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© 2021 2022 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

1 Introduction

This document describes the CDISC implementation of the Exacerbations of Chronic Pulmonary Disease Tool (EXACT^®) - Patient-Reported Outcome (PRO) (EXACT) instrument.

The EXACT questionnaire/daily diary that is used in clinical trials to provide a measure of patient-reported symptoms of Chronic Obstructive Pulmonary Disease (COPD) exacerbations.The Evaluating Respiratory Symptoms (Evaluating Respiratory Symptoms (E-RS^™) in COPD (E-RS^™:COPD) scale is part of the EXACT instrument. It is comprised of comprises 11 items (of the 14-item EXACT) which provide information specific to respiratory symptoms in stable chronic obstructive pulmonary disease (COPD). The E-RS:COPD is not administered separately from the EXACT. For this reason, a separate SDTM questionnaire supplement for the E-RS:COPD will not be developed. 

Instructions for scoring the EXACT and E-RS:COPD, done during analysis of a clinical trial, can be found in the user manuals provided from the copyright holder when copyright use permission is obtained. Both measures will have Analysis Data Model (ADaM) QRS Supplements supplements explaining the scoring and total of the results based on the user manual.

CDISC does did not modify this questionnaires, ratings, and scales (QRS) instruments instrument to meet Clinical Data Acquisition Standards Harmonization (CDASH) case report form (CRF) standards.

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The CDISC Intellectual Property Policy can be found on the CDISC website at: https://www.cdisc.org/about/bylaws.

1.1 Representations and Warranties, Limitations of Liability, and Disclaimers

This document is a supplement to the SDTMIG for Human Clinical Trials and is covered under Appendix F of that document, which describes representations, warranties, limitations of liability, and disclaimers. Please see Appendix F of the SDTMIG for a complete version of this material.

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Although the United States Food and Drug Administration (US FDA) has provided input with regard to this supplement, this input does not constitute US FDA endorsement of any particular instrument.

2 Copyright Status

Evidera, Inc., owns the copyright for the EXACT instrument and has granted CDISC permission to include this supplement in the CDISC library of QRS data standards supplements. Hence, CDISC developed QSTESTCD and QSTEST for each item based on the actual text on the questionnaire. There may be many versions of this instrument in the public domain or copyrightedthe instrument.

The CDISC documentation of this instrument consists of: (1) controlled terminology, (2) standard database structure with examples, and (3) CRF(s) annotated with the CDISC SDTMIG variables with submission values. 

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Note that the EXACT and E-RS:COPD have been validated for electronic administration (ePRO); pen-and-paper CRF administration is not recommended by the copyright holders.

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CDISC acknowledges principal author Nancy K. Leidy, EXACT-PRO Initiative, Evidera, Inc., for the approval to include the EXACT in the CDISC data standards.

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• Nancy K. Leidy, EXACT-PRO Initiative, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD; EXACT copyright 2013, Evidera, Inc. All rights reserved).
  • This also includes the
  subset EXACT-Respiratory Symptoms (E-RS)
  • subset E-RS:COPD questions. http://www.exactproinitiative.com
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• The Exacerbations of Chronic Pulmonary Disease Tool (EXACT) Patient-Reported Outcome (PRO) USER MANUAL (Version 7.0). October 2014, EXACT© 2013, Evidera, Inc. All rights reserved.

3 The QS Domain Model

3.1 Assumptions for the QS Domain Model

All assumptions and business rules described in the SDTMIG QS domain are applicable to this supplement. Additional assumptions specific to the EXACT are listed below.

The EXACT is a multiple-choice self-administered daily diary completed by respondents that clinicians may use to measure of patient-reported symptoms of Chronic Obstructive Pulmonary Disease ( COPD ) exacerbations. It consists of 14 items, each rated on a 5- point or 6-point scale depending on the question. These items together provide information on the frequency, severity, and duration of symptom-defined exacerbations. The E-RS:COPD uses 11 of these 14 items to evaluate respiratory symptoms of COPD. Instructions for electornic electronic data capture are described in the user manual.

1. The scale points include a text rating (e.g., "Not at all", "Slightly", etc.). 

   1. The E-RS The Exacerbations of Chronic Pulmonary Disease Tool (EXACT-Respiratory Symptoms)* USER MANUAL (Version 4.0) May 2015 that is provided upon user's ) Patient-Reported Outcome (PRO) USER MANUAL (Version 7.0, October 2014) that is provided upon receiving copyright permission provides the numeric scoring of the responses for the questions. Based on this being copyrightedBecause EXACT is a copyrighted instrument, the numeric scores cannot be provided in this supplement. Upon receiving permission, sponsors may sponsors must apply these numeric responses in their SDTM SDTMIG and ADaM datasets. For this EXACT supplement, QSORRES and QSSTRESC is populated with the text description while the ; the numeric rating is represented as missing "xxx" in QSSTRESC and QSSTRESN.

2. The time period of evaluation for the EXACT is populated in the QSEVINTX field. The evaluation interval for the EXACT is the past 7 days (QSEVINTX QSEVINTX = "EVERY EVENING BEFORE BEDTIME") , as represented on the CRF.

3. The EXACT instrument includes 3 raw and domain respiratory symptom scores, a raw total score, and an EXACT total score that are (not represented on the CRF, but described in the user manual), that are considered as captured data and is not considered as derived in the example below. These scores may be submitted in SDTM or derived in the Analysis Data Model (ADaM) ADaM per scoring instructions from the usewr user manual. The E-RS The Exacerbations of Chronic Pulmonary Disease Tool (EXACT-Respiratory Symptoms)* USER MANUAL (Version 4.0) May 2015 that is provided upon user's receiving ) Patient-Reported Outcome (PRO) USER MANUAL (Version 7.0, October 2014) that is provided upon receiving copyright permission provides information to calculate these itemssitems. The EXACT raw total score is computed across the 14 items and then transformed via a table lookup to obtain the EXACT total score that has a theoretical range of 0 to 100. Three raw respiratory symptom scores are also computed for : Breathlessness, Cough & Sputum, and Chest Symptomsbreathlessness, cough and sputum, and chest symptoms. These raw respiratory scores are transformed via a table lookup to obtain the respiratory symptom domain scores that have a theoretical range of 0 to 100.  

   1. If operationally defined by the sponsor, it is the sponsor's responsibility to set the --DRVFL flag based on their eCRF process to derive subtotals and total scores. An investigator-derived score will be considered a captured score and not flagged. When subtotal and total scores are derived by the sponsor, the derived flag (--DRVFL) is set to "Y". However, when the subtotal and total scores are received from a central provider or vendor, the value would go into --ORRES and --DRVFL would be null (see SDTMIG Section 4.1.8.1, Origin Metadata for Variables).

   2. If scores are received by the sponsor, it is recommended that they are submitted to SDTM and verified in ADaM.
4. VISITNUM is null at the time of publication of this document until CDISC develops guidance on how to consistently model timing information for daily diary instruments.
   1. The QSDTC variable contains the date/time the EXACT was completed by the subject and is used for the timing of this measure.

5. Timing of the EXACT instrument diary collection

   1. The QRS EXACT instrument diary or manual describes that it is a self-administered daily diary, completed by respondents each evening before bedtime. Any additional information regarding the timing of the diary capture should be described in a protocol.
   2. The following CDISC timing variables represent the EXACT collection timing.
      1. VISITNUM variable is represented as a null value because sponsors have different operating procedures to assign visit information relative to diary collection.
         1. QSDTC variable represents the date/time the diary information was collected by the subject and is used for the timing of this measure.
         2. QSEVINTX variable represents the evaluation interval text timing described on the instrument relative to diary collection.
6. As described in the user manual, where no diary As described in the user manual, where no diary entry exists for a given day, create a record in the data file dataset for that daycollection date. Each day a patient is followed in the study must have a record for the day. For these missing diary days, a records record is created for each question item with QSORRES, QSSTRESC and QSSTRESN are QSSTRESN represented with missing values and QSSTAT = "NOT DONE". If a reason for not collecting an item is collected, it is represneted represented in the QSREASND variable. Collecting this reason would be a good practice, but is not specfically specifically described in the manual.

   1. “Presence of Data” items missing data rule:

      1. A record is created in qs.xpt for all items.
      2. If the reason for the not done record is knowncollected, then QSSTAT = “NOT DONE” and QSREASND = reason provided (e.g., “PREFER NOT TO ANSWER”). If a reason for the not done record is not providedcollected, the QSREASND variable is not populated,

7. Terminology

   1. QSCAT, QSTESTCD, and QSTEST values are included in CDISC Controlled Terminology.

   2. A full list of value sets for the result fields is provided in Section 4, SDTM Mapping Strategy.

3.2 Example for the EXACT QS Domain Model

The EXACT example below shows the terminology used to implement the instrument in the QS domain. This example shows the data for 1 subject collected at 1 eveningat 7 evenings of diary data capture and an additional evening in which no responses were captured on capture on the EXACT instrument. The example uses CDISC Controlled Terminology for QSTESTCD, QSTEST, and QSCAT. All original results are represented with preferred terminology in QSORRES. This result is also represented as the standard character representation in QSSTRESC. Based on assumption 1 above, the numeric values from the user manual are represented as "xxx" in QSSTRESC and QSSTRESN. There is no baseline observation flags flag represented , since because the user manual describes how to drive derive and potentially re-derive rederive the baseline EXACT domain and total scores as an analysis variable based on the subject disease status.

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The table represents the items from the EXACT instrument. Rows 18 - 25 reprsent the rawThe timing of diary collection is explained in assumption 4. Rows 15-22 represent that the 08-Nov-2012 diary collected raw, domain, and EXACT total scores at the first diary day as described in assumption 3 above. These are also represented for each additional diary collection date. The subject did not fill out the EXACT at the second dairy day and the observations on this day are represented as described in assumption 3 above.Example without numeric scores as described in the manual in accordance with assumption 1.a. and V1.0 published supplement with "xxx" indicating the derived score valuesdiary on 09-Nov-2012 and no reason for not collecting the diary was provided. Although the reason for not completing the assessments was not collected, the protocol specified that evaluations occur nightly for 7 straight days, so the collection date is included for these missing evaluations. The remaining diary collection follows the same pattern through the completion of the dairy.