CDE Detailed Report
Disease: Mitochondrial Disease
Subdomain Name: Quality of Life/Patient Reported Outcomes
CRF: 12-Item Short Form Health Survey (SF-12)
Displaying 1 - 26 of 26
Subdomain Name: Quality of Life/Patient Reported Outcomes
CRF: 12-Item Short Form Health Survey (SF-12)
Displaying 1 - 26 of 26
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C08522 | 36-item Short Form Health Survey (SF-36) - Pain interfere work score | SF36PainInterfWrkScore | Score of bodily pain interfering with work (in home and outside) during the past 4 weeks as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | Score of interfered work (in home and outside) by bodily pain during the past 4 weeks as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | During the past 4 weeks how much did pain interfere with your normal work (including both outside the home and housework)? | 1;2;3;4;5 | Not at all;A little bit;Moderately;Quite a bit;Extremely | Numeric Values | SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52346 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Times downhearted depressed scale | SF12TimesDownDepressedScale | Scale of times feeling downhearted and depressed during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scale of times feeling downhearted and depressed during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | How much of the time during the past 4 weeks: Have you felt downhearted and depressed? | 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 |
Text before question group: These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C17397 | Visit number | VisitNum | The numeric value associated with a particular assessment/examination of a participant/subject on a study | The numeric value associated with a particular assessment/examination of a participant/subject on a study | Visit No. | Numeric Values | Adult | Exploratory | 1.00 | 2012-12-20 00:00:00.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
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| C52347 | 12-item Short Form Health Survey Version 2 (SF-12v2) -Role Emotional Raw Score | SF12RoleEmotinalRawScore | Raw score of role emotional (RE) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of role emotional (RE) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Role Emotional Raw Score | Numeric Values |
Items 3a+3b/ possible raw scale range=8 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 10:16:55.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
2 | 10 | ||||||||
| C17409 | Visit date | VisitDate | Date of interview or visit (actually the date when data in the form were captured) | Date of interview or visit | Visit Date | Date or Date & Time | Adult | Exploratory | 3.00 | 2013-06-21 00:00:00.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
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| C52348 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Vitality Raw Score | SF12VitalityRawScore | Raw score of vitality (VT) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of vitality (VT) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Vitality Raw Score | Numeric Values |
Items 2a+2b/ possible raw scale range=4 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 10:19:14.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
1 | 5 | ||||||||
| C19247 | Subject ID | SubIDNam | Subject identification ID | Subject identification ID | Participant No. | Alphanumeric | Adult | Exploratory | 1.00 | 2014-06-05 13:10:49.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52349 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Interfering social activties physical emotional scale | SF12InterfSocPhyEmotScale | Scale of interfered normal social activities due to physical and emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scale of interfered normal social activities due to physical and emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | During the past 4 weeks, how much of the time has your physicalhealth of emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? | 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 | SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52339 | Subject initial text | SubjectInitialTxt | The free-text field related to the initials of the subject | The free-text field related to the initials of the subjec | Initials | Alphanumeric | Adult | Exploratory | 1.00 | 2016-12-04 21:30:04.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points | 3 |
Free-Form Entry |
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| C52350 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Role Physical Raw Score | SF12RolePhysRawScore | Raw score of role physical (RP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of role physical (RP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Role Physical Raw Score | Numeric Values |
Items 3a+3b/ possible raw scale range=8 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 10:55:01.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
2 | 10 | ||||||||
| C52340 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Less accomplished physical health scale | SF12LesAccompPhyHlthScale | Scale for surveyee-reported less accomplishment as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scale for surveyee-reported less accomplishment as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | During the past 4 weeks, have you: Accomplished less than you would like? | 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 |
Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52351 | 12-item Short Form Health Survey Version 2 (SF-12v2) -Social Functioning Raw Score | SF12SocialFunctRawScore | Raw score of soocial functioning (SF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of soocial functioning (SF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Social Function Raw Score | Numeric Values |
Items 2a+2b/ possible raw scale range=4 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 10:56:09.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
1 | 5 | ||||||||
| C52341 | 12-item Short Form Health Survey Version 2 (SF-12v2)- Limited work activities physical health scale | SF12LmtWrkActPhyHlthScale | Scale for surveyee-reported limited work or activities as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scale for surveyee-reported limited work or activities as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | During the past 4 weeks, you: Were limited in the kind of work or other activities? | 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 |
Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52352 | 12-item Short Form Health Survey Version 2 (SF-12v2) -Mental Health Raw Score | SF12MentalHealthRawScore | Raw score of mental health (MH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of mental health (MH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Mental Health Raw Score | Numeric Values |
Items 3a+3b/ possible raw scale range=8 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 10:56:58.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
2 | 10 | ||||||||
| C06000 | Site identifier number | SiteIDNum | Unique identification number given to the study site to distinguish the location where data is recorded | Unique identification number given to the study site to distinguish the location where data is recorde | Site No. | Alphanumeric | Adult | Exploratory | 3.00 | 2013-07-17 09:26:36.973 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points | 255 |
Free-Form Entry |
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| C52342 | 12-item Short Form Health Survey Version 2 (SF-12v2)- Less accomplished emotional problems scale | SF12LesAccompEmotProbScale | Scale for surveyee-reported less accomplishment as a result of emotional problems, as part of version2.0 of 12-item Short Form Health Survey (SF-12) | Scale for surveyee-reported less accomplishment as a result of emotional problems, as part of version2.0 of 12-item Short Form Health Survey (SF-12) | During the past 4 weeks, have you: Accomplished less than you would like? | 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 |
"Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? " |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52353 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Bodily Pain Raw Score | SF12BodilyPainRawScore | Raw score of bodily pain (BP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of bodily pain (BP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Bodily Pain Raw Score | Numeric Values |
Items 2a+2b/ possible raw scale range=4 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 11:04:16.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
1 | 5 | ||||||||
| C08500 | 36-item Short Form Health Survey (SF-36) - General health score | SF36GenHlthScore | Score of surveyee-reported general health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | Score of surveyee-reported general health as a part of version 1.0 of 36-item Short Form Health Survey (SF-36) | In general, would you say your health is: | 1;2;3;4;5 | Excellent;Very good;Good;Fair;Poor | Numeric Values | SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52343 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Work not carefully emotional problem scale | SF12WkNotCarefulEmotProbScale | Scale for surveyee-reported doing work or other activities not as carefully as usual as a result of emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scale for surveyee-reported doing work or other activities not as carefully as usual as a result of emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | During the past 4 weeks, you: did work or other activities less carefully than usual? | 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 |
Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 16:57:17.79 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52354 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Physical Functioning Raw Score | SF12PhysFunctRawScore | Raw score of physical functioning (PF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of physical functioning (PF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Physical Functions Raw Score | Numeric Values |
Items 2a (SF36HlthLmtModActScore)+2b/ possible raw scale range=4 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 11:04:52.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
2 | 6 | ||||||||
| C08504 | 36-item Short Form Health Survey (SF-36) - Health limited moderate activities score | SF36HlthLmtModActScore | Score of surveyee-reported limited moderate activities due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | Score of surveyee-reported limited moderate activities due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | Moderate activite, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf? | 1;2;3 | Yes, limited a lot;Yes, limited a little;No, not limited at all | Numeric Values |
The following questions are about activities you might do during a typical day. Does your health now limit you in these activites? If so, how much? |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52344 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Times calm peaceful scale | SF12TimesCalmPcfulScale | Scale of times feeling calm and peaceful during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scale of times feeling calm and peaceful during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | How much of the time during the past 4 weeks: Have you felt calm and peaceful? | 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 |
Text before question group: These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 16:57:17.79 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52355 | 12-item Short Form Health Survey Version 2 (SF-12v2) - General Health Raw Score | SF12GeneralHealthRawScore | Raw score of general health (GH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Raw score of general health (GH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | General Health Raw Score | Numeric Values |
Items 2a+2b/ possible raw scale range=4 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 11:05:33.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
1 | 5 | ||||||||
| C08507 | 36-item Short Form Health Survey (SF-36) - Health limited climbing one stair score | SF36HlthLmtClmb1StairScore | Score of surveyee-reported limited climbing one flight of stairs due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | Score of surveyee-reported limited climbing one flight of stair due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | Climbing several flights for stairs | 1;2;3 | Yes, limited a lot;Yes, limited a little;No, not limited at all | Numeric Values |
The following questions are about activities you might do during a typical day. Does your health now limit you in these activites? If so, how much? |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52345 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Times energy scale | SF12TimesEnrgyScale | Scale of times having a lot of energy during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scale of times having a lot of energy during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | How much of the time during the past 4 weeks: Did you have a lot of energy? | 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 |
Text before question group: These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks... |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 3.00 | 2013-07-22 12:47:20.623 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C52356 | 12-item Short Form Health Survey Version 2 (SF-12v2) -Scaled score | SF12ScaledScore | Scaled score, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scaled score, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | Scaled Score | Numeric Values |
[(acutal raw score-lowest posssible raw score)/possible raw scale range]*100 |
SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. | Adult | Exploratory | 1.00 | 2016-12-30 11:06:01.0 | 12-Item Short Form Health Survey (SF-12) | Quality of Life/Patient Reported Outcomes | Outcomes and End Points |
Free-Form Entry |
0 | 100 |
