CDE Detailed Report

Disease: Spinal Cord Injury
Sub-Domain: Therapies
CRF: Falls Diary

Displaying 1 - 15 of 15
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
C58652 Fall record time AM PM category FallRecordTimeAmPmCat Category of the part of the day in which the time of the subject/participant's fall occurred. Category of the part of the day in which the time of the subject/participant's fall occurred. Time of Day am;PM am;PM Alphanumeric Adult;Pediatric Supplemental 1.00 2019-11-20 13:35:23.0 Falls Diary Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C21638 Fall details footwear specify text FallDetFootwrSpecfyTxt The free-text field to specify the type of other footwear worn when the fall recorded in the Falls Diary occurred. The free-text field to specify the type of other footwear worn when the fall recorded in the Falls Diary occurred. Other, please describe Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Falls Diary Therapies Treatment/Intervention Data 255

Free-Form Entry

C21639 Fall details assistive device type FallDetAssistDevTyp Type of assistive device(s) the participant/subject was using when the fall recorded in the Falls Diary occurred. Type of assistive device(s) the participant/subject was using when the fall recorded in the Falls Diary occurred. If you fell while walking, were you using an assistive device Cane;One crutch;Other, please specify;Two crutches;Walker Cane;One crutch;Other, please specify;Two crutches;Walker Alphanumeric

check all that apply

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Multiple Pre-Defined Values Selected

C21640 Fall details assistive device specify text FallDetAssisDevSpecfyTxt The free-text field to specify the other type of assistive device used when the fall recorded in the Falls Diary occurred. The free-text field to specify the other type of assistive device used when the fall recorded in the Falls Diary occurred. Other, please specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Falls Diary Therapies Treatment/Intervention Data 255

Free-Form Entry

C10628 Diary day falls status DiaryFallsStatus Describes whether the participant/subject experienced falls on a particular day The status to report occurrence of fall(s) that the participant/subject experienced on the day of the diary as part of the Clinical Milestones and Events questionnaire Falls Data Collection Grid No Falls;Near Falls;Falls No Falls;Near Falls;Falls Alphanumeric

If a near fall or falls is checked, indicate the number.

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Single Pre-Defined Value Selected

C21641 Fall details injury sustained test FallDetInjSustTxt Description of the injuries sustained when the fall recorded in the Falls Diary occurred. Description of the injuries sustained when the fall recorded in the Falls Diary occurred. Injuries sustained: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data 255

Free-Form Entry

C10629 Diary day falls experienced number DiaryNearFallDailyCt Number of falls the participant/subject experienced on a particular day. Number of near falls that the participant/subject experienced on the day of the diary as part of the Clinical Milestones and Events questionnaire Falls Numeric Values

Record the number of falls on days when "Falls" is checked/chosen

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Free-Form Entry

C21642 Fall details not walking type FallDetNotWalkTyp Details of the participant's/subject's position if fall recorded in Falls Diary occurred when not walking. Details of the participant's/subject's position if fall recorded in Falls Diary occurred when not walking. If you fell while sitting, transferring or moving in your wheelchair, please check all statements that apply: I fell while moving my wheelchair;I fell while transferring into the shower/bath;I fell while transferring to or from my wheelchair;When I fell, I was (check all that apply) I fell while moving my wheelchair;I fell while transferring into the shower/bath;I fell while transferring to or from my wheelchair;When I fell, I was (check all that apply) Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Multiple Pre-Defined Values Selected

C10630 Diary day near falls experienced number DiaryFallDailyCt Number of near falls the participant/subject experienced on a particular day. Number of falls that the participant/subject experienced on the day of the diary as part of the Clinical Milestones and Events questionnaire Near Falls Numeric Values

Record the number of near falls on days when "Near Falls" is checked/chosen

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Free-Form Entry

C21643 Fall details specify type FallDetSpecTyp Description of what the participant/subject was doing when the fall recorded in Falls Diary occurred when not walking. Description of what the participant/subject was doing when the fall recorded in Falls Diary occurred when not walking. When I fell, I was Being helped by someone else;Using equipment such as a transfer board, hoyer lift, etc.;Using other equipment Being helped by someone else;Using equipment such as a transfer board, hoyer lift, etc.;Using other equipment Alphanumeric

(check all that apply)

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Multiple Pre-Defined Values Selected

C19144 Activity description ActivityDescription Description of activity Description of activity Activity: Alphanumeric Adult;Pediatric Supplemental 1.00 2014-05-29 10:46:32.0 Falls Diary Therapies Treatment/Intervention Data 4000

Free-Form Entry

C21634 Diary day falls date DiaryDayFallsDate Date in the diary when the participant/subject recorded a fall. Date in the diary when the participant/subject recorded a fall. Date 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.).

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Free-Form Entry

C21635 Fall record date and time FallRecDatTime Date and time for each fall recorded in the falls diary by the participant/subject. Date and time for each fall recorded in the falls diary by the participant/subject. Date; Time of Day 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.).

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Free-Form Entry

C21636 Fall details location text FallDetLocTxt Location of the fall the participant/subject experienced recorded in the Falls Diary. Location of the fall the participant/subject experienced recorded in the Falls Diary. Location: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data 255

Free-Form Entry

C21637 Fall details footwear type FallDetFootwrTyp Type of footwear the participant/subject was wearing when the fall recorded in the Falls Diary occurred. Type of footwear the participant/subject was wearing when the fall recorded in the Falls Diary occurred. If you fell while walking, were you wearing any of the following Leg braces;Only socks;Other, please specify;Socks and shoes/sneakers Leg braces;Only socks;Other, please specify;Socks and shoes/sneakers Alphanumeric

check all that apply

Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Falls Diary Therapies Treatment/Intervention Data

Multiple Pre-Defined Values Selected

CSV