CDE Detailed Report

Disease: Duchenne Muscular Dystrophy/Becker Muscular Dystrophy
Sub-Domain: Devices
CRF: External Devices and Other Treatments

Displaying 1 - 28 of 28
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C18181 Therapy rehabilitation session duration TherapuRehabSessDur Duration of a therapy or rehabilitation session Duration of a therapy or rehabilitation session Duration 15 minutes;30 minutes;45 minutes;60 minutes;Other, specify 15 minutes;30 minutes;45 minutes;60 minutes;Other, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

minute
C18199 Therapeutic use indicator TherapuUseInd Indicator for whether the participant/subject uses the type of therapy Indicator for whether the participant/subject uses the type of therapy Use of Therapy Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18182 Therapy rehabilitation frequency TherapuRehabFreq Frequency the participant/subject received the therapy or rehabilitation Frequency the participant/subject received the therapy or rehabilitation Frequency 0;1;2;3;4;5;6;7 0;1;2;3;4;5;6;7 Numeric Values

days/week

CDISC SDTM Frequency Terminology (http://www.cancer.gov/cancertopics/cancerlibrary/terminologyresources/cdisc) Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18200 Therapeutic stretching type TherapuStretchTyp Type of stretching therapy Type of stretching therapy Stretching Active;Passive Active;Passive Alphanumeric

check all that apply

No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Multiple Pre-Defined Values Selected

C12679 Mobility device use indicator MobilityDvcUseInd Whether the participant/subject uses a mobility device (e.g., wheelchair) Whether the participant/subject uses a mobility device (e.g., wheelchair) Does the participant/subject use mobility devices? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Yes(complete section 1)
Supplemental - Highly Recommended

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18183 Wheelchair driven subject indicator WheelchairDriveSubjInd Indicator for whether the power wheelchair is driven by the participant/subject Indicator for whether the power wheelchair is driven by the participant/subject Is the wheelchair driven by the participant/ subject? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Supplemental - Highly Recommended

No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18870 Mobility device other text MobilityDvcOTH The free-text field related to 'Mobility device type' specifying other text. Type for all mobility devices currently used by the participant/subject The free-text field related to 'Mobility device type' specifying other text. Type for all mobility devices currently used by the participant/subject Other, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 External Devices and Other Treatments Devices Treatment/Intervention Data 4000

Free-Form Entry

C12682 Orthosis use indicator OrthosisUseInd Whether the participant/subject uses orthosis (i.e., external orthopedic appliance that prevents or assists the movement of the spine or limbs) Whether the participant/subject uses orthosis (i.e., external orthopedic appliance that prevents or assists the movement of the spine or limbs) Does the participant/subject use orthoses? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Yes(complete section 2)

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18188 Other mobility device type OthrMobilityDevTyp Type of other mobility device that the participant/ subject uses Type of other mobility device that the participant/ subject uses Other mobility device Scooter;Stroller;Standers;Other, specify Scooter;Stroller;Standers;Other, specify Alphanumeric

Choose all that apply
Supplemental - Highly Recommended

No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Multiple Pre-Defined Values Selected

C18883 Orthosis other text OrthosisOTH The free-text field related to 'Orthosis type' specifying other text. Type of orthosis (i.e., external orthopedic appliance that prevents or assists the movement of the spine or limbs) The free-text field related to 'Orthosis type' specifying other text. Type of orthosis (i.e., external orthopedic appliance that prevents or assists the movement of the spine or limbs) Other, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 External Devices and Other Treatments Devices Treatment/Intervention Data 4000

Free-Form Entry

C12683 Mobility device type MobilityDvcTyp Type for all mobility devices currently used by the participant/subject Type for all mobility devices currently used by the participant/subject Mobility Devices Manual wheelchair;Power wheelchair;Power assist wheelchair;Other Mobility Device;Positioning Wheelchair;Upper Extremity Devices Manual wheelchair;Power wheelchair;Power assist wheelchair;Other Mobility Device;Positioning Wheelchair;Upper Extremity Devices Alphanumeric

Supplemental - Highly Recommended

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Multiple Pre-Defined Values Selected

C18190 Regular daily tilt indicator RegDailyTiltInd Indicator for whether the participant/subject has a regular daily tilt in the positioning of wheelchair Indicator for whether the participant/subject has a regular daily tilt in the positioning of wheelchair Regular/daily tilt Yes;No;Not applicable;Unknown Yes;No;Not applicable;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C19066 Therapy rehabilitation session other text TherapyRehabSessOTH The free-text field related to 'Therapy rehabilitation session duration' specifying other text. Duration of a therapy or rehabilitation session The free-text field related to 'Therapy rehabilitation session duration' specifying other text. Duration of a therapy or rehabilitation session Other, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data 4000

Free-Form Entry

minute
C12684 Mobility device type use indicator MobltyDevTypUseInd Indicator whether the participant/subject currently uses the selected types of mobility device Indicator whether the participant/subject currently uses the selected types of mobility device Device used? Yes;No;Not applicable;Unknown Yes;No;Not applicable;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18191 Serial cast start date SerialCastStartDate Date on which the serial casting therapy started Date on which the serial casting therapy started Start Date Date or Date & Time No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Free-Form Entry

C19067 Other mobility device other text OthrMobilityDevOTH The free-text field related to 'Other mobility device type' specifying other text. Type of other mobility device that the participant/ subject uses The free-text field related to 'Other mobility device type' specifying other text. Type of other mobility device that the participant/ subject uses Other, specify Alphanumeric

Choose all that apply

No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data 4000

Free-Form Entry

C12685 Wheelchair use frequency WheelchairUseFreq Frequency with which the participant/subject uses their wheelchair, if applicable Frequency with which the participant/subject uses their wheelchair, if applicable Power Wheelchair Full-time;Part-time Full-time;Part-time Alphanumeric

Supplemental-Highly Recommended

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18192 Serial cast stop date SerialCastStopDate Date on which the serial casting therapy ended Date on which the serial casting therapy ended Stop Date Date or Date & Time No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Free-Form Entry

C19068 Upper extremity device specify text UpperExtremityDevST The free-text field related to 'Upper extremity device indicator'. Indicator for whether an upper extremity device is used The free-text field related to 'Upper extremity device indicator'. Indicator for whether an upper extremity device is used Yes, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data 4000

Free-Form Entry

C12686 Orthosis type use indicator OrthsisTypUseInd Indicator whether the participant/subject currently uses the selected types of orthosis Indicator whether the participant/subject currently uses the selected types of orthosis Device used? Yes;No;Not applicable;Unknown Yes;No;Not applicable;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18193 Support stand use indicator SuprtStandUseInd Indicator for whether the participant/subject has a supported standing use in the positioning of wheelchair Indicator for whether the participant/subject has a supported standing use in the positioning of wheelchair Supported standing use Yes;No;Not applicable;Unknown Yes;No;Not applicable;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C21667 Therapy rehabilitation ICD 10 CM code TherpyRehabICD10CMCd ICD-10-CM code that describes the therapy or rehabilitation received by the participant/subject ICD-10-CM code that describes the therapy or rehabilitation received by the participant/subject Therapy ICD-9-CM code Alphanumeric International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): http://www.cdc.gov/nchs/icd/icd9cm.htm Adult;Pediatric Supplemental 1.00 2013-07-20 10:21:25.65 External Devices and Other Treatments Devices Treatment/Intervention Data 255

Free-Form Entry

C12688 Orthosis knee ankle foot orthosis ischial weight bearing indicator OrthsisKnAnkFoOIschlWgtBrngInd Indicator whether any knee-ankle-foot orthosis (KAFO) currently used by the participant/subject is ischial weight bearing Indicator whether any knee-ankle-foot orthosis (KAFO) currently used by the participant/subject is ischial weight bearing Yes, ischial weight bearing? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18195 Ankle foot orthosis type AnklFootOrthosisTyp Type of ankle-foot orthosis the participant/subject uses Type of ankle-foot orthosis the participant/subject uses Type Solid;Articulating;Dynamic ankle-foot orthosis style type Solid;Articulating;Dynamic ankle-foot orthosis style type Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C12943 Orthosis type OrthosisTyp Type of orthosis (i.e., external orthopedic appliance that prevents or assists the movement of the spine or limbs) Type of orthosis (i.e., external orthopedic appliance that prevents or assists the movement of the spine or limbs) Orthoses and Positioning Devices Inserts of any type;Supramalleolar orthotic;Ankle-foot orthosis (AFO);Knee-ankle-foot orthosis;Hip-knee-ankle-foot orthosis (HKAFO);Stander;Body jacket/Thoracic-lumbar-sacral orthoses;Reciprocal gait orthoses (RGO);Other, specify Inserts of any type;Supramalleolar orthotic (SMO);Ankle-foot orthosis (AFO);Knee-ankle-foot orthosis (KAFO);Hip-knee-ankle-foot orthosis (HKAFO);Stander;Body jacket/Thoracic-lumbar-sacral orthoses (TLSO);Reciprocal gait orthoses (RGO);Other, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 External Devices and Other Treatments Devices Treatment/Intervention Data

Multiple Pre-Defined Values Selected

C18197 Upper extremity device indicator UpperExtremityDevInd Indicator for whether an upper extremity device is used Indicator for whether an upper extremity device is used Upper extremity devices Yes, specify;No;Not applicable;Unknown Yes, specify;No;Not applicable;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18176 Therapy rehabilitation indicator TherapyRehabInd Indicator for whether the participant/subject uses other therapy or rehabilitation procedures besides the use of mobility devices, orthoses, and positioning devices Indicator for whether the participant/subject uses other therapy or rehabilitation procedures besides the use of mobility devices, orthoses, and positioning devices Besides use of mobility devices, orthoses, and positioning devices, does the participant/ subject utilize other therapies? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If Yes, complete section 3

No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Single Pre-Defined Value Selected

C18198 Ankle foot orthosis use type AnklFootOrthosisUseTyp Type of use for ankle-foot orthosis Type of use for ankle-foot orthosis Use Walking;Resting splints Walking;Resting splints Alphanumeric

Choose all that apply

No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 External Devices and Other Treatments Devices Treatment/Intervention Data

Multiple Pre-Defined Values Selected

CSV