CDE Detailed Report
Disease: Spinal Cord Injury
Subdomain Name: Therapies
CRF: Falls Diary
Displaying 1 - 15 of 15
Subdomain Name: Therapies
CRF: Falls Diary
Displaying 1 - 15 of 15
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C58652 | Fall record time AM PM category | FallRecordTimeAmPmCat | Category of the part of the day in which the time of the subject/participant's fall occurred | Category of the part of the day in which the time of the subject/participant's fall occurre | Time of Day | am;PM | am;PM | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2019-11-20 13:35:23.0 | Falls Diary | Therapies | Treatment/Intervention Data |
Single Pre-Defined Value Selected |
||||||||||
| C21642 | Fall details not walking type | FallDetNotWalkTyp | Details of the participant's/subject's position if fall recorded in Falls Diary occurred when not walking | Details of the participant's/subject's position if fall recorded in Falls Diary occurred when not walkin | If you fell while sitting, transferring or moving in your wheelchair, please check all statements that apply: | I fell while moving my wheelchair;I fell while transferring into the shower/bath;I fell while transferring to or from my wheelchair;When I fell, I was (check all that apply) | I fell while moving my wheelchair;I fell while transferring into the shower/bath;I fell while transferring to or from my wheelchair;When I fell, I was (check all that apply) | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Multiple Pre-Defined Values Selected |
||||||||||
| C10630 | Diary day near falls experienced number | DiaryFallDailyCt | Number of near falls the participant/subject experienced on a particular day | Number of falls that the participant/subject experienced on the day of the diary as part of the Clinical Milestones and Events questionnaire | Near Falls | Numeric Values |
Record the number of near falls on days when "Near Falls" is checked/chosen |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Free-Form Entry |
|||||||||||
| C21643 | Fall details specify type | FallDetSpecTyp | Description of what the participant/subject was doing when the fall recorded in Falls Diary occurred when not walking | Description of what the participant/subject was doing when the fall recorded in Falls Diary occurred when not walkin | When I fell, I was | Being helped by someone else;Using equipment such as a transfer board, hoyer lift, etc.;Using other equipment | Being helped by someone else;Using equipment such as a transfer board, hoyer lift, etc.;Using other equipment | Alphanumeric |
(check all that apply) |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Multiple Pre-Defined Values Selected |
|||||||||
| C19144 | Activity description | ActivityDescription | Description of activity | Description of activity | Activity: | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-29 10:46:32.0 | Falls Diary | Therapies | Treatment/Intervention Data | 4000 |
Free-Form Entry |
|||||||||||
| C21634 | Diary day falls date | DiaryDayFallsDate | Date in the diary when the participant/subject recorded a fall | Date in the diary when the participant/subject recorded a fal | Date | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Free-Form Entry |
|||||||||||
| C21635 | Fall record date and time | FallRecDatTime | Date and time for each fall recorded in the falls diary by the participant/subject | Date and time for each fall recorded in the falls diary by the participant/subjec | Date; Time of Day | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Free-Form Entry |
|||||||||||
| C21636 | Fall details location text | FallDetLocTxt | Location of the fall the participant/subject experienced recorded in the Falls Diary | Location of the fall the participant/subject experienced recorded in the Falls Diar | Location: | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data | 255 |
Free-Form Entry |
|||||||||||
| C21637 | Fall details footwear type | FallDetFootwrTyp | Type of footwear the participant/subject was wearing when the fall recorded in the Falls Diary occurred | Type of footwear the participant/subject was wearing when the fall recorded in the Falls Diary occurre | If you fell while walking, were you wearing any of the following | Leg braces;Only socks;Other, please specify;Socks and shoes/sneakers | Leg braces;Only socks;Other, please specify;Socks and shoes/sneakers | Alphanumeric |
check all that apply |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Multiple Pre-Defined Values Selected |
|||||||||
| C21638 | Fall details footwear specify text | FallDetFootwrSpecfyTxt | The free-text field to specify the type of other footwear worn when the fall recorded in the Falls Diary occurred | The free-text field to specify the type of other footwear worn when the fall recorded in the Falls Diary occurre | Other, please describe | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Falls Diary | Therapies | Treatment/Intervention Data | 255 |
Free-Form Entry |
|||||||||||
| C21639 | Fall details assistive device type | FallDetAssistDevTyp | Type of assistive device(s) the participant/subject was using when the fall recorded in the Falls Diary occurred | Type of assistive device(s) the participant/subject was using when the fall recorded in the Falls Diary occurre | If you fell while walking, were you using an assistive device | Cane;One crutch;Other, please specify;Two crutches;Walker | Cane;One crutch;Other, please specify;Two crutches;Walker | Alphanumeric |
check all that apply |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Multiple Pre-Defined Values Selected |
|||||||||
| C21640 | Fall details assistive device specify text | FallDetAssisDevSpecfyTxt | The free-text field to specify the other type of assistive device used when the fall recorded in the Falls Diary occurred | The free-text field to specify the other type of assistive device used when the fall recorded in the Falls Diary occurre | Other, please specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Falls Diary | Therapies | Treatment/Intervention Data | 255 |
Free-Form Entry |
|||||||||||
| C10628 | Diary day falls status | DiaryFallsStatus | Describes whether the participant/subject experienced falls on a particular day | The status to report occurrence of fall(s) that the participant/subject experienced on the day of the diary as part of the Clinical Milestones and Events questionnaire | Falls Data Collection Grid | No Falls;Near Falls;Falls | No Falls;Near Falls;Falls | Alphanumeric |
If a near fall or falls is checked, indicate the number. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Single Pre-Defined Value Selected |
|||||||||
| C21641 | Fall details injury sustained test | FallDetInjSustTxt | Description of the injuries sustained when the fall recorded in the Falls Diary occurred | Description of the injuries sustained when the fall recorded in the Falls Diary occurre | Injuries sustained: | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data | 255 |
Free-Form Entry |
|||||||||||
| C10629 | Diary day falls experienced number | DiaryNearFallDailyCt | Number of falls the participant/subject experienced on a particular day | Number of near falls that the participant/subject experienced on the day of the diary as part of the Clinical Milestones and Events questionnaire | Falls | Numeric Values |
Record the number of falls on days when "Falls" is checked/chosen |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Falls Diary | Therapies | Treatment/Intervention Data |
Free-Form Entry |
