Data Dictionary for radcmotint
Number of Blaise fields: 265
| Seq # | Var | Question | Data Type/Coding |
|---|---|---|---|
| 1 | versiondate | Version Date | |
| 2 | formdescr | Form Description | |
| 3 | formno | Form Number | String[10] |
| 4 | version | Version Number | String[10] |
| 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] | |
| 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) 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] | |
| 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] | |
| 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] | |
| 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. | |
| 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 | part_study | What study is the participant enrolled in? | 1= ROS 2= MAP 3= MARS 4= Clinical Core / AA Core 5= Latino Core 6= Other |
| 18 | gaitquip | Is the Gait Test Equipment Available? | 1= Yes 2= No |
| 19 | domove2 | [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] | 1= Yes 2= No |
| 20 | dynaid | DynaPort Device id | String[10] |
| 21 | diskid | Disk ID | String[10] |
| 22 | defer | Do you want to defer Gait data entry? | 1= Yes 2= No |
| 23 | 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) |
| 24 | move7b | Time (seconds): | 1.0 .. 60.0 |
| 25 | move7c | Number of steps taken: | 1 .. 60 |
| 26 | 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) |
| 27 | move7d | Time (seconds): | 1.0 .. 60.0 |
| 28 | move7e | Number of steps taken: | 1 .. 60 |
| 29 | 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 7= Rollator |
| 30 | move7a1 | [SPECIFY] | String[20] |
| 31 | 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) |
| 32 | 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) |
| 33 | move6f | Number of steps taken: | 1 .. 60 |
| 34 | move6e | Time (seconds): | 1.0 .. 60.0 |
| 35 | 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) |
| 36 | move6h | Number of steps: | 1 .. 60 |
| 37 | move6g | Time (seconds): | 1.0 .. 60.0 |
| 38 | move6i | Record Aid used for 360 turn: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other 7= Rollator |
| 39 | move6i1 | [SPECIFY] | String[20] |
| 40 | 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) |
| 41 | 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) |
| 42 | 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) |
| 43 | getaid | Record Aid used for GET UP AND GO: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other 7= Rollator |
| 44 | getaid_specify | [SPECIFY] | String[20] |
| 45 | 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) |
| 46 | move8 | Interviewer: Record number of errors, e.g. Sidesteps: | 0 .. 60 |
| 47 | tandaid | Record Aid used for Tandem Walk: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other 7= Rollator |
| 48 | tandaid_specify | [SPECIFY] | String[20] |
| 49 | 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) |
| 50 | walk8aid | Record Aid used for BACK AND FORTH WALK: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other 7= Rollator |
| 51 | walk8aid_specify | [SPECIFY] | String[20] |
| 52 | 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) |
| 53 | move6 | Time (seconds) : | 1.0 .. 10.0 |
| 54 | 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) |
| 55 | move6a | Time (seconds) : | 1.0 .. 10.0 |
| 56 | 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) |
| 57 | move6c | Time (seconds) : | 1.0 .. 10.0 |
| 58 | s3gug | Will performances 14 (sit serial 3's), 15 (GUG Task 1) and 16 (GUG Task 2) be collected? | 1= Yes 2= No |
| 59 | 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) |
| 60 | ser3respcnt | C. PARTICIPANT #2: RECORD TRIAL : Then repeat again and record all the numbers: HOW MANY RESPONSES WERE GIVEN, 0 to 5? | 0 .. 5 |
| 61 | ser3resp1 | 0 .. 1000 | |
| 62 | ser3resp2 | 0 .. 1000 | |
| 63 | ser3resp3 | 0 .. 1000 | |
| 64 | ser3resp4 | 0 .. 1000 | |
| 65 | ser3resp5 | 0 .. 1000 | |
| 66 | 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) |
| 67 | gugcog1cnt | How many number responses were given during the first trial? *Note: Record protocol deviation if the only available chair is atypical. | 0 .. 20 |
| 68 | gugcog1resp01 | 0 .. 1000 | |
| 69 | gugcog1resp02 | 0 .. 1000 | |
| 70 | gugcog1resp03 | 0 .. 1000 | |
| 71 | gugcog1resp04 | 0 .. 1000 | |
| 72 | gugcog1resp05 | 0 .. 1000 | |
| 73 | gugcog1resp06 | 0 .. 1000 | |
| 74 | gugcog1resp07 | 0 .. 1000 | |
| 75 | gugcog1resp08 | 0 .. 1000 | |
| 76 | gugcog1resp09 | 0 .. 1000 | |
| 77 | gugcog1resp10 | 0 .. 1000 | |
| 78 | gugcog1resp11 | 0 .. 1000 | |
| 79 | gugcog1resp12 | 0 .. 1000 | |
| 80 | gugcog1resp13 | 0 .. 1000 | |
| 81 | gugcog1resp14 | 0 .. 1000 | |
| 82 | gugcog1resp15 | 0 .. 1000 | |
| 83 | gugcog1resp16 | 0 .. 1000 | |
| 84 | gugcog1resp17 | 0 .. 1000 | |
| 85 | gugcog1resp18 | 0 .. 1000 | |
| 86 | gugcog1resp19 | 0 .. 1000 | |
| 87 | gugcog1resp20 | 0 .. 1000 | |
| 88 | 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) |
| 89 | gugcog2cnt | How many number responses were given during the second trial? *Note: Record protocol deviation if the only available chair is atypical. | 0 .. 20 |
| 90 | gugcog2resp01 | 0 .. 1000 | |
| 91 | gugcog2resp02 | 0 .. 1000 | |
| 92 | gugcog2resp03 | 0 .. 1000 | |
| 93 | gugcog2resp04 | 0 .. 1000 | |
| 94 | gugcog2resp05 | 0 .. 1000 | |
| 95 | gugcog2resp06 | 0 .. 1000 | |
| 96 | gugcog2resp07 | 0 .. 1000 | |
| 97 | gugcog2resp08 | 0 .. 1000 | |
| 98 | gugcog2resp09 | 0 .. 1000 | |
| 99 | gugcog2resp10 | 0 .. 1000 | |
| 100 | gugcog2resp11 | 0 .. 1000 | |
| 101 | gugcog2resp12 | 0 .. 1000 | |
| 102 | gugcog2resp13 | 0 .. 1000 | |
| 103 | gugcog2resp14 | 0 .. 1000 | |
| 104 | gugcog2resp15 | 0 .. 1000 | |
| 105 | gugcog2resp16 | 0 .. 1000 | |
| 106 | gugcog2resp17 | 0 .. 1000 | |
| 107 | gugcog2resp18 | 0 .. 1000 | |
| 108 | gugcog2resp19 | 0 .. 1000 | |
| 109 | gugcog2resp20 | 0 .. 1000 | |
| 110 | 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 7= Rollator |
| 111 | gugcogaid_specify | [SPECIFY] | String[20] |
| 112 | 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) |
| 113 | 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) |
| 114 | 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] |
| 115 | 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] |
| 116 | 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] |
| 117 | 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] |
| 118 | trial11 | 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 119 | trial21 | 2. Trial 2, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 120 | 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 |
| 121 | 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 |
| 122 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
| 123 | 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] |
| 124 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2040 |
| 125 | autodate | Automatic Date. | Date type |
| 126 | autotime | Automatic Time. | TimeType |
| 127 | autolog | Automatic Logged Date. | Date type |
| 128 | intid | INTERVIEWER ID | 100 .. 997 |
| 129 | compid | Laptop ID | String[20] |
| 130 | dateint | Date of interview | Date type |
| 131 | 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 |
| 132 | formlang | What language will be used to administer this form? | 1= English 2= Español |
| 133 | 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 |
| 134 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
| 135 | 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 |
| 136 | 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 |
| 137 | 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 |
| 138 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
| 139 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
| 140 | statid | Please enter you staff id. | 100 .. 997 |
| 141 | formch | Has the form been modified? | 1= Yes 2= No |
| 142 | revidate | Enter the date that the form was modified. | Date type |
| 143 | revintd | Enter your staff id number. | 100 .. 997 |
| 144 | anydev | Are there any protocol deviations or missing data items to enter? | 1= Yes 2= No |
| 145 | numdev | How many total protocol deviations and tests with missing items to enter? | 1 .. 20 |
| 146 | reas00 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 147 | test00 | Enter test or procedure. | String[15] |
| 148 | item00 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 149 | code00 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 150 | oth00 | Enter other code used. | String[20] |
| 151 | expl00 | Explain what happened | String[100] |
| 152 | reas01 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 153 | test01 | Enter test or procedure. | String[15] |
| 154 | item01 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 155 | code01 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 156 | oth01 | Enter other code used. | String[20] |
| 157 | expl01 | Explain what happened | String[100] |
| 158 | reas02 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 159 | test02 | Enter test or procedure. | String[15] |
| 160 | item02 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 161 | code02 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 162 | oth02 | Enter other code used. | String[20] |
| 163 | expl02 | Explain what happened | String[100] |
| 164 | reas03 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 165 | test03 | Enter test or procedure. | String[15] |
| 166 | item03 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 167 | code03 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 168 | oth03 | Enter other code used. | String[20] |
| 169 | expl03 | Explain what happened | String[100] |
| 170 | reas04 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 171 | test04 | Enter test or procedure. | String[15] |
| 172 | item04 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 173 | code04 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 174 | oth04 | Enter other code used. | String[20] |
| 175 | expl04 | Explain what happened | String[100] |
| 176 | reas05 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 177 | test05 | Enter test or procedure. | String[15] |
| 178 | item05 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 179 | code05 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 180 | oth05 | Enter other code used. | String[20] |
| 181 | expl05 | Explain what happened | String[100] |
| 182 | reas06 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 183 | test06 | Enter test or procedure. | String[15] |
| 184 | item06 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 185 | code06 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 186 | oth06 | Enter other code used. | String[20] |
| 187 | expl06 | Explain what happened | String[100] |
| 188 | reas07 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 189 | test07 | Enter test or procedure. | String[15] |
| 190 | item07 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 191 | code07 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 192 | oth07 | Enter other code used. | String[20] |
| 193 | expl07 | Explain what happened | String[100] |
| 194 | reas08 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 195 | test08 | Enter test or procedure. | String[15] |
| 196 | item08 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 197 | code08 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 198 | oth08 | Enter other code used. | String[20] |
| 199 | expl08 | Explain what happened | String[100] |
| 200 | reas09 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 201 | test09 | Enter test or procedure. | String[15] |
| 202 | item09 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 203 | code09 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 204 | oth09 | Enter other code used. | String[20] |
| 205 | expl09 | Explain what happened | String[100] |
| 206 | reas10 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 207 | test10 | Enter test or procedure. | String[15] |
| 208 | item10 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 209 | code10 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 210 | oth10 | Enter other code used. | String[20] |
| 211 | expl10 | Explain what happened | String[100] |
| 212 | reas11 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 213 | test11 | Enter test or procedure. | String[15] |
| 214 | item11 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 215 | code11 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 216 | oth11 | Enter other code used. | String[20] |
| 217 | expl11 | Explain what happened | String[100] |
| 218 | reas12 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 219 | test12 | Enter test or procedure. | String[15] |
| 220 | item12 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 221 | code12 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 222 | oth12 | Enter other code used. | String[20] |
| 223 | expl12 | Explain what happened | String[100] |
| 224 | reas13 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 225 | test13 | Enter test or procedure. | String[15] |
| 226 | item13 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 227 | code13 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 228 | oth13 | Enter other code used. | String[20] |
| 229 | expl13 | Explain what happened | String[100] |
| 230 | reas14 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 231 | test14 | Enter test or procedure. | String[15] |
| 232 | item14 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 233 | code14 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 234 | oth14 | Enter other code used. | String[20] |
| 235 | expl14 | Explain what happened | String[100] |
| 236 | reas15 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 237 | test15 | Enter test or procedure. | String[15] |
| 238 | item15 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 239 | code15 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 240 | oth15 | Enter other code used. | String[20] |
| 241 | expl15 | Explain what happened | String[100] |
| 242 | reas16 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 243 | test16 | Enter test or procedure. | String[15] |
| 244 | item16 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 245 | code16 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 246 | oth16 | Enter other code used. | String[20] |
| 247 | expl16 | Explain what happened | String[100] |
| 248 | reas17 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 249 | test17 | Enter test or procedure. | String[15] |
| 250 | item17 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 251 | code17 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 252 | oth17 | Enter other code used. | String[20] |
| 253 | expl17 | Explain what happened | String[100] |
| 254 | reas18 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 255 | test18 | Enter test or procedure. | String[15] |
| 256 | item18 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 257 | code18 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 258 | oth18 | Enter other code used. | String[20] |
| 259 | expl18 | Explain what happened | String[100] |
| 260 | reas19 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 261 | test19 | Enter test or procedure. | String[15] |
| 262 | item19 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 263 | code19 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 264 | oth19 | Enter other code used. | String[20] |
| 265 | expl19 | Explain what happened | String[100] |