CDE Detailed Report
Disease: content
Subdomain Name: Dysphagia
CRF: welcome
Displaying 1 - 50 of 66
Subdomain Name: Dysphagia
CRF: welcome
Displaying 1 - 50 of 66
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C10317 | Quality of Life in Swallowing Disorders (SWAL-QOL) - trouble staying asleep indicator | SWALQOLTrblStyngAslpInd | Scale assessing how true the following statement has been for the participant during the last month: Having trouble staying asleep? As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject has trouble staying asleep, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Having trouble staying asleep? | 1;2;3;4;5 | All of the time;Most of the time;Some of the time;A little of the time;None of the time | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10285 | Quality of Life in Swallowing Disorders (SWAL-QOL) - thick saliva phlegm problem indicator | SWALQOLThicSalvPhlgmProbInd | Scale assessing how true the following statement has been for the participant during the last month: Having thick saliva or phlegm. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences having thick saliva or phlegm, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Having thick saliva or phlegm | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10296 | Quality of Life in Swallowing Disorders (SWAL-QOL) - figuring out eating problem indicator | SWALQOLFigrngOtEatngProbInd | Scale assessing how true the following statement has been for the participant during the last month: Figuring out what I can and can't eat is a problem for me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject feels figuring out what to eat/not to eat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Figuring out what I can and can't eat is a problem for me | 1;2;3;4;5 | Strongly agree;Agree;Uncertain;Disagree;Strongly disagree | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C17840 | Quality of Life in Swallowing Disorders (SWAL-QOL) - marital status | SWALQOLMaritalStatus | Status of whether the participant is married, divorced, separated, widowed, or never married | Status of whether the participant is married, divorced, separated, widowed, or never marrie | What is your current marital status | 1;2;3;4;5 | Never married;Married;Divorced;Separated;Widowed | Numeric Values |
circle one |
No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10307 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem frustrating indicator | SWALQOLSwllwngProbFrstrngInd | Scale assessing how true the following statement has been for the participant during the last month: My swallowing problem frustrates me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how much swallowing problem frustrates the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | My swallowing problem frustrates me. | 1;2;3;4;5 | Always true;Often true;Sometimes true;Hardly ever true;Never true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18107 | Quality of Life in Swallowing Disorders (SWAL-QOL) - completion date | SWALQOLCompltDate | Date the subject completed this questionnaire, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Date the subject completed this questionnaire, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Please write today's date here | Date or Date & Time | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-18 09:11:50.26 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Free-Form Entry |
|||||||||||
| C10275 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem indicator | SWALQOLSwllwProbInd | Scale assessing how true the following statement has been for the participant during the last month: Dealing with my swallowing problem is very difficult, as part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how difficult dealing with swallowing problem is, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Dealing with my swallowing problem is very difficult. | 1;2;3;4;5 | Very much true;Quite a bit true;Somewhat true;A little true;Not at all true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10286 | Quality of Life in Swallowing Disorders (SWAL-QOL) - gagging problem indicator | SWALQOLGagngProbInd | Scale assessing how true the following statement has been for the participant during the last month: Gagging. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences gagging problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Gagging | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10318 | Quality of Life in Swallowing Disorders (SWAL-QOL) - feeling exhausted indicator | SWALQOLFlngExhstdInd | Scale assessing how true the following statement has been for the participant during the last month: Feel exhausted? As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject feels exhausted, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Feel exhausted? | 1;2;3;4;5 | All of the time;Most of the time;Some of the time;A little of the time;None of the time | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10297 | Quality of Life in Swallowing Disorders (SWAL-QOL) - difficult find food indicator | SWALQOLDifcltFndFdInd | Scale assessing how true the following statement has been for the participant during the last month: It is difficult to find foods that I both like and can eat. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject feels finding food that subject both like and can eat is difficult, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | It is difficult to find foods that I both like and can eat. | 1;2;3;4;5 | Strongly agree;Agree;Uncertain;Disagree;Strongly disagree | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C17841 | Quality of Life in Swallowing Disorders (SWAL-QOL) - questionnaire general comment text | SWALQOLQuestGenComntTxt | Text regarding the subject's/participant's comments about the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire | Text regarding the subject's/participant's comments about the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnair | Comments | Alphanumeric |
Do you have any comments about this questionnaire? We welcome your comments about the questionnaire in general or about specific questions, especially any that were unclear or confusing to you |
No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points | 255 |
Free-Form Entry |
|||||||||
| C10308 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem impatient problem indicator | SWALQOLSwllwngProbImpttProbInd | Scale assessing how true the following statement has been for the participant during the last month: I get impatient dealing with my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how impatient the subject gets with swallowing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I get impatient dealing with my swallowing problem. | 1;2;3;4;5 | Always true;Often true;Sometimes true;Hardly ever true;Never true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18108 | Quality of Life in Swallowing Disorders (SWAL-QOL) - comment text | SWALQOLCmntTxt | Comment from the subject regarding this questionnaire, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Comment from the subject regarding this questionnaire, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Do you have any comments about this questionnaire? We welcome your comments about the questionnaire in general or about specific questions, especially any that were unclear or confusing to you. | Alphanumeric | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-18 09:11:50.26 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points | 255 |
Free-Form Entry |
||||||||||
| C10276 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem distraction indicator | SWALQOLSwllwProbDistrctnInd | Scale assessing how true the following statement has been for the participant during the last month: My swallowing problem is a major distraction in my life, as part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how distracting swallowing problem is, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | My swallowing problem is a major distraction in my life. | 1;2;3;4;5 | Very much true;Quite a bit true;Somewhat true;A little true;Not at all true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10287 | Quality of Life in Swallowing Disorders (SWAL-QOL) - drooling problem indicator | SWALQOLDrlngProbInd | Scale assessing how true the following statement has been for the participant during the last month: Drooling. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences drooling problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Drooling | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10319 | Quality of Life in Swallowing Disorders (SWAL-QOL) - intake feeding tube indicator | SWALQOLIntkFdngTubInd | Scale assessing how true the following statement has been for the participant during the last month: Do you now take any food or liquid through a feeding tube? As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Scale assessing how true the following statement has been for the participant during the last month: Do you now take any food or liquid through a feeding tube? As part of Quality of Life in Swallowing Disorders (SWAL-QOL | Do you now take any food or liquid through a feeding tube? | 1;2 | No;Yes | Numeric Values |
Circle one |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10298 | Quality of Life in Swallowing Disorders (SWAL-QOL) - people hard understanding problem indicator | SWALQOLPplHrdUndstndProbInd | Scale assessing how true the following statement has been for the participant during the last month: People have a hard time understanding me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject feels that people have a hard time understanding, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | People have a hard time understanding me. | 1;2;3;4;5 | All of the time;Most of the time;Some of the time;A little of the time;None of the time | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C17842 | Quality of Life in Swallowing Disorders (SWAL-QOL) - racial ethnic type | SWALQOLRacEthnicTyp | Race or ethnicity of the subject/participant | Race or ethnicity of the subject/participan | What is your main racial or ethnic group? | 1;2;3;4;5 | White or Caucasian, but not Hispanic or Latino;Black or African-American, but not Hispanic or Latino;Hispanic or Latino;Asian;Other | Numeric Values |
circle one |
No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10309 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem not go out indicator | SWALQOLSwllwngProbNtGoOtInd | Scale assessing how true the following statement has been for the participant during the last month: I do not go out to eat because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject doesn't go out to eat because of swallowing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I do not go out to eat because of my swallowing problem. | 1;2;3;4;5 | Strongly agree;Agree;Uncertain;Disagree;Strongly disagree | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10277 | Quality of Life in Swallowing Disorders (SWAL-QOL) - eating importance indicator | SWALQOLEatngImprtncInd | Scale assessing how true the following statement has been for the participant during the last month: Most days, I don't care if I eat or not, as part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how much the subject cares about eating, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Most days, I don't care if I eat or not. | 1;2;3;4;5 | Very much true;Quite a bit true;Somewhat true;A little true;Not at all true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10288 | Quality of Life in Swallowing Disorders (SWAL-QOL) - chewing problem indicator | SWALQOLChewngProbInd | Scale assessing how true the following statement has been for the participant during the last month: Problems Chewing. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences problem with chewing, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Problems Chewing | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10320 | Quality of Life in Swallowing Disorders (SWAL-QOL) - consistency texture food indicator | SWALQOLConsstncyTxtrFdInd | Category of consistency or texture of the food the participant has been eating most often in the last week. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates consistency or texture of the food subject has been eating in the last week, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Please circle the letter of the one description below that best describes the consistency or texture of the food you have been eating most often in the last week. | A;B;C;D;E | A;B;C;D;E | Alphanumeric |
Choose only one |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19499 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10299 | Quality of Life in Swallowing Disorders (SWAL-QOL) - difficult speak clear problem indicator | SWALQOLDifcltSpkClrProbInd | Scale assessing how true the following statement has been for the participant during the last month: It's been difficult for me to speak clearly. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject feels it's difficult to speak clearly, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | It's been difficult for me to speak clearly. | 1;2;3;4;5 | All of the time;Most of the time;Some of the time;A little of the time;None of the time | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18099 | Quality of Life in Swallowing Disorders (SWAL-QOL) - birth date | SWALQOLBrthDate | Date of the subject's birthday, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Date of the subject's birthday, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Please write in your date of birth here | Date or Date & Time | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-18 09:11:50.26 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Free-Form Entry |
|||||||||||
| C10310 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem hard social life indicator | SWALQOLSwllwProbHrdSoclLifInd | Scale assessing how true the following statement has been for the participant during the last month: My swallowing problem makes it hard to have a social life. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject's swallowing problem makes it hard to have a social life, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | My swallowing problem makes it hard to have a social life. | 1;2;3;4;5 | Strongly agree;Agree;Uncertain;Disagree;Strongly disagree | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10278 | Quality of Life in Swallowing Disorders (SWAL-QOL) - eating longer indicator | SWALQOLEatngLngrInd | Scale assessing how true the following statement has been for the participant during the last month: It takes me longer to eat than other people, as part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject takes how much longer to eat than other people, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | It takes me longer to eat than other people. | 1;2;3;4;5 | Very much true;Quite a bit true;Somewhat true;A little true;Not at all true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10289 | Quality of Life in Swallowing Disorders (SWAL-QOL) - excess saliva phlegm problem indicator | SWALQOLExcsSalvPhlgmProbInd | Scale assessing how true the following statement has been for the participant during the last month: Having excess saliva or phlegm. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences having excess saliva or phlegm, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Having excess saliva or phlegm | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10321 | Quality of Life in Swallowing Disorders (SWAL-QOL) - consistency liquid indicator | SWALQOLConsstncyLiqInd | Category of consistency or texture of the liquids participant has been drinking most often in the last week. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates consistency of the liquid subject has been drinking in the last week, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Please circle the letter of the one description below that best describes the consistency of liquids you have been drinking most often in the last week. | A;B;C;D;E | A;B;C;D;E | Alphanumeric |
Choose only one |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19500 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10300 | Quality of Life in Swallowing Disorders (SWAL-QOL) - fear choke food problem indicator | SWALQOLFrChokFdProbInd | Scale assessing how true the following statement has been for the participant during the last month: I fear I may start choking when I eat food. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject feels fear of choking on food again, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I fear I amy start choking when I eat food. | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18100 | Quality of Life in Swallowing Disorders (SWAL-QOL) - age value | SWALQOLAgVal | Age of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Age of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | What is your age today? | Numeric Values | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-18 09:11:50.26 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Free-Form Entry |
|||||||||||
| C10311 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem changed activities indicator | SWALQOLSwllwngProbChngdActInd | Scale assessing how true the following statement has been for the participant during the last month: My usual work or leisure activities have changed because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject's work or leisure activities have changed because of swallowing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | My usual work or leisure activities have changed because of my swallowing problem. | 1;2;3;4;5 | Strongly agree;Agree;Uncertain;Disagree;Strongly disagree | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10279 | Quality of Life in Swallowing Disorders (SWAL-QOL) - rare realization hunger indicator | SWALQOLRarRealztnHugrInd | Scale assessing how true the following statement has been for the participant during the last month: I'm rarely hungry anymore, as part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how rarely subject feels hungry, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I'm rarely hungry anymore. | 1;2;3;4;5 | Very much true;Quite a bit true;Somewhat true;A little true;Not at all true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10290 | Quality of Life in Swallowing Disorders (SWAL-QOL) - clear throat problem indicator | SWALQOLClrThrtProbInd | Scale assessing how true the following statement has been for the participant during the last month: Having to clear your throat. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences having to clear throat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Having to clear your throat | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10322 | Quality of Life in Swallowing Disorders (SWAL-QOL) - general health indicator | SWALQOLGenrlHlthInd | Scale assessing the general health of the participant. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates the subject's general health condition, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | In general, would you say your health is | 1;2;3;4;5 | Poor;Fair;Good;Very Good;Excellent | Numeric Values |
Circle one |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10301 | Quality of Life in Swallowing Disorders (SWAL-QOL) - worry pneumonia problem indicator | SWALQOLWryPnemnProbInd | Scale assessing how true the following statement has been for the participant during the last month: I worry about getting pneumonia. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject fear of getting pneumonia, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I worry about getting pneumonia. | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18101 | Quality of Life in Swallowing Disorders (SWAL-QOL) - gender indicator | SWALQOLGendrInd | Gender of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Gender of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Are you | 1;2 | 1;2 | Numeric Values | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-18 09:11:50.26 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
|||||||||
| C10312 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem enjoyable social indicator | SWALQOLSwllwngProbEnjblSoclInd | Scale assessing how true the following statement has been for the participant during the last month: Social gatherings (like holidays or get-togethers) are not enjoyable because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates subject no longer enjoys social gatherings because of swallowing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Social gatherings (like holidays or get-togethers) are not enjoyable because of my swallowing problem. | 1;2;3;4;5 | Strongly agree;Agree;Uncertain;Disagree;Strongly disagree | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10280 | Quality of Life in Swallowing Disorders (SWAL-QOL) - long eating period indicator | SWALQOLLngEatngPerdInd | Scale assessing how true the following statement has been for the participant during the last month: It takes me forever to eat a meal. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how much longer subject to eat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | It takes me forever to eat a meal. | 1;2;3;4;5 | Very much true;Quite a bit true;Somewhat true;A little true;Not at all true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10291 | Quality of Life in Swallowing Disorders (SWAL-QOL) - food sticking throat problem indicator | SWALQOLFdStckngThrtProbInd | Scale assessing how true the following statement has been for the participant during the last month: Food sticking in your throat. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences food sticking to throat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Food sticking in your throat | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C17833 | Quality of Life in Swallowing Disorders (SWAL-QOL) - questionnaire help indicator | SWALQOLQuestHelpInd | Indicator of whether the subject/participant received help filling out the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire | Indicator of whether the subject/participant received help filling out the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnair | Did anybody help you complete this questionnaire? | 1;2 | No, I did it myself;Yes, someone helped me fill it out | Numeric Values |
circle one |
No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10302 | Quality of Life in Swallowing Disorders (SWAL-QOL) - fear choke liquid problem indicator | SWALQOLFrChokLiqProbInd | Scale assessing how true the following statement has been for the participant during the last month: I am afraid of choking when I drink liquids. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject fears choking on liquid again, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I am afraid of choking when I drink liquids. | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18102 | Quality of Life in Swallowing Disorders (SWAL-QOL) - race indicator | SWALQOLRcInd | Racial group of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Racial group of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | What is your main racial or ethnic group? | 1;2;3;4;5 | 1;2;3;4;5 | Numeric Values | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-18 09:11:50.26 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
|||||||||
| C10313 | Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem changed family friends role indicator | SWALQOLSwllwngProbChngdRolInd | Scale assessing how true the following statement has been for the participant during the last month: My role with family and friends has changed because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Scale assessing how true the following statement has been for the participant during the last month: My role with family and friends has changed because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL | My role with family and friends has changed because of my swallowing problem. | 1;2;3;4;5 | Strongly agree;Agree;Uncertain;Disagree;Strongly disagree | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10281 | Quality of Life in Swallowing Disorders (SWAL-QOL) - eating enjoyment indicator | SWALQOLEatngEnjmntInd | Scale assessing how true the following statement has been for the participant during the last month: I don't enjoy eating anymore. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how much subject does not enjoy eating, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I don't enjoy eating anymore. | 1;2;3;4;5 | Very much true;Quite a bit true;Somewhat true;A little true;Not at all true | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10292 | Quality of Life in Swallowing Disorders (SWAL-QOL) - food sticking mouth problem indicator | SWALQOLFdStckngMthProbInd | Scale assessing how true the following statement has been for the participant during the last month: Food sticking in your mouth. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences food sticking to mouth, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Food sticking in your mouth | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C17834 | Quality of Life in Swallowing Disorders (SWAL-QOL) - age number | SWALQOLAgeNum | Age of subject/participant | Age of subject/participan | What is your age today? | Numeric Values | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Free-Form Entry |
|||||||||||
| C10303 | Quality of Life in Swallowing Disorders (SWAL-QOL) - unsure when choke problem indicator | SWALQOLUnsrWhnChokProbInd | Scale assessing how true the following statement has been for the participant during the last month: I never know when I am going to choke. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject fears of not knowing when subject will choking again, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | I never know when I am going to choke. | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18103 | Quality of Life in Swallowing Disorders (SWAL-QOL) - education scale | SWALQOLEduInd | Education level of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Education level of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | What is the highest year of school or collge you have ever completed? | 1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;16+ | 1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;16+ | Alphanumeric | No references available | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-18 09:11:50.26 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
|||||||||
| C10314 | Quality of Life in Swallowing Disorders (SWAL-QOL) - feeling weak indicator | SWALQOLFeelngWkInd | Scale assessing how true the following statement has been for the participant during the last month: Feel weak? As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject feels weak, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Feel weak? | 1;2;3;4;5 | All of the time;Most of the time;Some of the time;A little of the time;None of the time | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C10282 | Quality of Life in Swallowing Disorders (SWAL-QOL) - coughing problem indicator | SWALQOLCoughngProbInd | Scale assessing how true the following statement has been for the participant during the last month: Coughing. As part of Quality of Life in Swallowing Disorders (SWAL-QOL) | Indicates how often subject experiences the coughing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) | Coughing | 1;2;3;4;5 | Almost always;Often;Sometimes;Hardly ever;Never | Numeric Values |
Circle one number on each line |
Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 | Adult | NeuroRehab Supplemental-Highly Recommended | 3.00 | 2013-07-22 16:57:17.79 | Quality of Life in Swallowing Disorders (SWAL-QOL) | Dysphagia | Outcomes and End Points |
Single Pre-Defined Value Selected |
