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ID
6158
Description
Patientenfragebogen Multiple Sklerose REGIMS http://epi.uni-muenster.de
Link
Keywords
Versions (18)
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 11/29/14 11/29/14 - Martin Dugas
- 12/1/14 12/1/14 - Martin Dugas
- 12/2/14 12/2/14 - Martin Dugas
- 12/3/14 12/3/14 - Martin Dugas
- 12/3/14 12/3/14 - Martin Dugas
- 12/4/14 12/4/14 - Martin Dugas
- 12/5/14 12/5/14 - Martin Dugas
- 12/5/14 12/5/14 - Martin Dugas
- 12/8/14 12/8/14 - Martin Dugas
- 12/9/14 12/9/14 - Martin Dugas
Uploaded on
December 9, 2014
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Multiple Sclerosis - Patient Questionnaire (REGIMS)
Multiple Sclerosis - Patient Questionnaire (REGIMS)
- StudyEvent: ODM-Test
Similar models
Multiple Sclerosis - Patient Questionnaire (REGIMS)
- StudyEvent: ODM-Test
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Birth Year
Item
Birth Year
integer
C2826771 (UMLS CUI-1)
Age at disease onset
Item
How old were You when You had Your first symptoms of multiple sclerosis?
integer
C0001779 (UMLS CUI-1)
C0277793 (UMLS CUI-2)
C0277793 (UMLS CUI-2)
Age at diagnosis
Item
How old were You when multiple sclerosis was diagnosed?
integer
C1828181 (UMLS CUI-1)
CL Item
Neurology (1)
C0027855 (UMLS CUI-1)
CL Item
Opthalmology (2)
C0029087 (UMLS CUI-1)
CL Item
Pediatrics (3)
C0030755 (UMLS CUI-1)
CL Item
General Practitioners (4)
C0017319 (UMLS CUI-1)
CL Item
Other (5)
Medical Speciality
Item
Diagnosis: other medical specialty
text
C0037778 (UMLS CUI-1)
CL Item
Doppelbilder (1)
CL Item
Andere Sehstörungen, Verschwommensehen (2)
CL Item
Gefühlsstörung des Gesichts (3)
CL Item
Andere Gefühlsstörungen (4)
CL Item
Gesichtslähmungen (5)
CL Item
Andere motorische Störungen (Schwäche/Lähmungen in Armen/Beinen) (6)
CL Item
Hörminderung/Sprach-/Schluckstörung (7)
CL Item
Koordinations- oder Feinmotorikstörungen (8)
CL Item
Konzentrations- oder Gedächtnisstörungen (9)
CL Item
Erschöpfbarkeit, verminderte Belastbarkeit (10)
CL Item
Euphorische/gesteigerte Stimmung (11)
CL Item
Gedrückte Stimmung, vermehrte Traurigkeit (12)
CL Item
Zittern/Zeigeunsicherheit von Händen/Armen (13)
CL Item
Blasenfunktionsstörungen (vermehrt/verminderter Harndrang/Inkontinenz) (14)
CL Item
Darmentleerungsstörung (Verstopfung/Durchfall/Inkontinenz) (15)
CL Item
Sexuelle Störungen (16)
CL Item
Andere (Wenn ja bitte nennen) (17)
First symptoms
Item
First symptoms: other
text
C0205435 (UMLS CUI-1)
C1457887 (UMLS CUI-2)
C1457887 (UMLS CUI-2)
Item Group
Diagnostic procedure within the past 12 months
C0430022 (UMLS CUI-1)
C3843288 (UMLS CUI-2)
C3843288 (UMLS CUI-2)
MRT Brain
Item
MRT Brain
boolean
C0024485 (UMLS CUI-1)
C0006104 (UMLS CUI-2)
C0006104 (UMLS CUI-2)
MRT Spinal Cord
Item
MRT Spinal Cord
boolean
C0024485 (UMLS CUI-1)
C0037925 (UMLS CUI-2)
C0037925 (UMLS CUI-2)
CT scan of brain
Item
CT scan of brain
boolean
C0412585 (UMLS CUI-1)
Lumbar Puncture
Item
Lumbar Puncture
boolean
C0037943 (UMLS CUI-1)
Echocardiography
Item
Echocardiography
boolean
C0013516 (UMLS CUI-1)
ECG
Item
ECG
boolean
C1623258 (UMLS CUI-1)
Item Group
Fatigability Multiple Sclerosis
C0231230 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
C0026769 (UMLS CUI-2)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(7)
Item
Erschöpfung beeinträchtigt mich bei der Arbeit im familiären und sozialen Leben
integer
C3830176 (UMLS CUI-1)
Code List
Erschöpfung beeinträchtigt mich bei der Arbeit im familiären und sozialen Leben
CL Item
trifft überhaupt nicht zu (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
trifft vollständig zu (7)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(7)
Number of Hospital Stays
Item
integer
C0237753 (UMLS CUI-1)
C3489408 (UMLS CUI-2)
C3489408 (UMLS CUI-2)
Number of other hospital stays within past 12 months
Item
integer
Number of outpatient visits within past 12 months
Item
integer
Rehabilitation Days Within past 12 months
Item
integer
C0034991 (UMLS CUI-1)
C3640790 (UMLS CUI-2)
C3843288 (UMLS CUI-3)
C3640790 (UMLS CUI-2)
C3843288 (UMLS CUI-3)
Crutch
Item
boolean
C0180199 (UMLS CUI-1)
Rollator
Item
boolean
C0184339 (UMLS CUI-1)
Housing modification
Item
boolean
C0020056 (UMLS CUI-1)
C0392747 (UMLS CUI-2)
C0392747 (UMLS CUI-2)
Car modification
Item
boolean
C0004381 (UMLS CUI-1)
C0392747 (UMLS CUI-2)
C0392747 (UMLS CUI-2)
Foot lifter cuff
Item
boolean
Wheelchair
Item
boolean
C0043143 (UMLS CUI-1)
Bed lift
Item
boolean
Stairway lift
Item
boolean
C1140673 (UMLS CUI-1)
Eyeglasses
Item
boolean
C0015421 (UMLS CUI-1)
Incontinence pads
Item
boolean
C0085099 (UMLS CUI-1)
Other aid
Item
text
C0449435 (UMLS CUI-1)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
Paid by patient
Item
boolean
Nursing home visit
Item
boolean
C0848616 (UMLS CUI-1)
Domestic helper
Item
boolean
C0341652 (UMLS CUI-1)
Ambulance transport
Item
boolean
C0809765 (UMLS CUI-1)
Taxi transportation
Item
boolean
C0497715 (UMLS CUI-1)
Social counseling
Item
boolean
C0474156 (UMLS CUI-1)
CL Item
(1)
CL Item
(0)
CL Item
(-1)
Item
Wie zufrieden sind Sie mit dem Erfolg lhrer derzeitigen MS-Therapie?
integer
C0679864 (UMLS CUI-1)
CL Item
Sehr zufrieden (1)
CL Item
Eher zufrieden (2)
CL Item
Eher unzufrieden (3)
CL Item
Sehr unzufrieden (4)
CL Item
Very satisfied (1)
C3840671 (UMLS CUI-1)
CL Item
Moderately satisfied (2)
C3843336 (UMLS CUI-1)
CL Item
Moderately dissatisfied (3)
C3843338 (UMLS CUI-1)
CL Item
Very dissatisfied (4)
C3843339 (UMLS CUI-1)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(7)
CL Item
(8)
CL Item
(9)
Family member other
Item
text
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(7)
CL Item
(8)
CL Item
(9)
CL Item
(10)
CL Item
(11)
CL Item
(12)
CL Item
(13)
CL Item
(14)
CL Item
(15)
Medication side effect
Item
text
C0041755 (UMLS CUI-1)
Other symptoms
Item
text
Item Group
Medication within last 7 days
C0013227 (UMLS CUI-1)
C3843296 (UMLS CUI-2)
C3843296 (UMLS CUI-2)
Medication name
Item
text
C2360065 (UMLS CUI-1)
Dose
Item
text
C1960417 (UMLS CUI-1)
Daily
Item
boolean
C0332173 (UMLS CUI-1)
CL Item
(1)
CL Item
(2)
CL Item
(3)
Payment source patient
Item
boolean
C3263709 (UMLS CUI-1)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(0)
CL Item
(0)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
Sick Leave
Item
integer
C0242807 (UMLS CUI-1)
Sick leave due to multiple sclerosis
Item
integer
C0242807 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
C0026769 (UMLS CUI-2)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
Retirement age
Item
integer
C0035345 (UMLS CUI-1)
C0001779 (UMLS CUI-2)
C0001779 (UMLS CUI-2)
Retirement due to Multiple Sclerosis
Item
boolean
CL Item
(1)
CL Item
(2)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
Household
Item
boolean
C0020052 (UMLS CUI-1)
Born in Germany
Item
boolean
C1277360 (UMLS CUI-1)
Lived in Germany since
Item
partialDate
Country of birth
Item
text
C1300001 (UMLS CUI-1)
CL Item
Never smoked (1)
C0425293 (UMLS CUI-1)
CL Item
Former smoker (2)
C0337671 (UMLS CUI-1)
CL Item
Light tobacco smoker (3)
C3494624 (UMLS CUI-1)
CL Item
Heavy smoker (4)
C0857118 (UMLS CUI-1)
Cigarettes per day
Item
integer
C3694146 (UMLS CUI-1)
Smoking pipes per day
Item
integer
C0240766 (UMLS CUI-1)
C0439505 (UMLS CUI-2)
C0439505 (UMLS CUI-2)
Cigars per day
Item
integer
C0678446 (UMLS CUI-1)
C0439505 (UMLS CUI-2)
C0439505 (UMLS CUI-2)
Smoking history
Item
integer
C1519384 (UMLS CUI-1)
Smoking cessation age
Item
integer
C3172720 (UMLS CUI-1)
Smoking history
Item
integer
C1519384 (UMLS CUI-1)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(7)
CL Item
(8)
CL Item
(9)
CL Item
(10)
CL Item
(11)
CL Item
(12)
Other physician
Item
text
Number of doctor visits within past 12 months
Item
integer
Health status today
Item
integer
C0018759 (UMLS CUI-1)
C0750526 (UMLS CUI-2)
C0750526 (UMLS CUI-2)
Disability
Item
boolean
C0231170 (UMLS CUI-1)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(7)
Nursing care requested
Item
boolean
C0028682 (UMLS CUI-1)
C0332153 (UMLS CUI-2)
C0332153 (UMLS CUI-2)
CL Item
(0)
CL Item
(1)
CL Item
(2)
CL Item
(1)
CL Item
(2)
CL Item
(3)
Nursing care start date
Item
partialDate
C0028682 (UMLS CUI-1)
C0808070 (UMLS CUI-2)
C0808070 (UMLS CUI-2)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
CL Item
(6)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(2)
CL Item
(1)
CL Item
(0)
Item
integer
C0449295 (UMLS CUI-1)
C2963282 (UMLS CUI-2)
C2963282 (UMLS CUI-2)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(2)
CL Item
(1)
CL Item
(0)
Item
integer
C0449295 (UMLS CUI-1)
C3828907 (UMLS CUI-2)
C3828907 (UMLS CUI-2)
CL Item
(2)
CL Item
(1)
CL Item
(0)
Item
integer
C0449295 (UMLS CUI-1)
C2963889 (UMLS CUI-2)
C2963889 (UMLS CUI-2)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(2)
CL Item
(1)
CL Item
(0)
Item
integer
C0449295 (UMLS CUI-1)
C0518460 (UMLS CUI-2)
C1305428 (UMLS CUI-3)
C0518460 (UMLS CUI-2)
C1305428 (UMLS CUI-3)
CL Item
(2)
CL Item
(1)
CL Item
(0)
Physical Health Cut Down Time on Work past 4 weeks
Item
boolean
C3828897 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Physical Health Accomplish Less past 4 weeks
Item
boolean
C3828898 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Physical Health Limited in the Kind of Work past 4 weeks
Item
boolean
C3828895 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Physical Health Difficulty Perform Work past 4 weeks
Item
boolean
C3828896 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Emotional Problem Cut Down Time on Work past 4 weeks
Item
boolean
C3828931 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Emotional Problem Accomplish Less past 4 weeks
Item
boolean
C3828932 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Emotional Problem Did Not Do Work Carefully past 4 weeks
Item
boolean
C3828930 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Item
integer
C3828928 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Code List
Extend Physical Health or Emotional Problem Interfere With Social Activities past 4 weeks
CL Item
(0)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(0)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
Item
integer
C3828899 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
CL Item
(1)
CL Item
(2)
CL Item
(3)
CL Item
(4)
CL Item
(5)
Item
integer
C3828892 (UMLS CUI-1)
C3828653 (UMLS CUI-2)
C3828653 (UMLS CUI-2)
Code List
Time Physical Health or Emotional Problem Interfere With Social Activities past 4 weeks
CL Item
(4)
CL Item
(3)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(-1)
CL Item
(-2)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(-1)
CL Item
(-2)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(-1)
CL Item
(-2)
CL Item
(2)
CL Item
(1)
CL Item
(0)
CL Item
(-1)
CL Item
(-2)