CDE Detailed Report

Disease: NeuroRehab
Subdomain Name: General and Motor
CRF: Assessments and Examinations Demographic and Clinical Conditions

Displaying 1 - 35 of 35
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guidance) Subdomain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C58781 Gender identity type other text GenderIdTypOTH The free-text field related to 'Gender identity type', specifying other text. Gender identity self-identified by the participant. Gender type may or may not match sex assigned at birth The free-text field related to 'Gender identity type', specifying other text. Gender identity self-identified by the participant. Gender type may or may not match sex assigned at birth Other, specify Alphanumeric

No instructions available

No references available Adult NeuroRehab Supplemental-Highly Recommended 1.1 10/16/2024 8:51:17 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 4000

Free-Form Entry

C02304 Adverse event study intervention relatedness investigator assessment grade AdvrsEvntStdyIntRltInvAstGrade Grade of the causality between the treatment modality/intervention and the specific adverse event Grade of the causality between the treatment modality/intervention and the specific adverse event Investigator Assessment of Causality Unrelated;Unlikely;Definite;Reasonable Possibility;Unknown Unrelated;Unlikely;Definite;Reasonable Possibility;Unknown Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where adverse events are a potential concern. Choose one. Record the investigator's assessment as to whether there is at least a reasonable possibility that the AE is related to (or caused by) use of the study intervention. Definitions for each of the relatedness response should be supplied in the protocol.

No references available Adult NeuroRehab Supplemental-Highly Recommended 4 10/16/2024 8:51:08 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

1285
C08147 Data source DataSource Source of the data provided on the case report form Source of the data provided on the case report form Data Source Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Alphanumeric

Choose all that apply.

No references available Adult NeuroRehab Core 3.00 2013-07-20 10:46:24.96 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Multiple Pre-Defined Values Selected

C21925 Balance falls frequency BalanceFallsFreq The frequency as related to falls The frequency as related to fall Falls Daily;Weekly;Occasionally;Rarely Daily;Weekly;Occasionally;Rarely Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where balance, falls, and ambulation are a focus.

No references available Adult NeuroRehab Supplemental-Highly Recommended 1.00 2016-06-06 14:17:52.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C02307 Adverse event verbatim term text AdvrsEvntVerbatimTermT xt The free-text field that describes the adverse event word for word as described by the participant The free-text field that describes the adverse event word for word as described by the participant Adverse event(s) Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where adverse events are a potential concern. Any untoward medical occurrence in a study participant/subject that does not necessarily have a causal relationship with the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a study intervention or study procedure, whether related or not related to the study intervention or procedure. Each AE should be listed on a separate row. Any worsening of a baseline condition or reoccurrence of a baseline condition that had previously ended for a time should be listed as an AE. Events, such as nausea and vomiting are considered two events, and therefore should be listed on separate lines. A participant/subject may experience an unexpected AE (UAE). An unexpected adverse reaction has a nature or severity of which is not consistent with the study intervention description (e.g., Investigator's Brochure for an unapproved investigational product or package insert/summary of product characteristics for an approved product). The unexpected AE must be reported, whether related to the study intervention or not, with as much detail as is available. See the Data Dictionary for additional information on coding the adverse events using either the Common Terminology Criteria for Adverse Events (CTCAE) or the Medical Dictionary for Regulatory Activities (MedDRA).

No references available Adult NeuroRehab Supplemental-Highly Recommended 3.1 10/16/2024 8:50:33 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 4000

Free-Form Entry

2188132
C14639 Ambulatory status AmbulatStatus Status that reflects the participant's ability to walk Status that reflects the participant's ability to walk Ambulatory status Able to ambulate independently (no help from another person) w/ or w/o device;With assistance (from person);Unable to ambulate;Unknown Patient ambulating without assistance (no help from another person) with or without a device. This means Patient is able to ambulate without help from another person. The use of a device, such as a cane, still meets this definition.;Patient ambulating with assistance of another person.;Patient is on bed rest. Patient is only getting out of bed to the bedside commode (or up in chair) and is primarily in the bed (or immobile).;Unknown or not documented. It is unable to determine from documentation. Alphanumeric

No instructions available

No references available Adult NeuroRehab Core 3.10 2024-02-29 15:49:22.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C22804 Pain present eleven point intensity scale PainPrsnt11IntensityScl Scale for the participant's current pain intensity based on an a scale of 0-10 Scale for the participant's current pain intensity based on an a scale of 0-10 0-10 Numeric Pain Rating Scale: 0;1;10;2;3;4;5;6;7;8;9 0;1;10;2;3;4;5;6;7;8;9 Numeric Values

NeuroRehab Supplemental - Highly Recommended for studies where pain may be relevant to the outcome. On a scale from 0 to 10, with 0 being no pain and 10 being the worst pain imaginable, how bad is your pain right now? 0 = no pain; 10 = the most intense pain imaginable Please note that if there is more than one pain, this section should be consistent with the International Spinal Cord Injury Pain Basic Data Set and apply to Worst, 2nd Worst and 3rd Worst pains.

No references available Adult NeuroRehab Supplemental-Highly Recommended 4.00 2023-05-18 16:39:30.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C02308 Adverse event during study indicator AdvrsEvntDuringStudyInd Indicator of whether the participant experienced any adverse events during the study Indicator of whether the participant experienced any adverse events during the study Has the participant/subject had any adverse events during the study? Yes;No;Unknown Yes;No;Unknown Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where adverse events are a potential concern.

No references available Adult NeuroRehab Supplemental-Highly Recommended 3.1 10/16/2024 8:51:02 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

2188132;3177812
C17402 Site name SiteName The name of the site for the study The name of the site for the study Site Name Alphanumeric

Enter the name of the study site.

No references available Adult NeuroRehab Core 3.00 2013-06-21 00:00:00.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 255

Free-Form Entry

C52564 Data source family relation specify text DataSourceFamRelSpecifyTxt Free-text field specifying the relationship of the family member from which data on the participant was obtained Free-text field specifying the relationship of the family member from which data on the participant was obtained Family, specify relation Alphanumeric

No instructions available

No references available Adult NeuroRehab Supplemental-Highly Recommended 1.10 2024-02-29 15:42:33.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 255

Free-Form Entry

C02309 Serious adverse event indicator SeriousAdvrsEvntInd Indicator of whether the adverse event is serious Indicator of whether the adverse event is serious Serious Adverse Event? Yes;No;Unknown Yes;No;Unknown Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where adverse events are a potential concern. This question should only be answered YES if the outcome of the AE results in at least one of the following: death; a life-threatening adverse drug experience; results in inpatient hospitalization or prolongation of existing hospitalization; a persistent or significant disability/incapacity; or a congenital anomaly/birth defect. If an AE is serious, this provides a trigger that additional information must be provided by the site investigator. The site investigator then completes a SAE form. Additionally, the site institution and/or IRB may also have an SAE form and procedures for reporting SAEs. If an AE is serious, this provides a trigger that additional information must be provided by the site investigator. The site investigator then completes a SAE form. Additionally, the site institution and/or IRB may also have an SAE form and procedures for reporting SAEs. Serious Adverse Event: An adverse event is defined by the investigator or sponsor as "serious" when it is life-threatening, results in death, requires in-patient hospitalization, prolongs existing hospitalization, results in persistent or significant disability, or is a congenital anomaly/birth defect.

No references available Adult NeuroRehab Supplemental-Highly Recommended 3.1 10/16/2024 8:50:29 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

2199908
C17447 Event description text EvntDescrTxt The free-text field to describe the event The free-text field to describe the even Describe event or problem Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where adverse events are a potential concern.

No references available Adult NeuroRehab Supplemental-Highly Recommended 3.00 2013-06-11 00:00:00.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 255

Free-Form Entry

C53062 Diabetes mellitus medical history indicator DiabetesMellMedHistInd Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Diabetes Yes;No;Unknown Yes;No;Unknown Alphanumeric

No instructions available

No references available Adult NeuroRehab Supplemental-Highly Recommended 3.00 2013-07-15 16:08:48.687 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C02310 Adverse event CTCAE term name AdvrsEvntCTCAETermName Name that represents the Common Terminology Criteria for Adverse Events (CTCAE) term for an adverse event Name that represents the Common Terminology Criteria for Adverse Events (CTCAE) term for an adverse event Adverse event(s) Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where adverse events are a potential concern. Any untoward medical occurrence in a study participant/subject that does not necessarily have a causal relationship with the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a study intervention or study procedure, whether related or not related to the study intervention or procedure. Each AE should be listed on a separate row. Any worsening of a baseline condition or reoccurrence of a baseline condition that had previously ended for a time should be listed as an AE. Events, such as nausea and vomiting are considered two events, and therefore should be listed on separate lines. A participant/subject may experience an unexpected AE (UAE). An unexpected adverse reaction has a nature or severity of which is not consistent with the study intervention description (e.g., Investigator's Brochure for an unapproved investigational product or package insert/summary of product characteristics for an approved product). The unexpected AE must be reported, whether related to the study intervention or not, with as much detail as is available. Code the adverse event verbatim text with the Common Terminology Criteria for Adverse Events (CTCAE) low level term name. CTCAE is a freely available standard terminology for adverse event data.

Common Terminology Criteria for Adverse Events (CTCAE) (http://evs.nci.nih.gov/ftp1/CTCAE/About.html) Adult NeuroRehab Supplemental-Highly Recommended 4 10/16/2024 8:50:33 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 255

Free-Form Entry

3125302
C18153 Data unknown text DataUnknwnTxt The free-text field to Mark an "X" in to record if data are unknown or not available The free-text field to Mark an "X" in to record if data are unknown or not availabl Unknown Alphanumeric

Check box for Unknown

No references available Adult NeuroRehab Core 3.00 2013-07-17 09:26:36.973 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 20

Free-Form Entry

C55568 Arthritis Indicator ArthritisInd Indicator as to whether the participant/subject has been diagnosed with arthritis Indicator as to whether the participant/subject has been diagnosed with arthritis Arthritis Yes;No Yes;No Alphanumeric

NeuroRehab Supplemental - Highly Recommended for motor rehabilitation studies.

No references available Adult NeuroRehab Supplemental-Highly Recommended 1.00 2017-05-12 16:07:02.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Multiple Pre-Defined Values Selected

C02311 Adverse event MedDRA lowest level term code AdvsEvntMedDRALowstLvlTermCode Code that corresponds to the Medical Dictionary for Regulatory Activities (MedDRA) Lowest Level Term (LLT) for an adverse event Code that corresponds to the Medical Dictionary for Regulatory Activities (MedDRA) Lowest Level Term (LLT) for an adverse event Adverse event(s) Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where adverse events are a potential concern. Any untoward medical occurrence in a study participant/subject that does not necessarily have a causal relationship with the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a study intervention or study procedure, whether related or not related to the study intervention or procedure. Each AE should be listed on a separate row. Any worsening of a baseline condition or reoccurrence of a baseline condition that had previously ended for a time should be listed as an AE. Events, such as nausea and vomiting are considered two events, and therefore should be listed on separate lines. A participant/subject may experience an unexpected AE (UAE). An unexpected adverse reaction has a nature or severity of which is not consistent with the study intervention description (e.g., Investigator's Brochure for an unapproved investigational product or package insert/summary of product characteristics for an approved product). The unexpected AE must be reported, whether related to the study intervention or not, with as much detail as is available. Code the adverse event verbatim text with the Medical Dictionary for Regulatory Activities (MedDRA) Lower Level Term (LLT) codes.

Medical Dictionary for Regulatory Activities (http://www.meddramsso.com/index.asp) Adult NeuroRehab Supplemental-Highly Recommended 3.1 10/16/2024 8:50:34 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 255

Free-Form Entry

3133353
C18667 Data source other text DataSourcOTH The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form Other, specify Alphanumeric

No instructions available

No references available Adult NeuroRehab Supplemental-Highly Recommended 1.00 2014-05-27 13:34:46.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 4000

Free-Form Entry

C55575 Neurological disorder indicator NeuroDisorderInd Indicator as to whether the participant/subject has a neurological disorder Indicator as to whether the participant/subject has a neurological disorder Neurological Disorder Yes;No Yes;No Alphanumeric

No instructions available

No references available Adult NeuroRehab Core 1.00 2017-05-12 16:07:02.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Multiple Pre-Defined Values Selected

C05130 Therapy or rehabilitation type TherpyRehabTyp Type of therapy or rehabilitation services received by the participant/subject Type of therapy or rehabilitation services received by the participant/subjec Type of Therapy or Rehabilitation Behavior support plan;Developmental Instruction;None;Occupational therapy;Other, specify;Physical therapy;Psychological;Recreational;Respiratory;Social skills training;Speech therapy;Vision Behavior support plan;Developmental Instruction;None;Occupational therapy;Other, specify;Physical therapy;Psychological;Recreational;Respiratory;Social skills training;Speech therapy;Vision Alphanumeric

Choose all that the participant/ subject receives. Response is obtained from report by the participant/subject, a reliable proxy or medical records. Add date stamp for when assessed. Recommend collection at end of initial medical care.

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): https://www.cdc.gov/nchs/icd/icd10cm.htm Adult NeuroRehab Core 3.00 2013-07-20 10:21:25.65 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Multiple Pre-Defined Values Selected

C18768 Therapy or rehabilitation other text TherpyRehabOTH The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject Other, specify Alphanumeric

No instructions available

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): https://www.cdc.gov/nchs/icd/icd10cm.htm Adult NeuroRehab Supplemental-Highly Recommended 1.00 2014-05-27 13:34:46.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 4000

Free-Form Entry

C57102 Sleep problem diagnosis type SlpPrbDiagTyp Type of diagnosis for sleep problem Type of diagnosis for sleep problem Sleep problem diagnosis Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where sleep may be relevant to the outcome.

No references available Adult NeuroRehab Supplemental-Highly Recommended 1.00 2017-12-27 15:52:17.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 255

Free-Form Entry

C05454 Hypertension indicator HypertensInd Indicator of hypertension. In adults, hypertension is defined as a systolic pressure >= 140 and a diastolic >= 90. In children, it is defined as systolic blood pressure >95th percentile for age Indicator of hypertension. In adults, hypertension is defined as a systolic pressure >= 140 and a diastolic >= 90. In children, it is defined as systolic blood pressure >95th percentile for ag Hypertension Yes;No;Unknown;Suspected Yes;No;Unknown;Suspected Alphanumeric

In adults, hypertension is defined as a systolic pressure = 140 and a diastolic pressure = 90.

No references available Adult NeuroRehab Supplemental-Highly Recommended 3.00 2013-07-20 10:21:25.65 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C19126 Clinical trial name ClinicalTrialName Name of clinical trial in which patient/participant is enrolled Name of clinical trial in which patient/participant is enrolled If patient/participant enrolled in any previous interventional clinical research studies/trials, enter trial name: Alphanumeric

No instructions available

No references available Adult NeuroRehab Core 1.00 2014-05-28 15:55:07.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 4000

Free-Form Entry

C58676 Birth sex assigned type BirthSexAssignTyp Self-reported phenotypic sex of participant, assigned at birth Self-reported phenotypic sex of participant, assigned at birth Sex assigned at birth Male;Female;Intersex;Unknown;Other, specify Male;Female;Intersex;Unknown;Other, specify Alphanumeric

Choose one. Response is obtained by report of the participant/subject or caretaker. The assemblage of physical properties or qualities by which male is distinguished from female. Male is a person who belongs to the sex that normally produces sperm. The term is used to indicate biological sex distinctions, cultural gender role distinctions, or both. Female is a person who belongs to the sex that normally produces ova. The term is used to indicate biological sex distinctions, or cultural gender role distinctions, or both. Intersex is a person (one of unisexual specimens) who is born with genitalia and/or secondary sexual characteristics of indeterminate sex, or which combine features of both sexes. The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget Directive No. 15.

No references available Adult NeuroRehab Core 1.1 10/16/2024 8:51:15 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C06005 Data collected date and time DataCollDateTime Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performe Date of data collection Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult NeuroRehab Core 3.00 2013-07-24 21:00:23.88 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Free-Form Entry

C19247 Subject ID SubIDNam Subject identification ID Subject identification ID Subject ID Alphanumeric

The participant or subject identifiers or IDs should be assigned by the study.

No references available Adult NeuroRehab Core 1.00 2014-06-05 13:10:49.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 255

Free-Form Entry

C58677 Gender identity type GenderIdTyp Gender identity self-identified by the participant. Gender type may or may not match sex assigned at birth Gender identity self-identified by the participant. Gender type may or may not match sex assigned at birth Gender identity Male;Female;Unknown;Other, specify Male;Female;Unknown;Other, specify Alphanumeric

Choose one. Response is obtained by report of the participant/subject or caretaker. Internally held sense of the participant/subject gender which may or may not correspond to the individual's genotypic or phenotypic sex.

No references available Adult NeuroRehab Core 1.1 10/16/2024 8:51:16 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C00007 Birth date BirthDate Date (and time, if applicable and known) the participant was born Date (and time, if applicable and known) the participant was born Date of birth Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.) and in the format acceptable to the study database. Recording date of birth will give the most detailed information required for calculation of age and is recommended as first choice. However, in some studies recording date of birth may elicit discussions on a potential violation of privacy legislation and specifically HIPAA regulations. In these cases, the calculated age should be recorded.

ISO 8601 - http://www.iso.org/iso/iso_catalogue.htm Adult NeuroRehab Core 3.1 10/16/2024 8:51:14 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Free-Form Entry

793
C06059 Pain location anatomic site PainLocAntmicSite Anatomic site on the body where the pain is experienced Anatomic site on the body where the pain is experienced Pain locations sites Head;Throat;Neck;Shoulder;Upper arm;Elbow;Forearm;Wrist;Hand/Fingers;Chest;Abdomen;Pelvis/Genitalia;Upper back;Lower back;Buttocks;Hip;Anus;Upper leg/Thigh;Knee;Shin;Calf;Ankle;Foot/Toes Head;Throat;Neck;Shoulder;Upper arm;Elbow;Forearm;Wrist;Hand/Fingers;Chest;Abdomen;Pelvis/Genitalia;Upper back;Lower back;Buttocks;Hip;Anus;Upper leg/Thigh;Knee;Shin;Calf;Ankle;Foot/Toes Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where pain may be relevant to the outcome. Can be more than one, so check all that apply.

Widerstrom-Noga E, Biering-Sorensen F, Bryce T, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ. The international spinal cord injury pain basic data set. Spinal Cord. 2008 Dec;46(12):818-23. Widerstrom-Noga E, Biering-Sorensen F, Bryce TN, C Adult NeuroRehab Supplemental-Highly Recommended 3.00 2013-07-17 09:26:36.973 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C19256 Study protocol name StudyProtocolName Name of study protocol Name of study protocol Study Name/ID pre-filled Alphanumeric

No instructions available

No references available Adult NeuroRehab Core 1.00 2014-06-05 16:38:14.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 4000

Free-Form Entry

C58780 Birth sex assigned type other text BirthSexAssignTypOTH The free-text field related to 'Birth sex assigned type', specifying other text. Self-reported phenotypic sex of participant, assigned at birth The free-text field related to 'Birth sex assigned type', specifying other text. Self-reported phenotypic sex of participant, assigned at birth Other, specify Alphanumeric

No instructions available

No references available Adult NeuroRehab Supplemental-Highly Recommended 1.1 10/16/2024 8:51:15 AM Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations 4000

Free-Form Entry

C00317 Medical history condition start date and time MedclHistCondStrtDateTime Date (and time, if applicable and known) for the start of an event in the participant's medical history Date (and time, if applicable and known) for the start of an event in the participant's medical history Medical history condition start date and time Date or Date & Time

NeuroRehab Specific: Refers to the neurological disorder being studied. Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult NeuroRehab Core 3.10 2024-02-29 15:42:43.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Free-Form Entry

2543596
C06060 Pain location indicator PainTypLatLoc Indicates if the participant experienced pain in the particular location described jointly by the laterality and anatomic site Indicates if the participant experienced pain in the particular location described jointly by the laterality and anatomic site Pain locations sites Right;Midline;Left Right;Midline;Left Alphanumeric

NeuroRehab Supplemental - Highly Recommended for studies where pain may be relevant to the outcome. Can be more than one, so check all that apply.

Widerstrom-Noga E, Biering-Sorensen F, Bryce T, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ. The international spinal cord injury pain basic data set. Spinal Cord. 2008 Dec;46(12):818-23. Widerstrom-Noga E, Biering-Sorensen F, Bryce TN, C Adult NeuroRehab Supplemental-Highly Recommended 3.00 2013-07-17 09:26:36.973 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Single Pre-Defined Value Selected

C19500 Assessment performed date AssessmentPerformedDate The date of assessment of the examination being performed The date of assessment of the examination being performed Date of assessment Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult NeuroRehab Core 1.00 2014-06-18 08:10:12.0 Assessments and Examinations Demographic and Clinical Conditions General and Motor Assessments and Examinations

Free-Form Entry

CSV