CDE Detailed Report

Disease: content
Subdomain Name: Therapies
CRF: welcome

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
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
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
CSV