CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: History of Disease/Injury Event
CRF: Return to Play

Displaying 1 - 14 of 14
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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C55631 No activity rehabilitation completed date NoActiveRehabStageCompDate The date the participant/subject completed the no activity (symptom limited physical and cognitive rest) rehabilitation stage as part of the Return to Play case report form The date the participant/subject completed the no activity (symptom limited physical and cognitive rest) rehabilitation stage as part of the Return to Play case report form No activity (symptom limited physical and cognitive rest) Date or Date & Time Adult;Pediatric Supplemental 1.00 2017-05-18 10:15:47.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C55632 Light aerobic exercise reahbilitation stage completed date LghtAeroExercRehabStagCompDate The date the participant/subject completed the light aerobic exercise (walking, swimming or stationary cycling keeping intensity <70% maximum permitted heart rate; no resistance training) rehabilitation stage as part of the Return to Play case report form The date the participant/subject completed the light aerobic exercise (walking, swimming or stationary cycling keeping intensity <70% maximum permitted heart rate; no resistance training) rehabilitation stage as part of the Return to Play case report form Light aerobic exercise (walking, swimming or stationary cycling keeping intensity <70% maximum permitted heart rate; no resistance training) Date or Date & Time Adult;Pediatric Supplemental 1.00 2017-05-18 10:15:47.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C55633 Sport-specific excercise rehabilitation stage completed date SprtSpecExerRehabStagCompDate The date the participant/subject completed the sport-specific exercise (skating drills in ice hockey, running drills in soccer; no head impact activities) rehabilitation stage as part of the Return to Play case report form The date the participant/subject completed the sport-specific exercise (skating drills in ice hockey, running drills in soccer; no head impact activities) rehabilitation stage as part of the Return to Play case report form Sport-specific exercise (skating drills in ice hockey, running drills in soccer; no head impact activities) Date or Date & Time Adult;Pediatric Supplemental 1.00 2017-05-18 10:15:47.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C05400 Injury date time InjDateTime Date (and time, if applicable and known) of injury Date (and time, if applicable and known) of injury Injury Date/Time Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C55634 Full-contact practice completed date FullContactCompDate The date the participant/subject completed the full contact (following medical clearance participate in normal training activities) rehabilitation stage as part of the Return to Play case report form The date the participant/subject completed the full contact (following medical clearance participate in normal training activities) rehabilitation stage as part of the Return to Play case report form Full-contact practice (following medical clearance participate in normal training activities) Date or Date & Time Adult;Pediatric Supplemental 1.00 2017-05-18 10:15:47.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C15910 Assessment date and time AssessDateTime The date of participant's injury The date of participant's injury Assessment Date/Time Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C55635 Non-contact rehabilitation stage complete date NonContactRehabStageCompDate The date the participant/subject completed the Non-contact (progression to more complex training drills, eg passing drills in football and ice hockey; may start progressive resistance training) rehabilitation stage as part of the Return to play CRF The date the participant/subject completed the Non-contact (progression to more complex training drills, eg passing drills in football and ice hockey; may start progressive resistance training) rehabilitation stage as part of the Return to play CRF Non-contact training drills (progression to more complex training drills, eg passing drills in football and ice hockey; may start progressive resistance training) Date or Date & Time Adult;Pediatric Supplemental 1.00 2017-05-18 10:15:47.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C17402 Site name SiteName The name of the site for the study The name of the site for the study Site Name Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events 255

Free-Form Entry

C55636 Return to play rehabilitation stage complete date RetrnPlaytRehabStageCompDate The date the participant/subject completed the return to play (normal game play) rehabilitation stage as part of the Return to play CRF The date the participant/subject completed the return to play (normal game play) rehabilitation stage as part of the Return to play CRF Return to play (normal game play) Date or Date & Time Adult;Pediatric Supplemental 1.00 2017-05-18 10:15:47.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C19247 Subject ID SubIDNam Subject identification ID Subject identification ID Subject ID Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-05 13:10:49.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events 255

Free-Form Entry

C19256 Study protocol name StudyProtocolName Name of study protocol Name of study protocol Study Name/ID pre-filled Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-05 16:38:14.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events 4000

Free-Form Entry

C55628 Return to sport indicator ReturnSportInd The indicator if the participant/subject return to play sport as part of the Return to Play case report form The indicator if the participant/subject return to play sport as part of the Return to Play case report form Did participant return to sport No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-18 08:50:23.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55629 Same sport indicator SameSportInd Indicator if the participant/subject returned to the same sport, as part of the Return to Play case report form Indicator if the participant/subject returned to the same sport, as part of the Return to Play case report form Did participant return to same sport? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-18 10:02:09.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C55630 Same level of activity indicator SameLvlActiveInd The indicator specificying if the participant/subject returned to the same level of activity as part of the Return to Play case report form The indicator specificying if the participant/subject returned to the same level of activity as part of the Return to Play case report form Did participant teturn to same level of activity No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-18 10:06:25.0 Return to Play History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

CSV