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titleInformation for Reviewers

Text in black is part of the template used to create this document and is not revised under CDISC internal or public 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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Title

Minnesota Tobacco Withdrawal Scale-Revised (MTWS-R)

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

MTWS-R

QRS Permission StatusPublic Domain
TeamTobacco Implementation Guide (TIG) and CDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version1.0 
StatusDRAFT
Date2024-0104-2208
Notes to Readers
  • This supplement is available 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.
Known Issues

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Revision History

DateVersion
2024-0104-24081.0 Draft

© 2024 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

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There is no known standard case report form (CRF) available for this instrument. CDISC created this CRF to represent the instrument which CDISC believes is in the public domain. This is not an endorsement of the instrument. The creation of this instrument was based on published articles describing the instrument. Sponsors may create this instrument’s CRF using their style guidelines, but they need to maintain the wording and order of the questions/items and responses as described on the CRF. The instrument is labeled a "Behavior Rating Scale" and not a "Withdrawal Scale" because subjects (1) are confused by filling out a “withdrawal” scale prior to cessation, and (2) will sometimes not report a symptom during abstinence if they do not believe it is due to withdrawal.

The representation of data collected for this instrument is based on the Study Data Tabulation Model Implementation Guide (SDTMIG) Questionnaire (QS) domain model, which can be found on the CDISC website at: https://www.cdisc.org/standards/foundational/sdtmig.

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The MTWS-R evaluates the effects of smoking cessation. It is a 15-item self-report measure of tobacco withdrawal. Each item is rated on a 5-point ordinal scale (0 = "None", 1 = "Slight", 2 = "Mild", 3 = "Moderate", 4 = "Severe"). A total score, based on 8 of these items, between 0-32 is also captured.

  1. The original scores include scores include a numeric rating (0-4) and a definition of what is represented by the rating (e.g., 0 = "None"). For the MTWS-R, QSORRES is populated with the text description while ; the numeric rating is represented in the standardized character and numeric result variables QSSTRESC and QSSTRESN.

  2. The time period of evaluation for the MTWS-R is populated in the QSEVLINTfield in ISO 8601 format when the evaluation interval can be precisely described as duration. The evaluation interval for the MTWS-R is typically the last 24 hours (QSEVLINT = "-PT24H")

  3. Records are created in qs.xpt for every instrument item

    1. For items with no data, QSORRES, QSSTRESC, and QSSTRESN are all missing and QSSTAT = "NOT DONE". If the reason is known, then that reason is represented in QSREASND (e.g., QSREASND = "PREFER NOT TO ANSWER"). If the reason is unknown, then QSSTAT = "NOT DONE" and QSREASND is missing.

    2. Due to the variability of the derived score generation process, records are not included for scores that are not provided.
  4. The MTWS-R instrument may include an overall score that is considered as captured data on the instrument and is not considered as derived in the example below. This overall score, or total withdrawal discomfort score, consists of the first eight 8 symptoms (i.e., QSTESTCDs MTWSR101 through MTWSR108). This score may be submitted in SDTM or derived in the Analysis Data Model (ADaM) per scoring instructions from http://www.med.uvm.edu/behaviorandhealth/research/minnesota-tobacco-withdrawal-scale.

    1. The overall score score is represented in QSORRES, QSSTRESC, and QSSTRESN.
    2. If the overall score is received or derived by the sponsor, it is recommended that it is submitted to SDTM and verified in ADaM whenever feasible. It is the sponsor's responsibility to do this verification based on the instrument's user manual or instructions from the owner.
  5. Terminology

    1. QSCAT, QSTESTCD, QSTEST, QSORRES, QSSTRESC, and QSSTRESN 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.

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Dataset wrap
Nameqs
Rowcaps
Rows 1-8:Show the eight well-validated, primary withdrawal symptom descriptors (single items) based on DSM-5 (QSTESTCDs MTWSR101 through MTWSR108).
Rows 9-15:Show the seven additional symptom candidates (e.g., “Craving to smoke;” “Constipation;” and “Dizziness”).
Row 16:Shows the total withdrawal discomfort score is calculated from the first eight symptoms.
Rows 17-32:Show the subject was not evaluated on this instrument at visit 2. Since the reason for not completing the visit was collected, the date is included in QSDTC for when the visit was planned.
Dataset2
RowSTUDYIDDOMAINUSUBJIDQSSEQQSTESTCDQSTESTQSCATQSORRESQSSTRESCQSSTRESNQSSTATQSREASNDQSLOBXFLVISITNUMQSDTCQSEVLINT
1STUDYXQS2324-P00011MTWSR101MTWSR1-Angry, Irritable, FrustratedMTWS-RSlight11

Y12023-08-13-PT24H
2STUDYXQS2324-P00012MTWSR102MTWSR1-Anxious, NervousMTWS-RModerate33

Y12023-08-13-PT24H
3STUDYXQS2324-P00013MTWSR103MTWSR1-Depressed Mood, SadMTWS-RMild22

Y12023-08-13-PT24H
4STUDYXQS2324-P00014MTWSR104MTWSR1-Difficulty ConcentratingMTWS-RMild22

Y12023-08-13-PT24H
5STUDYXQS2324-P00015MTWSR105MTWSR1-Inc Appetite, Hungry, Weight GainMTWS-RSlight11

Y12023-08-13-PT24H
6STUDYXQS2324-P00016MTWSR106MTWSR1-Sleep Problems/Awakening at NightMTWS-RSlight11

Y12023-08-13-PT24H
7STUDYXQS2324-P00017MTWSR107MTWSR1-RestlessMTWS-RModerate33

Y12023-08-13-PT24H
8STUDYXQS2324-P00018MTWSR108MTWSR1-ImpatientMTWS-RSlight11

Y12023-08-13-PT24H
9STUDYXQS2324-P00019MTWSR109MTWSR1-Craving to SmokeMTWS-RSevere44

Y12023-08-13-PT24H
10STUDYXQS2324-P000110MTWSR110MTWSR1-ConstipationMTWS-RSlight11

Y12023-08-13-PT24H
11STUDYXQS2324-P000111MTWSR111MTWSR1-DizzinessMTWS-RNone00

Y12023-08-13-PT24H
12STUDYXQS2324-P000112MTWSR112MTWSR1-CoughingMTWS-RSlight11

Y12023-08-13-PT24H
13STUDYXQS2324-P000113MTWSR113MTWSR1-Dreaming or NightmaresMTWS-RSlight11

Y12023-08-13-PT24H
14STUDYXQS2324-P000114MTWSR114MTWSR1-NauseaMTWS-RNone00

Y12023-08-13-PT24H
15STUDYXQS2324-P000115MTWSR115MTWSR1-Sore ThroatMTWS-RNone00

Y12023-08-13-PT24H
16STUDYXQS2324-P000116MTWSR116MTWSR1-Total Withdrawal Discomfort ScoreMTWS-R141414

Y12023-08-13-PT24H
17STUDYXQS2324-P000117MTWSR101MTWSR1-Angry, Irritable, FrustratedMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. 
22023-09-10
18STUDYXQS2324-P000118MTWSR102MTWSR1-Anxious, NervousMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT.
22023-09-10
19STUDYXQS2324-P000119MTWSR103MTWSR1-Depressed Mood, SadMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT.
22023-09-10
20STUDYXQS2324-P000120MTWSR104MTWSR1-Difficulty ConcentratingMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT.
22023-09-10
21STUDYXQS2324-P000121MTWSR105MTWSR1-Inc Appetite, Hungry, Weight GainMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
22STUDYXQS2324-P000122MTWSR106MTWSR1-Sleep Problems/Awakening at NightMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
23STUDYXQS2324-P000123MTWSR107MTWSR1-RestlessMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
24STUDYXQS2324-P000124MTWSR108MTWSR1-ImpatientMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
25STUDYXQS2324-P000125MTWSR109MTWSR1-Craving to SmokeMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
26STUDYXQS2324-P000126MTWSR110MTWSR1-ConstipationMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULEDVISIT.
22023-09-10
27STUDYXQS2324-P000127MTWSR111MTWSR1-DizzinessMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
28STUDYXQS2324-P000128MTWSR112MTWSR1-CoughingMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
29STUDYXQS2324-P000129MTWSR113MTWSR1-Dreaming or NightmaresMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
30STUDYXQS2324-P000130MTWSR114MTWSR1-NauseaMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
31STUDYXQS2324-P000131MTWSR115MTWSR1-Sore ThroatMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10
32STUDYXQS2324-P000132MTWSR116MTWSR1-Total Withdrawal Discomfort ScoreMTWS-R


NOT DONEPATIENT MISSED FORM AT VISIT. FILLED OUT ELECTRONICALLY FEW DAYS LATER AS UNSCHEDULED.
22023-09-10



4 SDTM Mapping Strategy

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