Data Dictionary for radcmotint
Number of Blaise fields: 528
| Seq # | Var | Question | Data Type/Coding |
|---|---|---|---|
| 1 | versiondate | Version Date | |
| 1 | versiondate | Version Date | |
| 2 | formdescr | Form Description | |
| 2 | formdescr | Form Description | |
| 3 | formno | Form Number | String[10] |
| 3 | formno | Form Number | String[10] |
| 4 | version | Version Number | String[10] |
| 4 | version | Version Number | String[10] |
| 5 | gaitremind | For each exercise: Say, 'Recuerde de mirar hacia adelante y mant�ngase los m�s quieto posible hasta que yo le diga, 'Comience'. Listo/a? Comencemos.' Say, 'Comencemos' and press the forward button on the remote to start the measurement (time will start on the program) Count Steps (when applicable) Say, 'Pare' and press the Forward button a second time to end the measurement. Stop Stopwatch (when applicable) If the measurement was accurately performed, press the Slideshow button on the remote to move onto the next measurement (once Slideshow button is pressed, you CANNOT repeat the measurement) If the measurement needs to be repeated, press the Back button on the remote or select 'cancel current trial' on the computer screen. Check device to ensure green light is still flashing. [Press enter to continue] | |
| 5 | gaitremind | For each exercise: Say, 'Remember to look straight ahead and stay as still as possible until I say, Begin. Ready? Begin.' Say, 'Begin' and press the forward button on the remote to start the measurement (time will start on the program) Count Steps (when applicable) Say, 'Stop' and press the Forward button a second time to end the measurement. Stop Stopwatch (when applicable) If the measurement was accurately performed, press the Slideshow button on the remote to move onto the next measurement (once Slideshow button is pressed, you CANNOT repeat the measurement) If the measurement needs to be repeated, press the Back button on the remote or select 'cancel current trial' on the computer screen. Check device to ensure green light is still flashing. [Press enter to continue] | |
| 6 | dynaintro | Say I'm going to place this belt around your waist. The belt contains a recording device that will track your movements. I'm going to press a button on a remote before and after each task. It is important that you don't begin the task until I say 'Begin' and don't stop until I say 'stop'. Before starting each task I want you to look straight ahead and stay as still as possibel until I say 'Begin' [Press enter to continue] | |
| 6 | dynaintro | Say Voy a poner este cinto alrededor de la cintura. El cinto contiene un aparato de grabaci�n que relizar� el seguimiento de sus movimientos. Voy a presionar un bot�n en el control remoto antes y despu�s de cada ejercicio. Es importante que usted no comience la actividad hasta que yo diga 'comience' y no pare hasta que yo diga 'pare'. Antes de comenzar cada actividad, es importante que mire hacia adelante y mant�ngase lo m�s quieto posible. [Press enter to continue] | |
| 7 | walkint1 | 8 foot walk (trial 1) Place the DynaPort device around the waist of the participant, like a belt. DynaPort device should be located on the waistline, in center of the participant's back. Insert the scan disk with the participant's ID number labeled on it into the DynaPort device. Check that the green light on the DynaPort is on and then slide the device into the belt. Open the Dyrector MT program on your computer. Select the Perform tab. Make sure the COM port is selected and you have selected 'gait' under protocol. When you are ready to begin the gait test, select 'Start Measurement'. Check that the green light on the DynaPort is blinking. [Press enter to continue] | |
| 7 | walkint1 | 8 foot walk (trial 1) Place the DynaPort device around the waist of the participant, like a belt. DynaPort device should be located on the waistline, in center of the participant's back. Insert the scan disk with the participant's ID number labeled on it into the DynaPort device. Check that the green light on the DynaPort is on and then slide the device into the belt. Open the Dyrector MT program on your computer. Select the Perform tab. Make sure the COM port is selected and you have selected 'gait' under protocol. When you are ready to begin the gait test, select 'Start Measurement'. Check that the green light on the DynaPort is blinking. [Press enter to continue] | |
| 8 | walkint2 | 8 foot walk (trial 1) Ahora, voy a observar c�mo camina a su paso normal. Este es nuestro curso. Quiero que camine hasta el otro lado del curso en su paso normal, como si estuviera caminando a la tienda. Quiero que camine toda la distancia despu�s de esta l�nea hasta que yo diga 'pare'. D�jeme mostrarle lo que ser�a mi paso normal si yo estuviera caminando por el curso. �Cree usted que se sentir�a seguro/a hacerlo conmigo? Recuerde, antes de comenzar cada actividad, es importante que mire hacia adelante y mant�ngase lo m�s quieto posible. Ok. Listo/a? Comience. [Press enter to continue] | |
| 8 | walkint2 | 8 foot walk (trial 1) Now I am going to observe how you walk at your normal pace. This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. I want you to walk all the way past this line until I say 'Stop.' Let me show you what my normal pace would be if I were to walk the course. [Demonstrate and then ask the participant:] Do you feel it would be safe for you to walk this course with me? [Have the participant stand with both feet together on top of the line.] Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 9 | sidebysintro | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN For the next exercise, I would like you to place one foot beside the other in a comfortable position in front of this line. [Demonstrate the position.] [Optional prompt if needed:] You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Now you try it. [Extend hands palm side up for the participant to use for balance.] I'm going to support your arms while you get into the position. Try to hold this position until I say 'Stop'. [Once the position is attained, the examiner's place is to the side and slightly behind the participant.] [Press enter to continue] | |
| 9 | sidebysintro | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN Para el pr�ximo ejercicio, me gustar�a que usted ponga un pie al lado del otro en una posici�n c�moda enfrente de esta l�nea. Usted puede usar sus brazos, doblar las rodillas, o mover su cuerpo para mantener el equilibrio, pero trate de no mover los pies. Voy a apoyar sus brazos mientras se prepara para comenzar el ejercicio. Trate de mantener esta posici�n hasta que yo diga 'pare'. Recuerde, antes de comenzar, es importante que mire hacia adelante y mant�ngase lo m�s quieto/a posible hasta que yo le diga 'comience'. Ahora quiero que lo intente. Listo/a? Comience. [Press enter to continue] | |
| 10 | turn1intro | 360� TURN Ahora me gustar�a que usted haga un giro completo a su paso de marcha normal y girar hasta llegar a su punto de partida. Ahora quiero que usted lo intente. Aline� los pies encima de la cinta y comience a girar cuando yo le diga 'comience'. Gire hasta llegar a su punto de partida. Recuerde, antes de comenzar, es importante que mire hacia adelante y mant�ngase lo m�s quieto posible hasta que yo le diga 'comience'. Listo/a? Comience. [Press enter to continue] | |
| 10 | turn1intro | 360� TURN Now I would like you to make a complete turn at your normal walking pace and turn until you reach your starting point. [Demonstrate] Now you try it. Line your feet on top of the tape and begin turning when I say 'Begin' and turn until you reach your starting point. Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 11 | poststndintro | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Now I want you to do this again, but this time I want you to do it with your eyes closed. I'm going to support your arms while you get into the position. Try to hold the position until I say 'Stop.' [Press enter to continue] | |
| 11 | poststndintro | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Ahora quiero que haga lo mismo otra vez, pero esta vez quiero que lo haga con sus ojos cerrados. Yo le apoyare sus brazos mientras usted se pone en esta posici�n. Trate de mantenerse en esta posici�n hasta que yo le diga 'Pare'. [Press enter to continue] | |
| 12 | getup1intro | GET UP AND GO (trial 1) Place a chair behind the start line for the eight foot walk. Ahora voy a pedir que camine este curso de nuevo, pero esta vez usted va a estar sentado/a en esta silla, sentado/a con su espalda recargada en el respaldo de la silla. Cuando yo le diga que comience, usted se va levantar de la silla, va caminar hasta el otro lado del curso a su paso normal hasta cruzar la l�nea, va dar vuelta al otro lado de la l�nea, caminar a su paso normal y sentarse de nuevo en la silla. Recuerde, antes de comenzar, es importante que mire hacia adelante y mant�ngase lo m�s quieto/a posible hasta que yo le diga 'comience'. Ahora quiero que lo intente. Listo/a? Comience. [Press enter to continue] | |
| 12 | getup1intro | GET UP AND GO (trial 1) Place a chair behind the start line for the eight foot walk. Now I'm going to have you walk this course again but this time you're going to be seated in this chair with your back rested agains the back of the chair. Then, you're going to stand up from this chair, walk to the other end of the course at your normal pace past the line, turn around, walk back to the chair and sit down. [Demonstrate exercise] [Press enter to continue] | |
| 13 | tandemintro | TANDEM WALK (HEEL-TOE WALK) Now I want you to walk this course again but this time I want you to place one foot in front of the other with the heel touching the toe of the other foot like this, alternating feet. [Demonstrate exercise.] If you feel you are losing your balance, step out like this and then resume walking again. I want you to continue this walk all the way past this line before you stop. Participant should start with both feet on top of the line of tape. Remind participant to stay as still as possible until you say 'begin'. Ready? Begin [Press enter to continue] | |
| 13 | tandemintro | TANDEM WALK (HEEL-TOE WALK) Ahora quiero que usted camine este curso de nuevo, pero esta vez quiero que usted ponga un pie delante del otro con el tal�n de un pie tocando el dedo del otro pie as�, alternando los pies. Si siente que pierde el equilibrio, tome un paso para restablecer su equilibrio y contin�e la caminada. Quiero que usted siga este camino hasta cruzar la l�nea antes de parar. Recuerde, antes de comenzar, es importante que mire hacia adelante y mant�ngase lo m�s quieto/a posible hasta que yo le diga 'comience'. Listo/a? Comience [Press enter to continue] | |
| 14 | walk8intro | BACK AND FORTH 8 FOOT WALK TWICE Ahora quiero que usted camine este curso de nuevo, pero esta vez quiero que usted ponga un pie delante del otro con el tal�n de un pie tocando el dedo del otro pie as�, alternando los pies. Si siente que pierde el equilibrio, tome un paso para restablecer su equilibrio y contin�e la caminada. Quiero que usted siga este camino hasta cruzar la l�nea antes de parar. Recuerde, antes de comenzar, es importante que mire hacia adelante y mant�ngase lo m�s quieto/a posible hasta que yo le diga 'comience'. Listo/a? Comience [Press enter to continue] | |
| 14 | walk8intro | BACK AND FORTH 8 FOOT WALK TWICE I would like you to walk this course again. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. This time, however, I want you to walk all the way past this line, turn around and walk back to the starting line. When you pass the starting line I want you to turn around and walk to the other end of the course, turn around and walk back. [Demonstrate] Do you feel it would be safe for you to walk this course with me? Participant should start with both feet on top of the line of tape. Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 15 | ser3intro | 14. Serial 3s while Sitting A. RA DEMONSTRATION: Next we are going to examine some subtraction, for example if we started with the number 50 and you took away 3 you would have 47. Then if you continue and take away 3 from 47 you would have 44. The taking away 3 again would leave 41. Some people find this very difficult and some do not. If you have difficulty just keep going and don't be concerned if you think you have made a mistake. | |
| 15 | ser3intro | 14. Serial 3s mientras est� Sentado A. RA DEMONSTRACION: A continuaci�n vamos a examinar unas substracciones, por ejemplo, si empezamos con el n�mero 50 y le quita 3 tendr�a 47. Entonces, si usted contin�a y le quita 3 de 47 que tendr�a 44. El quitarle 3 nuevamente dejar�a 41. Algunas personas encuentran esto muy dif�cil y algunos no. Si tiene dificultades simplemente siga adelante y no se preocupe si usted piensa que ha cometido un error. | |
| 16 | ser3note | NOTA: ya que el prop�sito del serial 3s en 15 y 16 es para dividir la atenci�n en una tarea cognitiva , pero no utilizar una tarea de memoria, cualquier persona que trata desempe�o 14 y est� dispuesto deben seguir al 15 aunque cometan errores y aunque no tenga ninguna de las 5 sustracciones correctas. Una persona que es incapaz de hacer matem�ticas o se siente inc�modo haciendo estas tareas y prefiere no hacerlo, pero ha hecho el TUG anteriormente debe ser etiquetado como ' incapaz ' y no etiquetados como ' negado'. | |
| 16 | ser3note | NOTE: since the purpose of the serial 3s in 15 and 16 is to divide attention on a cognitive task but not to use a rote task, anyone who tries performance 14 and is willing should continue to 15 even if they make errors and do not get any of the 5 subtractions correct. A person who is unable to do any math or is uncomfortable doing these tasks and prefers not to do it but has done the TUG above should be labeled as 'unable' and not labeled as 'refused'. | |
| 17 | gaitquip | Is the Gait Test Equipment Available? | 1= Yes 2= No |
| 17 | gaitquip | Is the Gait Test Equipment Available? | 1= Yes 2= No |
| 18 | domove2 | [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] | 1= Yes 2= No |
| 18 | domove2 | [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] | 1= Yes 2= No |
| 19 | dynaid | DynaPort Device id | String[10] |
| 19 | dynaid | DynaPort Device id | String[10] |
| 20 | diskid | Disk ID | String[10] |
| 20 | diskid | Disk ID | String[10] |
| 21 | defer | Do you want to defer Gait data entry? | 1= Yes 2= No |
| 21 | defer | Do you want to defer Gait data entry? | 1= Yes 2= No |
| 22 | walk1 | 8 foot Walk (trial 1) Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start Stopwatch Count Steps Say, 'Stop'. Press M to stop recording Check device to ensure green light is still flashing. Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 22 | walk1 | 8 foot Walk (trial 1) Press M on the DynaPort device to start recording Say, 'Listo/a? Comience.' Start Stopwatch Count Steps Say, 'Pare'. Press M to stop recording Check device to ensure green light is still flashing. Is test performed? | 1= Yes 2= Refused 3= unable |
| 23 | move7b | Time (seconds): | 1.0 .. 60.0 |
| 23 | move7b | Time (seconds): | 1.0 .. 60.0 |
| 24 | move7c | Number of steps taken: | 1 .. 60 |
| 24 | move7c | Number of steps taken: | 1 .. 60 |
| 25 | walk2 | 8 foot Walk (trial 2) Is test performed? | 1= Yes 2= Refused 3= unable |
| 25 | walk2 | 8 foot Walk (trial 2) Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 26 | move7d | Time (seconds): | 1.0 .. 60.0 |
| 26 | move7d | Time (seconds): | 1.0 .. 60.0 |
| 27 | move7e | Number of steps taken: | 1 .. 60 |
| 27 | move7e | Number of steps taken: | 1 .. 60 |
| 28 | move7a | Record Aid used for 8 foot walk: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair as walking aid 6= Other |
| 28 | move7a | Record Aid used for 8 foot walk: | 1= noaid 2= quad 3= othc 4= Walker 5= wc 6= Other |
| 29 | move7a1 | [SPECIFY] | String[20] |
| 29 | move7a1 | [SPECIFY] | String[20] |
| 30 | sidebys | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 30 | sidebys | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN Press M on the DynaPort device to start recording Say, 'Listo/a? Comience.'@ Start timing with the stopwatch Say, 'Pare'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 31 | turn1 | 360� TURN Press M on the DynaPort device to start recording Say, 'Listo/a? Comience.' Start timing with the stopwatch Say, 'Pare'. Press M on the DynaPort device when the turn is completed. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 31 | turn1 | 360� TURN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Press M on the DynaPort device when the turn is completed. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 32 | move6f | Number of steps taken: | 1 .. 60 |
| 32 | move6f | Number of steps taken: | 1 .. 60 |
| 33 | move6e | Time (seconds): | 1.0 .. 60.0 |
| 33 | move6e | Time (seconds): | 1.0 .. 60.0 |
| 34 | turn2 | 360� TURN Second trial Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 34 | turn2 | 360� TURN Second trial Is test performed? | 1= Yes 2= Refused 3= unable |
| 35 | move6h | Number of steps: | 1 .. 60 |
| 35 | move6h | Number of steps: | 1 .. 60 |
| 36 | move6g | Time (seconds): | 1.0 .. 60.0 |
| 36 | move6g | Time (seconds): | 1.0 .. 60.0 |
| 37 | move6i | Record Aid used for 360 turn: | 1= noaid 2= quad 3= othc 4= Walker 5= Wheelchair 6= Other |
| 37 | move6i | Record Aid used for 360 turn: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 38 | move6i1 | [SPECIFY] | String[20] |
| 38 | move6i1 | [SPECIFY] | String[20] |
| 39 | poststnd | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Press M on the DynaPort device to start recording Say, 'Listo/a? Comience.' Start timing with the stopwatch Say, 'Pare'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 39 | poststnd | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 40 | getup1 | GET UP AND GO (trial 1) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Press M on the DynaPort device when the participant has returned and sat back down in the chair. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 40 | getup1 | GET UP AND GO (trial 1) Press M on the DynaPort device to begin recording Say, 'Listo/a? Comience.' Press M on the DynaPort device when the participant has returned and sat back down in the chair. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 41 | getup2 | GET UP AND GO (trial 2) Is the test performed? | 1= Yes 2= Refused 3= unable |
| 41 | getup2 | GET UP AND GO (trial 2) Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 42 | getaid | Record Aid used for GET UP AND GO: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 42 | getaid | Record Aid used for GET UP AND GO: | 1= noaid 2= quad 3= othc 4= Walker 5= Wheelchair 6= Other |
| 43 | getaid_specify | [SPECIFY] | String[20] |
| 43 | getaid_specify | [SPECIFY] | String[20] |
| 44 | tandem | TANDEM WALK (HEEL-TOE WALK) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 44 | tandem | TANDEM WALK (HEEL-TOE WALK) Press M on the DynaPort device to begin recording Say, 'Listo/a? Comience.' Say, 'Pare' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 45 | move8 | Interviewer: Record number of errors, e.g. Sidesteps: | 0 .. 60 |
| 45 | move8 | Interviewer: Record number of errors, e.g. Sidesteps: | 0 .. 60 |
| 46 | tandaid | Record Aid used for Tandem Walk: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 46 | tandaid | Record Aid used for Tandem Walk: | 1= noaid 2= quad 3= othc 4= Walker 5= Wheelchair 6= Other |
| 47 | tandaid_specify | [SPECIFY] | String[20] |
| 47 | tandaid_specify | [SPECIFY] | String[20] |
| 48 | walk8 | BACK AND FORTH 8 FOOT WALK TWICE Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 48 | walk8 | BACK AND FORTH 8 FOOT WALK TWICE Press M on the DynaPort device to begin recording Say, 'Listo/a? Comience.' Say, 'Pare' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 49 | walk8aid | Record Aid used for BACK AND FORTH WALK: | 1= noaid 2= quad 3= othc 4= Walker 5= Wheelchair 6= Other |
| 49 | walk8aid | Record Aid used for BACK AND FORTH WALK: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 50 | walk8aid_specify | [SPECIFY] | String[20] |
| 50 | walk8aid_specify | [SPECIFY] | String[20] |
| 51 | sttoeopen | Toe Stand (Eyes Open) Describe the position while demonstrating. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Listo/a? Comience.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 51 | sttoeopen | Toe Stand (Eyes Open) Describe the position while demonstrating. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 52 | move6 | Time (seconds) : | 1.0 .. 10.0 |
| 52 | move6 | Time (seconds) : | 1.0 .. 10.0 |
| 53 | strlopen | Standing on Right Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Listo/a? Comience.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 53 | strlopen | Standing on Right Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 54 | move6a | Time (seconds) : | 1.0 .. 10.0 |
| 54 | move6a | Time (seconds) : | 1.0 .. 10.0 |
| 55 | stllopen | Standing on Left Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Listo/a? Comience.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes 2= Refused 3= unable |
| 55 | stllopen | Standing on Left Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 56 | move6c | Time (seconds) : | 1.0 .. 10.0 |
| 56 | move6c | Time (seconds) : | 1.0 .. 10.0 |
| 57 | s3gug | Will performances 14 (sit serial 3's), 15 (GUG Task 1) and 16 (GUG Task 2) be collected? | 1= Yes 2= No |
| 57 | s3gug | Will performances 14 (sit serial 3's), 15 (GUG Task 1) and 16 (GUG Task 2) be collected? | 1= Yes 2= No |
| 58 | ser3prac | B. PARTICIPANT #1: PRACTICE TRIAL : Please start with the number 100 and take away 3. Continue to take away 3 from what is left until I tell you to stop. TRY THIS TO SEE IF THE PERSON UNDERSTANDS THE TASK DO NOT RECORD NUMBERS THIS FIRST TIME. | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 58 | ser3prac | B. PARTICIPANTE #1: PRUEBA DE PRACTICA: Por favor, comience con el n�mero 100 y qu�tele 3. Contin�e quit�ndole 3 de lo que queda hasta que le diga que pare. TRATE LO SIGUIENTE PARA VER SI LA PERSONA ENTIENDE LA TAREA NO GRABE N�MEROS ESTA PRIMERA VEZ. | 1= Yes 2= Refused 3= unable |
| 59 | ser3respcnt | C. PARTICIPANTE #2: PRUEBA: Entonces repita de nuevo y escriba todos los n�meros: * Nota: Escriba las primeras 5 respuestas aun si hay errores. | 0 .. 5 |
| 59 | ser3respcnt | C. PARTICIPANT #2: RECORD TRIAL : Then repeat again and record all the numbers: HOW MANY RESPONSES WERE GIVEN, 0 to 5? | 0 .. 5 |
| 60 | ser3resp1 | 0 .. 1000 | |
| 60 | ser3resp1 | 0 .. 1000 | |
| 61 | ser3resp2 | 0 .. 1000 | |
| 61 | ser3resp2 | 0 .. 1000 | |
| 62 | ser3resp3 | 0 .. 1000 | |
| 62 | ser3resp3 | 0 .. 1000 | |
| 63 | ser3resp4 | 0 .. 1000 | |
| 63 | ser3resp4 | 0 .. 1000 | |
| 64 | ser3resp5 | 0 .. 1000 | |
| 64 | ser3resp5 | 0 .. 1000 | |
| 65 | gugcog1 | 15. Lev�ntese-Y-Vamos + Tarea Cognitiva de Matem�ticas Ahora yo le voy a repetir la tarea de Lev�ntese Y Vamos la cual usted completo anteriormente. Sin embargo, ahora usted contara de para atr�s en 3 mientras usted desempe�a esta tarea. Por favor comience a contar EN ALTO PARA QUE YO LO PUEDA ESCUCHAR para atr�s empezando del 100 de 3 y contin�e contando mientras desempe�a esta tarea. Cuando yo le diga COMIENCE, usted se va a levantar de esta silla, va a caminar hasta el final del trayecto en su paso normal, va a pasar la l�nea, se va a dar vuelta, y va a caminar de regreso a la silla y se va a sentar. Contin�e contando mientras usted desempe�a esta tarea [Demuestre el ejercicio] 'Recuerde de ver hacia enfrente y mantenerse lo m�s quieto posible hasta que yo le diga 'Comience a contar'. Listo/a? COMIENCE.' | 1= Yes 2= Refused 3= unable |
| 65 | gugcog1 | 15. Get-Up-And-Go + Cognitive Math Task Now I am going to repeat the Get Up and Go Task which you performed before. However, now you are going to count backward by 3 while you are performing this task. Please start to count OUT LOUD SO I CAN HEAR YOU backward starting from 100 by 3 and continue counting while you perform this task. When I say BEGIN, you are going to stand up from this chair, walk to the other end of the course at your normal pace past the line, turn around, walk back to the chair and sit down. Continue to count while you are performing this task [Demonstrate exercise] Remember to look straight ahead and stay as still as possible until I say 'Begin counting'. Ready? BEGIN. | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 66 | gugcog1cnt | How many number responses were given during the first trial? *Note: Record protocol deviation if the only available chair is atypical. | 0 .. 20 |
| 66 | gugcog1cnt | How many number responses were given during the first trial? *Nota: Escriba desviaci�n del protocolo si la �nica silla disponible es at�pica. *Nota: Escriba los n�meros que escucha durante el TUG. | 0 .. 20 |
| 67 | gugcog1resp01 | 0 .. 1000 | |
| 67 | gugcog1resp01 | 0 .. 1000 | |
| 68 | gugcog1resp02 | 0 .. 1000 | |
| 68 | gugcog1resp02 | 0 .. 1000 | |
| 69 | gugcog1resp03 | 0 .. 1000 | |
| 69 | gugcog1resp03 | 0 .. 1000 | |
| 70 | gugcog1resp04 | 0 .. 1000 | |
| 70 | gugcog1resp04 | 0 .. 1000 | |
| 71 | gugcog1resp05 | 0 .. 1000 | |
| 71 | gugcog1resp05 | 0 .. 1000 | |
| 72 | gugcog1resp06 | 0 .. 1000 | |
| 72 | gugcog1resp06 | 0 .. 1000 | |
| 73 | gugcog1resp07 | 0 .. 1000 | |
| 73 | gugcog1resp07 | 0 .. 1000 | |
| 74 | gugcog1resp08 | 0 .. 1000 | |
| 74 | gugcog1resp08 | 0 .. 1000 | |
| 75 | gugcog1resp09 | 0 .. 1000 | |
| 75 | gugcog1resp09 | 0 .. 1000 | |
| 76 | gugcog1resp10 | 0 .. 1000 | |
| 76 | gugcog1resp10 | 0 .. 1000 | |
| 77 | gugcog1resp11 | 0 .. 1000 | |
| 77 | gugcog1resp11 | 0 .. 1000 | |
| 78 | gugcog1resp12 | 0 .. 1000 | |
| 78 | gugcog1resp12 | 0 .. 1000 | |
| 79 | gugcog1resp13 | 0 .. 1000 | |
| 79 | gugcog1resp13 | 0 .. 1000 | |
| 80 | gugcog1resp14 | 0 .. 1000 | |
| 80 | gugcog1resp14 | 0 .. 1000 | |
| 81 | gugcog1resp15 | 0 .. 1000 | |
| 81 | gugcog1resp15 | 0 .. 1000 | |
| 82 | gugcog1resp16 | 0 .. 1000 | |
| 82 | gugcog1resp16 | 0 .. 1000 | |
| 83 | gugcog1resp17 | 0 .. 1000 | |
| 83 | gugcog1resp17 | 0 .. 1000 | |
| 84 | gugcog1resp18 | 0 .. 1000 | |
| 84 | gugcog1resp18 | 0 .. 1000 | |
| 85 | gugcog1resp19 | 0 .. 1000 | |
| 85 | gugcog1resp19 | 0 .. 1000 | |
| 86 | gugcog1resp20 | 0 .. 1000 | |
| 86 | gugcog1resp20 | 0 .. 1000 | |
| 87 | gugcog2 | 16. Lev�ntese-Y-Vamos + Tarea Cognitiva de Matem�ticas Ahora yo le voy a repetir la tarea de Lev�ntese Y Vamos la cual usted completo anteriormente. Sin embargo, ahora usted contara de para atr�s en 3 mientras usted desempe�a esta tarea. Por favor comience a contar EN ALTO PARA QUE YO LO PUEDA ESCUCHAR para atr�s empezando del 100 de 3 y contin�e contando mientras desempe�a esta tarea. Cuando yo le diga COMIENCE, usted se va a levantar de esta silla, va a caminar hasta el final del trayecto en su paso normal, va a pasar la l�nea, se va a dar vuelta, y va a caminar de regreso a la silla y se va a sentar. Contin�e contando mientras usted desempe�a esta tarea [Demuestre el ejercicio] | 1= Yes 2= Refused 3= unable |
| 87 | gugcog2 | 16. Get-Up-And-Go + Cognitive Math Task Now I am going to repeat the Get Up and Go Task which you performed before. However, now you are going to count backward by 3 while you are performing this task. Please start to count OUT LOUD SO I CAN HEAR YOU backward starting from 100 by 3 and continue counting while you perform this task. When I say BEGIN, you are going to stand up from this chair, walk to the other end of the course at your normal pace past the line, turn around, walk back to the chair and sit down. Continue to count while you are performing this task [Demonstrate exercise] Remember to look straight ahead and stay as still as possible until I say 'Begin counting'. Ready? BEGIN | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 88 | gugcog2cnt | How many number responses were given during the second trial? *Note: Record protocol deviation if the only available chair is atypical. | 0 .. 20 |
| 88 | gugcog2cnt | How many number responses were given during the second trial? Recuerde de ver hacia enfrente y mantenerse lo m�s quieto posible hasta que yo le diga 'Comience a contar'. Listo/a? COMIENCE. | 0 .. 20 |
| 89 | gugcog2resp01 | 0 .. 1000 | |
| 89 | gugcog2resp01 | 0 .. 1000 | |
| 90 | gugcog2resp02 | 0 .. 1000 | |
| 90 | gugcog2resp02 | 0 .. 1000 | |
| 91 | gugcog2resp03 | 0 .. 1000 | |
| 91 | gugcog2resp03 | 0 .. 1000 | |
| 92 | gugcog2resp04 | 0 .. 1000 | |
| 92 | gugcog2resp04 | 0 .. 1000 | |
| 93 | gugcog2resp05 | 0 .. 1000 | |
| 93 | gugcog2resp05 | 0 .. 1000 | |
| 94 | gugcog2resp06 | 0 .. 1000 | |
| 94 | gugcog2resp06 | 0 .. 1000 | |
| 95 | gugcog2resp07 | 0 .. 1000 | |
| 95 | gugcog2resp07 | 0 .. 1000 | |
| 96 | gugcog2resp08 | 0 .. 1000 | |
| 96 | gugcog2resp08 | 0 .. 1000 | |
| 97 | gugcog2resp09 | 0 .. 1000 | |
| 97 | gugcog2resp09 | 0 .. 1000 | |
| 98 | gugcog2resp10 | 0 .. 1000 | |
| 98 | gugcog2resp10 | 0 .. 1000 | |
| 99 | gugcog2resp11 | 0 .. 1000 | |
| 99 | gugcog2resp11 | 0 .. 1000 | |
| 100 | gugcog2resp12 | 0 .. 1000 | |
| 100 | gugcog2resp12 | 0 .. 1000 | |
| 101 | gugcog2resp13 | 0 .. 1000 | |
| 101 | gugcog2resp13 | 0 .. 1000 | |
| 102 | gugcog2resp14 | 0 .. 1000 | |
| 102 | gugcog2resp14 | 0 .. 1000 | |
| 103 | gugcog2resp15 | 0 .. 1000 | |
| 103 | gugcog2resp15 | 0 .. 1000 | |
| 104 | gugcog2resp16 | 0 .. 1000 | |
| 104 | gugcog2resp16 | 0 .. 1000 | |
| 105 | gugcog2resp17 | 0 .. 1000 | |
| 105 | gugcog2resp17 | 0 .. 1000 | |
| 106 | gugcog2resp18 | 0 .. 1000 | |
| 106 | gugcog2resp18 | 0 .. 1000 | |
| 107 | gugcog2resp19 | 0 .. 1000 | |
| 107 | gugcog2resp19 | 0 .. 1000 | |
| 108 | gugcog2resp20 | 0 .. 1000 | |
| 108 | gugcog2resp20 | 0 .. 1000 | |
| 109 | gugcogaid | Record Aid used for Get Up and Go Cog Task: | 1= noaid 2= quad 3= othc 4= Walker 5= Wheelchair 6= Other |
| 109 | gugcogaid | Record Aid used for Get Up and Go Cog Task: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 110 | gugcogaid_specify | [SPECIFY] | String[20] |
| 110 | gugcogaid_specify | [SPECIFY] | String[20] |
| 111 | pegboardrt | PURDUE PEGBOARD Is the test performed with right hand? | 1= Yes 2= Refused 3= unable |
| 111 | pegboardrt | PURDUE PEGBOARD Is the test performed with right hand? | 1= Yes (Pt. completed test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 112 | pegboardlt | PURDUE PEGBOARD Is the test performed with left hand? | 1= Yes (Pt. completed test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 112 | pegboardlt | PURDUE PEGBOARD Is the test performed with left hand? | 1= Yes 2= Refused 3= unable |
| 113 | admin1 | TABLA DE ESTACAS DE PURDUE -- ADMINISTRACION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `Quisiera ver qu� tan r�pido usted puede poner estas estacas (clavijas/palitos) [SE�ALE] dentro de estos agujeros - de la siguiente manera sin saltarse ning�n agujero. [EXAMINER PLACES 4 PEGS WITH RIGHT HAND IN RIGHT-HAND COLUMN.] Ahora para practicar, int�ntelo usted con su mano derecha.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `bien;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 113 | admin1 | PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH RIGHT HAND IN RIGHT-HAND COLUMN.] Now for practice you try it with your right hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 114 | admin2 | [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO RIGHT-HAND COLUMN] with your RIGHT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 114 | admin2 | [SAY: ] ` Muy bien. Ha captado la idea. Ahora, cuando yo le digo que comience, recoja las estacas (clavijas/palitos) una por una y p�ngalas en esta columna [POINT TO RIGHT-HAND COLUMN] con su MANO DERECHA tan r�pido como usted pueda. De nuevo, por favor, no se salte ning�n agujero. �Listo/a? Empiece.' [START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `pare'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 115 | admin3 | TABLA DE ESTACAS DE PURDUE -- ADMINISTRACION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `Quisiera ver qu� tan r�pido usted puede poner estas estacas (clavijas/palitos) [SE�ALE] dentro de estos agujeros - de la siguiente manera sin saltarse ning�n agujero. [EXAMINER PLACES 4 PEGS WITH RIGHT HAND IN RIGHT-HAND COLUMN.] Ahora para practicar, int�ntelo usted con su mano derecha.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `bien;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 115 | admin3 | PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH LEFT HAND IN LEFT-HAND COLUMN.] Now for practice you try it with your left hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 116 | admin4 | [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your LEFT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 116 | admin4 | [SAY: ] ` Muy bien. Ha captado la idea. Ahora, cuando yo le digo que comience, recoja las estacas (clavijas/palitos) una por una y p�ngalas en esta columna [POINT TO RIGHT-HAND COLUMN] con su MANO DERECHA tan r�pido como usted pueda. De nuevo, por favor, no se salte ning�n agujero. �Listo/a? Empiece.' [START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `pare'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 117 | trial11 | 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 117 | trial11 | 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 118 | trial21 | 2. Trial 2, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 118 | trial21 | 2. Trial 2, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 119 | trial301 | [AT COMPLETION OF TRIAL 2, REPLACE PEGS AND SAY:] `Now I want you to do this again with your RIGHT HAND. Place the pegs one at a time in this column [POINT TO RIGHT-HAND COLUMN COLUMN] with your right hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 3. Trial 3, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 119 | trial301 | [AT COMPLETION OF TRIAL 2, REPLACE PEGS AND SAY:] `Ahora quiero que lo haga de nuevo con su MANO DERECHA. Ponga las estacas (clavijas/palitos) una a una en esta columna [POINT TO RIGHT-HAND COLUMN COLUMN] con su MANO DERECHA. Trabaje tan r�pido como pueda y no se salte ning�n agujero. �Listo/a? Empiece. [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 3. Trial 3, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 120 | trial4 | [AT COMPLETION OF TRIAL 3, REPLACE PEGS AND SAY:] `Ahora quiero que lo haga de nuevo con su MANO IZQUIERDA. Ponga las estacas (clavijas/palitos) una a una en esta columna [POINT TO RIGHT-HAND COLUMN COLUMN] con su MANO IZQUIERDA. Trabaje tan r�pido como pueda y no se salte ning�n agujero. �Listo/a? Empiece. [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 4. Trial 4, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 120 | trial4 | [AT COMPLETION OF TRIAL 3, REPLACE PEGS AND SAY:] `Now I want you to do this again with your LEFT HAND. Place the pegs one at a time in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 4. Trial 4, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 121 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
| 121 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
| 122 | visit | Enter curent visit code from face sheet: CODE F/U Year CODE F/U Year CODE F/U Year CODE F/U Year 00 = Baseline 08 = 8th F/U 16 = 16th F/U 24 = 24th F/U 01 = 1st F/U 09 = 9th F/U 17 = 17th F/U 25 = 25th F/U 02 = 2nd F/U 10 = 10th F/U 18 = 18th F/U 26 = 26th F/U 03 = 3rd F/U 11 = 11th F/U 19 = 19th F/U 27 = 27th F/U 04 = 4th F/U 12 = 12th F/U 20 = 20th F/U 28 = 28th F/U 05 = 5th F/U 13 = 13th F/U 21 = 21th F/U 29 = 29th F/U 06 = 6th F/U 14 = 14th F/U 22 = 22th F/U 30 = 30th F/U 07 = 7th F/U 15 = 15th F/U 23 = 23th F/U 31 = 30th F/U ... 50 = 50th F/U | String[2] |
| 122 | visit | Enter curent visit code from face sheet: CODE F/U Year CODE F/U Year CODE F/U Year CODE F/U Year 00 = Baseline 08 = 8th F/U 16 = 16th F/U 24 = 24th F/U 01 = 1st F/U 09 = 9th F/U 17 = 17th F/U 25 = 25th F/U 02 = 2nd F/U 10 = 10th F/U 18 = 18th F/U 26 = 26th F/U 03 = 3rd F/U 11 = 11th F/U 19 = 19th F/U 27 = 27th F/U 04 = 4th F/U 12 = 12th F/U 20 = 20th F/U 28 = 28th F/U 05 = 5th F/U 13 = 13th F/U 21 = 21th F/U 29 = 29th F/U 06 = 6th F/U 14 = 14th F/U 22 = 22th F/U 30 = 30th F/U 07 = 7th F/U 15 = 15th F/U 23 = 23th F/U 31 = 30th F/U ... 50 = 50th F/U | String[2] |
| 123 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2025 |
| 123 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2025 |
| 124 | autodate | Automatic Date. | Date type |
| 124 | autodate | Automatic Date. | Date type |
| 125 | autotime | Automatic Time. | TimeType |
| 125 | autotime | Automatic Time. | TimeType |
| 126 | autolog | Automatic Logged Date. | Date type |
| 126 | autolog | Automatic Logged Date. | Date type |
| 127 | intid | INTERVIEWER ID | 100 .. 997 |
| 127 | intid | INTERVIEWER ID | 100 .. 997 |
| 128 | compid | Laptop ID | String[20] |
| 128 | compid | Laptop ID | String[20] |
| 129 | dateint | Date of interview | Date type |
| 129 | dateint | Date of interview | Date type |
| 130 | educ | ^educ_question Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... | 0 .. 30 |
| 130 | educ | ^educ_question Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... | 0 .. 30 |
| 131 | formlang | What language will be used to administer this form? | 1= ENG 2= ESP |
| 131 | formlang | What language will be used to administer this form? | 1= English 2= Espa�ol |
| 132 | howwell | 1. INTERVIEWER OBSERVATIONS How well do you think the participant understood the questions? | 1= Quite well 2= Fairly well 3= Somewhat 4= Very Little 5= Not at all |
| 132 | howwell | 1. INTERVIEWER OBSERVATIONS How well do you think the participant understood the questions? | 1= qw 2= fw 3= sw 4= vl 5= naa |
| 133 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
| 133 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
| 134 | visimp | 3. Does the participant have a SUBSTANTIAL visual impariment? | 1= Yes, completely blind 2= Yes, very poor 3= Yes, poor 4= No, not substantial |
| 134 | visimp | 3. Does the participant have a SUBSTANTIAL visual impariment? | 1= ycb 2= yvp 3= yp 4= nns |
| 135 | phyeffrt | 4. How great an effort do you think the participant put into the physical function items? | 1= agd 2= aca 3= ama 4= alb 5= ha |
| 135 | phyeffrt | 4. How great an effort do you think the participant put into the physical function items? | 1= A great deal 2= A considerable amount 3= A moderate amount 4= A little bit 5= Hardly any |
| 136 | formcode | Please enter status code. 11 = COMPLETE 13 = COMPLETE, portion with proxy 12 = INCOMPLETE, refused 14 = INCOMPLETE, too impaired 21 = INCOMPLETE interim, complete later 73 = NOT TESTED, out of town 31 = NOT TESTED, moved 33 = NOT TESTED, refused 75 = NOT TESTED, hospitalized 76 = NOT TESTED, other 42 = DECEASED 43 = WITHDRAWN 44 = WITHDRAWN, Autopsy OK | 11 .. 76 |
| 136 | formcode | Please enter status code. 11 = COMPLETE 13 = COMPLETE, portion with proxy 12 = INCOMPLETE, refused 14 = INCOMPLETE, too impaired 21 = INCOMPLETE interim, complete later 73 = NOT TESTED, out of town 31 = NOT TESTED, moved 33 = NOT TESTED, refused 75 = NOT TESTED, hospitalized 76 = NOT TESTED, other 42 = DECEASED 43 = WITHDRAWN 44 = WITHDRAWN, Autopsy OK | 11 .. 76 |
| 137 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
| 137 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
| 138 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
| 138 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
| 139 | statid | Please enter you staff id. | 100 .. 997 |
| 139 | statid | Please enter you staff id. | 100 .. 997 |
| 140 | formch | Has the form been modified? | 1= Yes 2= No |
| 140 | formch | Has the form been modified? | 1= Yes 2= No |
| 141 | revidate | Enter the date that the form was modified. | Date type |
| 141 | revidate | Enter the date that the form was modified. | Date type |
| 142 | revintd | Enter your staff id number. | 100 .. 997 |
| 142 | revintd | Enter your staff id number. | 100 .. 997 |
| 143 | anydev | Are there any protocol deviations or missing data items to enter? | 1= S� 2= No |
| 143 | anydev | Are there any protocol deviations or missing data items to enter? | 1= Yes 2= No |
| 144 | numdev | How many total protocol deviations and tests with missing items to enter? | 1 .. 20 |
| 144 | numdev | How many total protocol deviations and tests with missing items to enter? | 1 .. 20 |
| 145 | reas00 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 145 | reas00 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 146 | test00 | Enter test or procedure. | String[15] |
| 146 | test00 | Enter test or procedure. | String[15] |
| 147 | item00 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 147 | item00 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 148 | code00 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 148 | code00 | Enter data code used. | 1= dont 2= ref 3= other |
| 149 | oth00 | Enter other code used. | String[20] |
| 149 | oth00 | Enter other code used. | String[20] |
| 150 | expl00 | Explain what happened | String[100] |
| 150 | expl00 | Explain what happened | String[100] |
| 151 | reas01 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 151 | reas01 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 152 | test01 | Enter test or procedure. | String[15] |
| 152 | test01 | Enter test or procedure. | String[15] |
| 153 | item01 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 153 | item01 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 154 | code01 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 154 | code01 | Enter data code used. | 1= dont 2= ref 3= other |
| 155 | oth01 | Enter other code used. | String[20] |
| 155 | oth01 | Enter other code used. | String[20] |
| 156 | expl01 | Explain what happened | String[100] |
| 156 | expl01 | Explain what happened | String[100] |
| 157 | reas02 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 157 | reas02 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 158 | test02 | Enter test or procedure. | String[15] |
| 158 | test02 | Enter test or procedure. | String[15] |
| 159 | item02 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 159 | item02 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 160 | code02 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 160 | code02 | Enter data code used. | 1= dont 2= ref 3= other |
| 161 | oth02 | Enter other code used. | String[20] |
| 161 | oth02 | Enter other code used. | String[20] |
| 162 | expl02 | Explain what happened | String[100] |
| 162 | expl02 | Explain what happened | String[100] |
| 163 | reas03 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 163 | reas03 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 164 | test03 | Enter test or procedure. | String[15] |
| 164 | test03 | Enter test or procedure. | String[15] |
| 165 | item03 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 165 | item03 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 166 | code03 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 166 | code03 | Enter data code used. | 1= dont 2= ref 3= other |
| 167 | oth03 | Enter other code used. | String[20] |
| 167 | oth03 | Enter other code used. | String[20] |
| 168 | expl03 | Explain what happened | String[100] |
| 168 | expl03 | Explain what happened | String[100] |
| 169 | reas04 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 169 | reas04 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 170 | test04 | Enter test or procedure. | String[15] |
| 170 | test04 | Enter test or procedure. | String[15] |
| 171 | item04 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 171 | item04 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 172 | code04 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 172 | code04 | Enter data code used. | 1= dont 2= ref 3= other |
| 173 | oth04 | Enter other code used. | String[20] |
| 173 | oth04 | Enter other code used. | String[20] |
| 174 | expl04 | Explain what happened | String[100] |
| 174 | expl04 | Explain what happened | String[100] |
| 175 | reas05 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 175 | reas05 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 176 | test05 | Enter test or procedure. | String[15] |
| 176 | test05 | Enter test or procedure. | String[15] |
| 177 | item05 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 177 | item05 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 178 | code05 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 178 | code05 | Enter data code used. | 1= dont 2= ref 3= other |
| 179 | oth05 | Enter other code used. | String[20] |
| 179 | oth05 | Enter other code used. | String[20] |
| 180 | expl05 | Explain what happened | String[100] |
| 180 | expl05 | Explain what happened | String[100] |
| 181 | reas06 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 181 | reas06 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 182 | test06 | Enter test or procedure. | String[15] |
| 182 | test06 | Enter test or procedure. | String[15] |
| 183 | item06 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 183 | item06 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 184 | code06 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 184 | code06 | Enter data code used. | 1= dont 2= ref 3= other |
| 185 | oth06 | Enter other code used. | String[20] |
| 185 | oth06 | Enter other code used. | String[20] |
| 186 | expl06 | Explain what happened | String[100] |
| 186 | expl06 | Explain what happened | String[100] |
| 187 | reas07 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 187 | reas07 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 188 | test07 | Enter test or procedure. | String[15] |
| 188 | test07 | Enter test or procedure. | String[15] |
| 189 | item07 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 189 | item07 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 190 | code07 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 190 | code07 | Enter data code used. | 1= dont 2= ref 3= other |
| 191 | oth07 | Enter other code used. | String[20] |
| 191 | oth07 | Enter other code used. | String[20] |
| 192 | expl07 | Explain what happened | String[100] |
| 192 | expl07 | Explain what happened | String[100] |
| 193 | reas08 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 193 | reas08 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 194 | test08 | Enter test or procedure. | String[15] |
| 194 | test08 | Enter test or procedure. | String[15] |
| 195 | item08 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 195 | item08 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 196 | code08 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 196 | code08 | Enter data code used. | 1= dont 2= ref 3= other |
| 197 | oth08 | Enter other code used. | String[20] |
| 197 | oth08 | Enter other code used. | String[20] |
| 198 | expl08 | Explain what happened | String[100] |
| 198 | expl08 | Explain what happened | String[100] |
| 199 | reas09 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 199 | reas09 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 200 | test09 | Enter test or procedure. | String[15] |
| 200 | test09 | Enter test or procedure. | String[15] |
| 201 | item09 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 201 | item09 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 202 | code09 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 202 | code09 | Enter data code used. | 1= dont 2= ref 3= other |
| 203 | oth09 | Enter other code used. | String[20] |
| 203 | oth09 | Enter other code used. | String[20] |
| 204 | expl09 | Explain what happened | String[100] |
| 204 | expl09 | Explain what happened | String[100] |
| 205 | reas10 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 205 | reas10 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 206 | test10 | Enter test or procedure. | String[15] |
| 206 | test10 | Enter test or procedure. | String[15] |
| 207 | item10 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 207 | item10 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 208 | code10 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 208 | code10 | Enter data code used. | 1= dont 2= ref 3= other |
| 209 | oth10 | Enter other code used. | String[20] |
| 209 | oth10 | Enter other code used. | String[20] |
| 210 | expl10 | Explain what happened | String[100] |
| 210 | expl10 | Explain what happened | String[100] |
| 211 | reas11 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 211 | reas11 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 212 | test11 | Enter test or procedure. | String[15] |
| 212 | test11 | Enter test or procedure. | String[15] |
| 213 | item11 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 213 | item11 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 214 | code11 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 214 | code11 | Enter data code used. | 1= dont 2= ref 3= other |
| 215 | oth11 | Enter other code used. | String[20] |
| 215 | oth11 | Enter other code used. | String[20] |
| 216 | expl11 | Explain what happened | String[100] |
| 216 | expl11 | Explain what happened | String[100] |
| 217 | reas12 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 217 | reas12 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 218 | test12 | Enter test or procedure. | String[15] |
| 218 | test12 | Enter test or procedure. | String[15] |
| 219 | item12 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 219 | item12 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 220 | code12 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 220 | code12 | Enter data code used. | 1= dont 2= ref 3= other |
| 221 | oth12 | Enter other code used. | String[20] |
| 221 | oth12 | Enter other code used. | String[20] |
| 222 | expl12 | Explain what happened | String[100] |
| 222 | expl12 | Explain what happened | String[100] |
| 223 | reas13 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 223 | reas13 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 224 | test13 | Enter test or procedure. | String[15] |
| 224 | test13 | Enter test or procedure. | String[15] |
| 225 | item13 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 225 | item13 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 226 | code13 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 226 | code13 | Enter data code used. | 1= dont 2= ref 3= other |
| 227 | oth13 | Enter other code used. | String[20] |
| 227 | oth13 | Enter other code used. | String[20] |
| 228 | expl13 | Explain what happened | String[100] |
| 228 | expl13 | Explain what happened | String[100] |
| 229 | reas14 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 229 | reas14 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 230 | test14 | Enter test or procedure. | String[15] |
| 230 | test14 | Enter test or procedure. | String[15] |
| 231 | item14 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 231 | item14 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 232 | code14 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 232 | code14 | Enter data code used. | 1= dont 2= ref 3= other |
| 233 | oth14 | Enter other code used. | String[20] |
| 233 | oth14 | Enter other code used. | String[20] |
| 234 | expl14 | Explain what happened | String[100] |
| 234 | expl14 | Explain what happened | String[100] |
| 235 | reas15 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 235 | reas15 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 236 | test15 | Enter test or procedure. | String[15] |
| 236 | test15 | Enter test or procedure. | String[15] |
| 237 | item15 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 237 | item15 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 238 | code15 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 238 | code15 | Enter data code used. | 1= dont 2= ref 3= other |
| 239 | oth15 | Enter other code used. | String[20] |
| 239 | oth15 | Enter other code used. | String[20] |
| 240 | expl15 | Explain what happened | String[100] |
| 240 | expl15 | Explain what happened | String[100] |
| 241 | reas16 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 241 | reas16 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 242 | test16 | Enter test or procedure. | String[15] |
| 242 | test16 | Enter test or procedure. | String[15] |
| 243 | item16 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 243 | item16 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 244 | code16 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 244 | code16 | Enter data code used. | 1= dont 2= ref 3= other |
| 245 | oth16 | Enter other code used. | String[20] |
| 245 | oth16 | Enter other code used. | String[20] |
| 246 | expl16 | Explain what happened | String[100] |
| 246 | expl16 | Explain what happened | String[100] |
| 247 | reas17 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 247 | reas17 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 248 | test17 | Enter test or procedure. | String[15] |
| 248 | test17 | Enter test or procedure. | String[15] |
| 249 | item17 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 249 | item17 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 250 | code17 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 250 | code17 | Enter data code used. | 1= dont 2= ref 3= other |
| 251 | oth17 | Enter other code used. | String[20] |
| 251 | oth17 | Enter other code used. | String[20] |
| 252 | expl17 | Explain what happened | String[100] |
| 252 | expl17 | Explain what happened | String[100] |
| 253 | reas18 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 253 | reas18 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 254 | test18 | Enter test or procedure. | String[15] |
| 254 | test18 | Enter test or procedure. | String[15] |
| 255 | item18 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 255 | item18 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 256 | code18 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 256 | code18 | Enter data code used. | 1= dont 2= ref 3= other |
| 257 | oth18 | Enter other code used. | String[20] |
| 257 | oth18 | Enter other code used. | String[20] |
| 258 | expl18 | Explain what happened | String[100] |
| 258 | expl18 | Explain what happened | String[100] |
| 259 | reas19 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 259 | reas19 | Protocol Deviation or Missing Data? | 1= prot 2= miss |
| 260 | test19 | Enter test or procedure. | String[15] |
| 260 | test19 | Enter test or procedure. | String[15] |
| 261 | item19 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 261 | item19 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 262 | code19 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 262 | code19 | Enter data code used. | 1= dont 2= ref 3= other |
| 263 | oth19 | Enter other code used. | String[20] |
| 263 | oth19 | Enter other code used. | String[20] |
| 264 | expl19 | Explain what happened | String[100] |
| 264 | expl19 | Explain what happened | String[100] |