CDE Detailed Report

Disease: Sport Related Concussion
Subdomain Name: Therapies
CRF: Treatments and Interventions

Displaying 1 - 43 of 43
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
C55881 Vestibular oculomotor therapy text VstblrOclmtrThrpyTxt The free-text field to specify vestibular/oculomotor therapies used by the patient The free-text field to specify vestibular/oculomotor therapies used by the patien Yes, specify type of treatment Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:15:50.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55292 Concurrent injury treatment after concussion indicator ConcurrInjTxAfterConcussInd The indicator related to whether there was concurrent injury treatment following a concussion The indicator related to whether there was concurrent injury treatment following a concussion Concurrent injury treatment No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55894 Medication over the counter indicator MedicationOTCInd Indicator relating to whether or not the patient used OTC medication Indicator relating to whether or not the patient used OTC medicatio Medications: OTC No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:58:29.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55806 Academic accommodations text AcademicAccmmdtnsTxt Type of academic accommodations used by the patient Type of academic accommodations used by the patien Type of Accommodation (s): Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:29:31.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55882 Vestibular oculomotor therapies start date VstblrOclmtrThrpyStrtDate The start date of the patient's vestibular/oculomotor therapies The start date of the patient's vestibular/oculomotor therapie If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:34:27.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55293 Concurrent injury treatment after concussion specify text ConcurrInjTreatAftConcussSpTxt Free-text field to specify the type of concurrent injury treatment following a concussion Free-text field to specify the type of concurrent injury treatment following a concussion Yes, specify type of treatment Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data 500

Free-Form Entry

C55895 Medication otc start date MedicationOTCStrtDate The start date of the patient's use of OTC medication The start date of the patient's use of OTC medicatio If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:59:45.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55807 Cognitive therapy indicator CognitiveTherapyInd Indicator related to whether the patient used cognitive therapy or not Indicator related to whether the patient used cognitive therapy or no Cognitive therapy No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:30:46.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55283 Concussion education training performed indicator ConcussEduTrainPerformdInd Indicator related to whether concussion education or training was performed Indicator related to whether concussion education or training was performed Was concussion educational training/awareness done? No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55883 Vision therapy neuro optometry indicator VsnThrpyNroOptmtryInd Indicator related to whether or not the patient used vision therapy/neuro-optometry Indicator related to whether or not the patient used vision therapy/neuro-optometr Vision Therapy/Neuro-Optometry No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:36:06.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55294 Concurrent injury treatment after concussion duration ConcurrInjTreatAftConcussDur The element related to the duration of concurrent injury treatment following a concussion The element related to the duration of concurrent injury treatment following a concussion Length of time (minutes) Numeric Values

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55808 Cognitive therapy session number CognitiveTherapySessionNum Number of sessions of cognitive therapy that the patient attended Number of sessions of cognitive therapy that the patient attende Yes, indicate number of sessions Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:33:28.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55284 Concussion education training text ConcussEduTrainTxt Free-text field to specify the type of concussion education or training that was performed Free-text field to specify the type of concussion education or training that was performed Yes, specify type of education Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55884 Vision therapy neuro optometry start date VsnThrpyNroOptmtryStrtDate The start date of the patient's Vision therapy/neuro-optometry The start date of the patient's Vision therapy/neuro-optometr If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:38:11.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55295 Concurrent injury treatment after concussion start date ConcrrInjTreatAftCncssStrtDate The date that concurrent injury treatment following a concussion began The date that concurrent injury treatment following a concussion began If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55816 Cognitive therapy start date CognitiveTherapyStrtDate Start date of patient's cognitive therapy Start date of patient's cognitive therap If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:38:44.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55285 Concussion education training start date ConcussEduTrainStrtDate Date when concussion education or training was started Date when concussion education or training was started If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55885 Pharmacological therapy indicator PharmacologicalTherapyInd Indicator related to whether the patient used pharmacological therapies or not Indicator related to whether the patient used pharmacological therapies or no Pharmacological Therapies No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:42:19.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55799 Work accommodation indicator WorkAccmmdtnInd Indicator related to whether patient received some type of work accommodation Indicator related to whether patient received some type of work accommodatio Work Accommodation No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 10:55:41.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55819 Behavioral therapy management indicator BhvrlThrpyMngmntInd Indicator related to whether of not the patient used behavioral therapy/management Indicator related to whether of not the patient used behavioral therapy/managemen Behavioral Therapy/Management No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:56:13.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55286 Physical rest indicator PhysicalRestInd The element related to whether there was physical rest The element related to whether there was physical rest Was there physical rest? No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55886 Pharmacological therapy text PharmacologicalTherapyTxt Type of pharmacological therapy used by the patient Type of pharmacological therapy used by the patien Yes, specify type of treatment Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:44:33.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55800 Work accommodation duration WorkAccmmdatnDur Duration of time in days that work accommodation was received by the patient Duration of time in days that work accommodation was received by the patien Yes, indicate duration Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:03:41.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55820 Behavioral therapy management start date BhvrlThrpyMngmntStrtDate Start date of patient's behavioral therapy/management Start date of patient's behavioral therapy/managemen If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:58:19.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55287 Physical rest after concussion duration PhysicalRestAfterConcussDur Duration of physical rest following a concussion Duration of physical rest following a concussion Yes, indicate duration Numeric Values

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55887 Pharmacological therapy start date PhrmclgclThrpyStrtDate The start date of the patient's use of pharmacological therapies The start date of the patient's use of pharmacological therapie If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:48:10.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55801 Work accommodation text WorkAccmmdtnTxt Type of work accommodation that was used by the patient Type of work accommodation that was used by the patien If yes, date initiated: Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:06:56.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55847 Emotional psychological therapies psychotherapy indicator EmoPsychThrpsPsychthrpyInd Indicator related to whether emotional/psychological therapies/psychotherapy was used by the patient Indicator related to whether emotional/psychological therapies/psychotherapy was used by the patien Emotional/Psychological therapies/Psychotherapy No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 12:53:32.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55288 Physical rest after concussion start date PhysclRestAfterConcussStrtDate Date when physical rest was started following a concussion Date when physical rest was started following a concussion If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55888 Exertion therapy indicator ExertionTherapyInd Indicator relating to whether or not the patient used exertion therapy Indicator relating to whether or not the patient used exertion therap Exertion Therapy No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:50:57.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55802 Work accommodation start date WorkAccmmdtnStrtDate The start date of patient's work accommodation The start date of patient's work accommodatio Type of Accommodation: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:13:19.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55853 Emotional psychological therapies psychotherapy session number EmoPsychThrpyPsychthrpySesnNum Describes the number of sessions of emotional/psychological therapies/psychotherapy the patient attended Describes the number of sessions of emotional/psychological therapies/psychotherapy the patient attende Yes, indicate number of sessions Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 12:57:18.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55289 Cognitive rest after concussion indicator CognitiveRestAfterConcussInd The element related to whether there was cognitive rest following a concussion The element related to whether there was cognitive rest following a concussion Cognitive Rest No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55889 Exertion therapy start date ExertionTherapyStrtDate The start date of the patient's exertion therapy The start date of the patient's exertion therap If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:52:55.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55803 Academic accommodations indicator AcademicAccmmdtnsInd Indicator related to the academic accommodation(s) used by the patient Indicator related to the academic accommodation(s) used by the patien Academic Accommodation(s) No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:17:31.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55857 Emotional psychological therapies psychotherapy start date EmoPsyThrpyPsychthrpyStrtDate Start date of patient's emotional/psychological therapies/psychotherapy Start date of patient's emotional/psychological therapies/psychotherap If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:00:09.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55290 Cognitive rest after concussion duration CognitiveRestAfterConcussDur Duration of cognitive rest following a concussion Duration of cognitive rest following a concussion Yes, indicate duration Numeric Values

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55891 Medication prescription indicator MedicationRxInd Indicator related to whether or not the patient used prescription medication or not Indicator related to whether or not the patient used prescription medication or no Medications: Rx No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:55:23.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55804 Academic accommodations duration AcademicAccmmdtnsDur Duration of the academic accommodation(s) used by the patient Duration of the academic accommodation(s) used by the patien Yes, indicate duration (days) Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:19:59.0 Treatments and Interventions Therapies Treatment/Intervention Data 255

Free-Form Entry

C55878 Vestibular oculomotor therapy indicator VstblrOclmtrThrpyInd Indicator related to whether vestibular/oculomotor therapies were used by the patient Indicator related to whether vestibular/oculomotor therapies were used by the patien Vestibular/Oculomotor Therapies No;Yes No;Yes Alphanumeric

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:12:58.0 Treatments and Interventions Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C55291 Cognitive rest after concussion start date CognRestAfterConcussStrtDate Date when cognitive rest was started following a concussion Date when cognitive rest was started following a concussion If yes, date initiated Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55892 Medication rx start date MedicationRxStrtDate The start date of the patient's use of Rx medication The start date of the patient's use of Rx medicatio If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 13:57:18.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

C55805 Academic accommodations start time AcademicAccmmdtnsStrtTime Start time/date that the patient began using academic accommodations Start time/date that the patient began using academic accommodation If yes, date initiated: Date or Date & Time

Please see the Data Dictionary for definitions for each of the data elements included in this CRF Module.

Adult;Pediatric Supplemental 1.00 2017-06-01 11:26:22.0 Treatments and Interventions Therapies Treatment/Intervention Data

Free-Form Entry

CSV