code List
Have you been a happy person
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item
Did you feel tired
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0023380 (NCI Metathesaurus Property)
CL.32
Code List
Did you feel tired
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
A Good Bit Of The Time (A good bit of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
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 friends, relatives, etc.)
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C0037397 (NCI Metathesaurus ObjectClass)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
CL.33
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 friends, relatives, etc.)
CL Item
All Of The Time (All of the time)
CL Item
Most Of The Time (Most of the time)
CL Item
Some Of The Time (Some of the time)
CL Item
A Little Of The Time (A little of the time)
CL Item
None Of The Time (None of the time)
Item Group
Module Question 11
Item
I seem to get sick a little easier than other people
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
C0221423 (NCI Metathesaurus Property)
CL.34
Code List
I seem to get sick a little easier than other people
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item
I am as healthy as anybody I know
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25178 (NCI Thesaurus Property-2)
C0018684 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
CL.35
Code List
I am as healthy as anybody I know
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item
I expect my health to get worse
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL288707 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
CL.36
Code List
I expect my health to get worse
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item
My health is excellent
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL286081 (NCI Metathesaurus Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25178 (NCI Thesaurus ValueDomain-2)
C0018684 (UMLS 2011AA ValueDomain-2)
CL.37
Code List
My health is excellent
CL Item
Definitely True (Definitely true)
CL Item
Mostly True (Mostly true)
CL Item
Don't Know (Don't know)
CL Item
Mostly False (Mostly false)
CL Item
Definitely False (Definitely false)
Item Group
Footer Module
Date Form Completed
Item
Date Form Completed
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
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