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Title

Chronic Respiratory Questionnaire - Self-Administered Standardized Format Follow-up Administration Version (CRQ-SAS FOLLOW-UP ADMINISTRATION VERSION)

CDISC ReferenceQuestionnaire Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

CRQ-SAS FOLLOW-UP ADMINISTRATION VERSION

QRS Permission StatusApproved
TeamCDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version2.0
StatusREVISION DRAFT
Date2023-03-1423
Notes
  • This supplement is intended to be used with other CDISC user guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.

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DateVersionSummary of Changes

2023-03-

14

23

2.0
  • Converted the supplement to the current WIKI QRS supplement template.
  • Annotated CRF updated to the MSG V2.0 annotation guidelines
  • Removed the QSEVAL assumption and variables as this is not captured on the CRF and no assumptions are made on potential values.
2015-02-181.0Initial Final Version

© 2022 2023 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

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CDISC specifies how to structure the data that has been collected in a database, not what should be collected or how to conduct clinical assessments or implement protocols. CDISC disclaims any liability for your use of this material.

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Dataset wrap
Nameqs
Dataset2
RowSTUDYIDDOMAINUSUBJIDQSSEQQSTESTCDQSTESTQSCATQSORRESQSSTRESCQSSTRESNQSSTATVISITNUMQSDTCQSEVLINT
1STUDYXQS2324-P00011CRQ0201CRQ02-Feeling EmotionalCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONExtremely short of breath11
32022-05-15-P2W
2STUDYXQS2324-P00012CRQ0202CRQ02-Take Care of Basic NeedsCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONVery short of breath22
32022-05-15-P2W
3STUDYXQS2324-P00013CRQ0203CRQ02-WalkingCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONModerate shortness of breath44
32022-05-15-P2W
4STUDYXQS2324-P00014CRQ0204CRQ02-Performing ChoresCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONNot at all short of breath77
32022-05-15-P2W
5STUDYXQS2324-P00015CRQ0205CRQ02-Participate in Social ActivitiesCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONNot Done88
32022-05-15-P2W
6STUDYXQS2324-P00016CRQ0206CRQ02-Felt Frustrated or ImpatientCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONA good bit of the time33
32022-05-15-P2W
7STUDYXQS2324-P00017CRQ0207CRQ02-Feeling of Fear or PanicCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONSome of the time44
32022-05-15-P2W
8STUDYXQS2324-P00018CRQ0208CRQ02-FatigueCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONExtremely tired11
32022-05-15-P2W
9STUDYXQS2324-P00019CRQ0209CRQ02-Embarrassed by CoughingCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONA little of the time55
32022-05-15-P2W
10STUDYXQS2324-P000110CRQ0210CRQ02-Confident to Deal With IllnessCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONA little of the time22
32022-05-15-P2W
11STUDYXQS2324-P000111CRQ0211CRQ02-EnergyCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONFull of energy77
32022-05-15-P2W
12STUDYXQS2324-P000112CRQ0212CRQ02-Feel Upset, Worried or DepressedCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONHardly any of the time66
32022-05-15-P2W
13STUDYXQS2324-P000113CRQ0213CRQ02-Control of Breathing ProblemsCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONMost of the time55
32022-05-15-P2W
14STUDYXQS2324-P000114CRQ0214CRQ02-Feel Relaxed and Free of TensionCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONA good bit of the time44
32022-05-15-P2W
15STUDYXQS2324-P000115CRQ0215CRQ02-Felt Low in EnergyCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONA good bit of the time33
32022-05-15-P2W
16STUDYXQS2324-P000116CRQ0216CRQ02-Felt Discouraged or DownCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONMost of the time22
32022-05-15-P2W
17STUDYXQS2324-P000117CRQ0217CRQ02-Felt Worn Out or SluggishCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONAll of the time11
32022-05-15-P2W
18STUDYXQS2324-P000118CRQ0218CRQ02-Happy, Satisfied or PleasedCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONHappy most of the time55
32022-05-15-P2W
19STUDYXQS2324-P000119CRQ0219CRQ02-Feel Upset Diff Getting BreathCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONMost of the time22
32022-05-15-P2W
20STUDYXQS2324-P000120CRQ0220CRQ02-Felt Restless, Tense or UptightCRQ-SAS FOLLOW-UP ADMINISTRATION VERSIONSome of the time44
32022-05-15-P2W
21STUDYXQS2324-P000121CRQ0201CRQ02-Feeling EmotionalCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

22STUDYXQS2324-P000122CRQ0202CRQ02-Take Care of Basic NeedsCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

23STUDYXQS2324-P000123CRQ0203CRQ02-WalkingCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

24STUDYXQS2324-P000124CRQ0204CRQ02-Performing ChoresCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

25STUDYXQS2324-P000125CRQ0205CRQ02-Participate in Social ActivitiesCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

26STUDYXQS2324-P000126CRQ0206CRQ02-Felt Frustrated or ImpatientCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

27STUDYXQS2324-P000127CRQ0207CRQ02-Feeling of Fear or PanicCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

28STUDYXQS2324-P000128CRQ0208CRQ02-FatigueCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

29STUDYXQS2324-P000129CRQ0209CRQ02-Embarrassed by CoughingCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

30STUDYXQS2324-P000130CRQ0210CRQ02-Confident to Deal With IllnessCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

31STUDYXQS2324-P000131CRQ0211CRQ02-EnergyCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

32STUDYXQS2324-P000132CRQ0212CRQ02-Feel Upset, Worried or DepressedCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

33STUDYXQS2324-P000133CRQ0213CRQ02-Control of Breathing ProblemsCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

34STUDYXQS2324-P000134CRQ0214CRQ02-Feel Relaxed and Free of TensionCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

35STUDYXQS2324-P000135CRQ0215CRQ02-Felt Low in EnergyCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

36STUDYXQS2324-P000136CRQ0216CRQ02-Felt Discouraged or DownCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

37STUDYXQS2324-P000137CRQ0217CRQ02-Felt Worn Out or SluggishCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

38STUDYXQS2324-P000138CRQ0218CRQ02-Happy, Satisfied or PleasedCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

39STUDYXQS2324-P000139CRQ0219CRQ02-Feel Upset Diff Getting BreathCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W

40STUDYXQS2324-P000140CRQ0220CRQ02-Felt Restless, Tense or UptightCRQ-SAS FOLLOW-UP ADMINISTRATION VERSION


NOT DONE4-P2W


4 SDTM Mapping Strategy

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.

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QSTESTCD = "CRQ0205" QSTEST = "CRQ02-Participate in Social Activities"

QSORRES

QSSTRESC

QSSTRESN

Extremely short of breath11
Very short of breath22
Quite a bit short of breath33
Moderate shortness of breath44
Some shortness of breath55
A little shortness of breath66
Not at all short of breath77
Not Done88

QSTESTCD = "CRQ0206" QSTEST = "CRQ02-Felt Frustrated or Impatient"

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QSTESTCD = "CRQ0220" QSTEST = "CRQ02-Felt Restless, Tense or Uptight"

QSORRES

QSSTRESC

QSSTRESN

All of the time11
Most of the time22
A good bit of the time33
Some of the time44
A little of the time55
Hardly any of the time66
None of the time77

QSTESTCD = "CRQ0208" QSTEST = "CRQ02-Fatigue"

QSORRES

QSSTRESC

QSSTRESN

Extremely tired11
Very tired22
Quite a bit of tiredness33
Moderately tired44
Somewhat tired55
A little tired66
Not at all tired77

QSTESTCD = "CRQ0210" QSTEST = "CRQ02-Confident to Deal With Illness"

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QSTESTCD = "CRQ0214" QSTEST = "CRQ02-Feel Relaxed and Free of Tension"

QSORRES

QSSTRESC

QSSTRESN

None of the time11
A little of the time22
Some of the time33
A good bit of the time44
Most of the time55
Almost all of the time66
All of the time77

QSTESTCD = "CRQ0211" QSTEST = "CRQ02-Energy"

QSORRES

QSSTRESC

QSSTRESN

No energy at all11
A little energy22
Some energy33
Moderately energetic44
Quite a bit of energy55
Very energetic66
Full of energy77

QSTESTCD = "CRQ0218" QSTEST = "CRQ02-Happy, Satisfied or Pleased"

QSORRES

QSSTRESC

QSSTRESN

Very dissatisfied, unhappy most of the time11
Generally dissatisfied, unhappy22
Somewhat dissatisfied, unhappy33
Generally satisfied, pleased44
Happy most of the time55
Very happy most of the time66
Extremely happy, could not be more satisfied or pleased77


End of Document