Sub-Domain: Additional Proposed Instruments
CRF: PhenX Toolkit: Quality of Life - Adult
CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (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 | Source | Form Set | Form | Field | Domain | CDASH Variable | CDASH Definition | CDASH Label | Controlled Terminology | Prompt | Essentiality | Question Text | CDASH imp guidance | SDTM IG target | csDSR | PhenX | Data Type | CRF Completion Inst | SDTMIG Target Var | SDTMIG Target Map | Codelist Name | PVs | Pre Pop Value | Query Display | List Style |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
C59259 | Activity with friend difficulty grade | ActvtyWFriendDifficultyGrade | Grade of difficulty doing activities with friends | Grade of difficulty doing activities with friends | I have trouble doing all of the activities with friends that I want to do | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:09:43.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 24 | ||||||||||||||||||||||||||
C59238 | Walk 15 minute difficulty grade | Walk15MinuteDiffGrade | Grade of difficulty the subject/participant has walking for 15 minutes | Grade of difficulty the subject/participant has walking for 15 minutes | Are you able to go for a walk of at least 15 minutes? | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 09:53:12.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 3 | ||||||||||||||||||||||||||
C59249 | Fatigue interfere start activity past 7 day status | FatigIntrfrStrtActvtPst7DyStat | Status over the past 7 days of the subject/participant's fatigue interfering with his or her ability to start activities | Status over the past 7 days of the subject/participant's fatigue interfering with his or her ability to start activities | During the past 7 days I have trouble starting things because I am tired | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:35:56.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 14 | ||||||||||||||||||||||||||
C59260 | Pain interfere daily activity past 7 day grade | PnIntrfrDlyActvtyPst7DyGrade | Grade of interference with daily activities due to pain over the past 7 days | Grade of interference with daily activities due to pain over the past 7 days | In the past 7 days how much did pain interfere with your day to day activities? | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:19:14.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 25 | ||||||||||||||||||||||||||
C59239 | Shop run errand difficulty grade | ShopRunErrandDiffGrade | Grade of difficulty the subject/participant has shopping and running errands | Grade of difficulty the subject/participant has shopping and running errands | Are you able to run errands and shop? | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 09:53:12.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 4 | ||||||||||||||||||||||||||
C59250 | Feel run down past 7 day average status | FeelRunDownPst7DyAvgStat | Status over the past 7 days of the subject/participant's average feeling of being run down | Status over the past 7 days of the subject/participant's average feeling of being run down | In the past 7 days how run-down did you feel on average? | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:35:56.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 15 | ||||||||||||||||||||||||||
C59261 | Pain interfere home work past 7 day grade | PnIntrfrHomeWorkPst7DyGrade | Grade of interference with work around home due to pain over the past 7 days | Grade of interference with work around home due to pain over the past 7 days | In the past 7 days how much did pain interfere with work around the home | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:19:14.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 26 | ||||||||||||||||||||||||||
C59240 | Fearful past 7 day frequency grade | FearfulPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant felt fearful | Grade of frequency over the past 7 days that the subject/participant felt fearful | In the past 7 days I felt fearful | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 5 | ||||||||||||||||||||||||||
C59251 | Feel fatigue past 7 day average status | FeelFatiguePst7DyAvgStat | Status over the past 7 days of the subject/participant's average feeling of fatigue | Status over the past 7 days of the subject/participant's average feeling of fatigue | In the past 7 days how fatigued were you on average? | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:35:56.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 16 | ||||||||||||||||||||||||||
C59262 | Pain interfere social activity past 7 day grade | PnIntrfrSoclActvtyPst7DyGrade | Grade of interference with social activities due to pain over the past 7 days | Grade of interference with social activities due to pain over the past 7 days | In the past 7 days how much did pain interfere with your ability to participate in social activities? | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:19:14.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 27 | ||||||||||||||||||||||||||
C59241 | Hard focus anything anxiety past 7 day frequency grade | HdFocAnyAnxPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant had difficulty focusing on anything but his or her anxiety | Grade of frequency over the past 7 days that the subject/participant had difficulty focusing on anything but his or her anxiety | In the past 7 days I found it hard to focus on anything other than my anxiety | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 6 | ||||||||||||||||||||||||||
C59252 | Sleep quality past 7 day grade | SleepQualtyPst7DyGrade | Grade of the subject/participant's sleep quality over the past 7 days | Grade of the subject/participant's sleep quality over the past 7 days | In the past 7 days my sleep quality was | Very Poor;Poor;Fair;Good;Very good | Very Poor;Poor;Fair;Good;Very good | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:56:01.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 17 | ||||||||||||||||||||||||||
C59263 | Pain interfere household chore past 7 day grade | PnIntrfrHshldChorPst7DyGrade | Grade of interference with household chores due to pain over the past 7 days | Grade of interference with household chores due to pain over the past 7 days | In the past 7 days how much did pain interfere with your household chores? | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:19:14.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 28 | ||||||||||||||||||||||||||
C59242 | Worry overwhelm past 7 day frequency grade | WorryOvrwhlmPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant was overwhelmed by his or her worries | Grade of frequency over the past 7 days that the subject/participant was overwhelmed by his or her worries | In the past 7 days my worries overwhelmed me | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 7 | ||||||||||||||||||||||||||
C59253 | Sleep refresh past 7 day grade | SleepRefreshPst7DyGrade | Grade of refreshing sleep over the past 7 days | Grade of refreshing sleep over the past 7 days | In the past 7 days my sleep was refreshing | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:00:57.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 18 | ||||||||||||||||||||||||||
C59243 | Feel uneasy past 7 day frequency grade | FeelUneasyPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant felt uneasy | Grade of frequency over the past 7 days that the subject/participant felt uneasy | In the past 7 days I felt uneasy | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 8 | ||||||||||||||||||||||||||
C59254 | Sleep problem past 7 day grade | SleepProblemPst7DyGrade | Grade of problems with sleep over the past 7 days | Grade of problems with sleep over the past 7 days | In the past 7 days I had a problem with my sleep | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:00:57.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 19 | ||||||||||||||||||||||||||
C59244 | Feel worthless past 7 day frequency grade | FeelWrthlssPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant felt worthless | Grade of frequency over the past 7 days that the subject/participant felt worthless | In the past 7 days I felt worthless | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 9 | ||||||||||||||||||||||||||
C59255 | Fall asleep difficult past 7 day grade | FallAslpDiffcltPst7DyGrade | Grade of difficulty falling asleep over the past 7 days | Grade of difficulty falling asleep over the past 7 days | In the past 7 days I had difficulty falling asleep | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:00:57.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 20 | ||||||||||||||||||||||||||
C59245 | Feel helpless past 7 day frequency grade | FeelHelplssPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant felt helpless | Grade of frequency over the past 7 days that the subject/participant felt helpless | In the past 7 days I felt helpless | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 10 | ||||||||||||||||||||||||||
C59256 | Leisure activity difficulty grade | LeisurAcivityDifficultyGrade | Grade of difficulty doing regular leisure activities | Grade of difficulty doing regular leisure activities | I have trouble doing all of my regular leisure activities with others | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:09:43.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 21 | ||||||||||||||||||||||||||
C59235 | Pain intensity average past 7 day scale | PainIntnstyAvgPst7DyScl | Scale of the subject/participant's average pain intensity over the past 7 days | Scale of the subject/participant's average pain intensity over the past 7 days | In the past 7 days how would you rate your pain on average? | 0;10;1;2;3;4;5;6;7;8;9 | No Pain;Worst pain imaginable;1;2;3;4;5;6;7;8;9 | Numeric Values | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-27 15:01:10.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Pediatric | 25 | ||||||||||||||||||||||||||
C59246 | Feel depressed past 7 day frequency grade | FeelDepressedPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant felt depressed | Grade of frequency over the past 7 days that the subject/participant felt depressed | In the past 7 days I felt depressed | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 11 | ||||||||||||||||||||||||||
C59257 | Family activity difficulty grade | FamilyAcivityDifficultyGrade | Grade of difficulty doing family activities | Grade of difficulty doing family activities | I have trouble doing all of the family activities that I want to do | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:09:43.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 22 | ||||||||||||||||||||||||||
C59236 | Do chore difficulty grade | DoChoreDifficultyGrade | Grade of difficulty the subject/participant has doing chores. | Grade of difficulty the subject/participant has doing chores. | Are you able to do chores such as vacuuming or yard work? | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 09:53:12.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 1 | ||||||||||||||||||||||||||
C59247 | Feel hopeless past 7 day frequency grade | FeelHopelssPst7DyFreqGrade | Grade of frequency over the past 7 days that the subject/participant felt hopeless | Grade of frequency over the past 7 days that the subject/participant felt hopeless | In the past 7 days I felt hopeless | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:10:17.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 12 | ||||||||||||||||||||||||||
C59258 | Work difficulty grade | WorkDifficultyGrade | Grade of difficulty doing usual work including work at home | Grade of difficulty doing usual work including work at home | I have trouble doing all of my usual work (include work at home) | Never;Rarely;Sometimes;Often;Always | Never;Rarely;Sometimes;Often;Always | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 11:09:43.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 23 | ||||||||||||||||||||||||||
C59237 | Use stairs normal pace difficulty grade | UseStairNrmlPacDiffGrade | Grade of difficulty the subject/participant has using stairs at a normal pace. | Grade of difficulty the subject/participant has using stairs at a normal pace. | Are you able to go up and down stairs at a normal pace | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Without any difficulty;With a little difficulty;With much difficulty;With some difficulty;Unable to do | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 09:53:12.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 2 | ||||||||||||||||||||||||||
C59248 | Feel fatigue past 7 day status | FeelFatiguePst7DyStat | Status over the past 7 days of the subject/participant's feelings of fatigue | Status over the past 7 days of the subject/participant's feelings of fatigue | During the past 7 days I feel fatigued | Not at all;A little bit;Somewhat;quite a bit;very much | Not at all;A little bit;Somewhat;quite a bit;very much | Alphanumeric | PhenX Protocol: Quality of Life - Adult (#221302) | Adult | Proposed | 1.00 | 2019-03-28 10:35:56.0 | PhenX Toolkit: Quality of Life - Adult | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Quality of Life - Adult | 13 |