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Text in black is part of the template used to create this document and is not under review. Please review the blue text; this text represents the changes made to the template that are specific to this QRS instrument. |
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This section is used for reference regarding the CRF data capture and to understand the alignment of the instrument to the SDTM QS domain. It also provides guidance on how the result variables (QSORRES, QSSTRESC, and QSSTRESN) should be populated.
QSTESTCD = "CRQ0101" QSTEST = "CRQ01-Feeling Emotional"
QSTESTCD = "CRQ0102" QSTEST = "CRQ01-Take Care of Basic Needs"
QSTESTCD = "CRQ0103" QSTEST = "CRQ01-Walking"
QSTESTCD = "CRQ0104" QSTEST = "CRQ01-Performing Chores"
QSTESTCD = "CRQ0105" QSTEST = "CRQ01-Participate in Social Activities"
QSORRES | QSSTRESC | QSSTRESN |
|---|---|---|
| Extremely short of breath | 1 | 1 |
| Very short of breath | 2 | 2 |
| Quite a bit short of breath | 3 | 3 |
| Moderate shortness of breath | 4 | 4 |
| Some shortness of breath | 5 | 5 |
| A little shortness of breath | 6 | 6 |
| Not at all short of breath | 7 | 7 |
| Not Done | 8 | 8 |
QSTESTCD = "CRQ0106" QSTEST = "CRQ01-Felt Frustrated or Impatient"
QSTESTCD = "CRQ0107" QSTEST = "CRQ01-Feeling of Fear or Panic"
QSTESTCD = "CRQ0109" QSTEST = "CRQ01-Embarrassed by Coughing"
QSTESTCD = "CRQ0112" QSTEST = "CRQ01-Feel Upset, Worried or Depressed"
QSTESTCD = "CRQ0115" QSTEST = "CRQ01-Felt Low in Energy"
QSTESTCD = "CRQ0116" QSTEST = "CRQ01-Felt Discouraged or Down"
QSTESTCD = "CRQ0117" QSTEST = "CRQ01-Felt Worn Out or Sluggish"
QSTESTCD = "CRQ0119" QSTEST = "CRQ01-Feel Upset Diff Getting Breath"
QSTESTCD = "CRQ0120" QSTEST = "CRQ01-Felt Restless, Tense or Uptight"
QSORRES | QSSTRESC | QSSTRESN |
|---|---|---|
| All of the time | 1 | 1 |
| Most of the time | 2 | 2 |
| A good bit of the time | 3 | 3 |
| Some of the time | 4 | 4 |
| A little of the time | 5 | 5 |
| Hardly any of the time | 6 | 6 |
| None of the time | 7 | 7 |
QSTESTCD = "CRQ0108" QSTEST = "CRQ01-Fatigue"
QSORRES | QSSTRESC | QSSTRESN |
|---|---|---|
| Extremely tired | 1 | 1 |
| Very tired | 2 | 2 |
| Quite a bit of tiredness | 3 | 3 |
| Moderately tired | 4 | 4 |
| Somewhat tired | 5 | 5 |
| A little tired | 6 | 6 |
| Not at all tired | 7 | 7 |
QSTESTCD = "CRQ0110" QSTEST = "CRQ01-Confident to Deal With Illness"
QSTESTCD = "CRQ0113" QSTEST = "CRQ01-Control of Breathing Problems"
QSTESTCD = "CRQ0114" QSTEST = "CRQ01-Feel Relaxed and Free of Tension"
QSORRES | QSSTRESC | QSSTRESN |
|---|---|---|
| None of the time | 1 | 1 |
| A little of the time | 2 | 2 |
| Some of the time | 3 | 3 |
| A good bit of the time | 4 | 4 |
| Most of the time | 5 | 5 |
| Almost all of the time | 6 | 6 |
| All of the time | 7 | 7 |
QSTESTCD = "CRQ0111" QSTEST = "CRQ01-Energy"
QSORRES | QSSTRESC | QSSTRESN |
|---|---|---|
| No energy at all | 1 | 1 |
| A little energy | 2 | 2 |
| Some energy | 3 | 3 |
| Moderately energetic | 4 | 4 |
| Quite a bit of energy | 5 | 5 |
| Very energetic | 6 | 6 |
| Full of energy | 7 | 7 |
QSTESTCD = "CRQ0118" QSTEST = "CRQ01-Happy, Satisfied or Pleased"
QSORRES | QSSTRESC | QSSTRESN |
|---|---|---|
| Very dissatisfied, unhappy most of the time | 1 | 1 |
| Generally dissatisfied, unhappy | 2 | 2 |
| Somewhat dissatisfied, unhappy | 3 | 3 |
| Generally satisfied, pleased | 4 | 4 |
| Happy most of the time | 5 | 5 |
| Very happy most of the time | 6 | 6 |
| Extremely happy, could not be more satisfied or pleased | 7 | 7 |
End of Document
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