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Multiple Sclerosis - Patient Questionnaire (REGIMS)

German English

Multiple Sclerosis - Patient Questionnaire (REGIMS)

1 forms  
General information
Description

General information

Alias
UMLS CUI-1
C1508263
Birth Year
Description

Birth Year

Data type

integer

Alias
UMLS CUI-1
C2826771
Age at disease onset
Data type

integer

Measurement units
  • Jahre
Alias
UMLS CUI-1
C0001779
UMLS CUI-2
C0277793
Jahre
Wie alt waren Sie als die Diagnose MS gestellt wurde?
Description

Age at diagnosis

Data type

integer

Measurement units
  • Jahre
Alias
UMLS CUI-1
C1828181
Jahre
Medical Speciality
Data type

integer

Alias
UMLS CUI-1
C0037778
Medical Speciality
Data type

text

Alias
UMLS CUI-1
C0037778
First Symptoms
Description

First Symptoms

Alias
UMLS CUI-1
C0205435
UMLS CUI-2
C1457887
Welche Erstsymptome sind bei Ihnen aufgetreten?
Description

First symptoms

Data type

integer

Alias
UMLS CUI-1
C0205435
UMLS CUI-2
C1457887
Erstsymptome: Andere
Description

First symptoms

Data type

text

Alias
UMLS CUI-1
C0205435
UMLS CUI-2
C1457887
Diagnostic procedure within the past 12 months
Description

Diagnostic procedure within the past 12 months

Alias
UMLS CUI-1
C0430022
UMLS CUI-2
C3843288
Kernspintomographie Gehirn
Description

MRT Brain

Data type

boolean

Alias
UMLS CUI-1
C0024485
UMLS CUI-2
C0006104
MRT Spinal Cord
Data type

boolean

Alias
UMLS CUI-1
C0024485
UMLS CUI-2
C0037925
CT scan of brain
Data type

boolean

Alias
UMLS CUI-1
C0412585
Lumbar Puncture
Data type

boolean

Alias
UMLS CUI-1
C0037943
Echocardiography
Data type

boolean

Alias
UMLS CUI-1
C0013516
Elektrokardiogram (EKG)
Description

ECG

Data type

boolean

Alias
UMLS CUI-1
C1623258
Fatigability Multiple Sclerosis
Description

Fatigability Multiple Sclerosis

Alias
UMLS CUI-1
C0231230
UMLS CUI-2
C0026769
Fatigability Physical activity
Data type

integer

Alias
UMLS CUI-1
C0231230
UMLS CUI-2
C0026606
Erschöpfung beeinträchtigt mich bei der Arbeit im familiären und sozialen Leben
Description

Fatigue interferes Work, Family, or Social Life

Data type

integer

Alias
UMLS CUI-1
C3830176
Mental Fatigue
Data type

integer

Alias
UMLS CUI-1
C0015676
Course
Description

Course

Alias
UMLS CUI-1
C0750729
Number of Hospital Stays
Data type

integer

Alias
UMLS CUI-1
C0237753
UMLS CUI-2
C3489408
Number of other hospital stays within past 12 months
Data type

integer

Number of outpatient visits within past 12 months
Data type

integer

Rehabilitation Days Within past 12 months
Data type

integer

Alias
UMLS CUI-1
C0034991
UMLS CUI-2
C3640790
UMLS CUI-3
C3843288
Aid, manufactured
Description

Aid, manufactured

Alias
UMLS CUI-1
C0449435
Crutch
Data type

boolean

Alias
UMLS CUI-1
C0180199
Rollator
Data type

boolean

Alias
UMLS CUI-1
C0184339
Housing modification
Data type

boolean

Alias
UMLS CUI-1
C0020056
UMLS CUI-2
C0392747
Car modification
Data type

boolean

Alias
UMLS CUI-1
C0004381
UMLS CUI-2
C0392747
Foot lifter cuff
Data type

boolean

Wheelchair
Data type

boolean

Alias
UMLS CUI-1
C0043143
Bed lift
Data type

boolean

Stairway lift
Data type

boolean

Alias
UMLS CUI-1
C1140673
Eyeglasses
Data type

boolean

Alias
UMLS CUI-1
C0015421
Incontinence pads
Data type

boolean

Alias
UMLS CUI-1
C0085099
Other aid
Data type

text

Alias
UMLS CUI-1
C0449435
Medical benefits
Description

Medical benefits

Medical benefits
Data type

integer

Paid by patient
Data type

boolean

Medical benefits past 12 months
Description

Medical benefits past 12 months

Nursing home visit
Data type

boolean

Alias
UMLS CUI-1
C0848616
Domestic helper
Data type

boolean

Alias
UMLS CUI-1
C0341652
Ambulance transport
Data type

boolean

Alias
UMLS CUI-1
C0809765
Taxi transportation
Data type

boolean

Alias
UMLS CUI-1
C0497715
Social counseling
Data type

boolean

Alias
UMLS CUI-1
C0474156
Copayment exemption
Data type

integer

Alias
UMLS CUI-1
C0680272
UMLS CUI-2
C2348482
Treatment satisfaction
Description

Treatment satisfaction

Alias
UMLS CUI-1
C3476649
Wie zufrieden sind Sie mit dem Erfolg lhrer derzeitigen MS-Therapie?
Description

Treatment success

Data type

integer

Alias
UMLS CUI-1
C0679864
Treatment satisfaction side effects
Data type

integer

Alias
UMLS CUI-1
C3476649
UMLS CUI-2
C0879626
Family history
Description

Family history

Alias
UMLS CUI-1
C0241889
Family member
Data type

integer

Alias
UMLS CUI-1
C0086282
Family member other
Data type

text

Symptoms within past 12 months
Description

Symptoms within past 12 months

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C3843288
Symptoms
Data type

integer

Alias
UMLS CUI-1
C1457887
Medication side effect
Data type

text

Alias
UMLS CUI-1
C0041755
Other symptoms
Data type

text

Medication within last 7 days
Description

Medication within last 7 days

Alias
UMLS CUI-1
C0013227
UMLS CUI-2
C3843296
Medication name
Data type

text

Alias
UMLS CUI-1
C2360065
Dose
Data type

text

Alias
UMLS CUI-1
C1960417
Daily
Data type

boolean

Alias
UMLS CUI-1
C0332173
Frequency
Data type

integer

Alias
UMLS CUI-1
C0439603
Payment source patient
Data type

boolean

Alias
UMLS CUI-1
C3263709
Demographics
Description

Demographics

Alias
UMLS CUI-1
C1704791
School graduation
Data type

integer

Alias
UMLS CUI-1
C0237640
Education, professional
Data type

integer

Alias
UMLS CUI-1
C0013647
Occupation
Data type

integer

Alias
UMLS CUI-1
C0028811
Sick Leave
Data type

integer

Measurement units
  • days per year
Alias
UMLS CUI-1
C0242807
days per year
Sick leave due to multiple sclerosis
Data type

integer

Measurement units
  • days per year
Alias
UMLS CUI-1
C0242807
UMLS CUI-2
C0026769
days per year
Occupation
Data type

integer

Alias
UMLS CUI-1
C0028811
Retirement age
Data type

integer

Measurement units
  • years
Alias
UMLS CUI-1
C0035345
UMLS CUI-2
C0001779
years
Retirement due to Multiple Sclerosis
Data type

boolean

Gender
Data type

integer

Alias
UMLS CUI-1
C0079399
Marital status
Data type

integer

Alias
UMLS CUI-1
C0024819
Household
Data type

boolean

Alias
UMLS CUI-1
C0020052
Born in Germany
Data type

boolean

Alias
UMLS CUI-1
C1277360
Lived in Germany since
Data type

partialDate

Measurement units
  • YYYY
YYYY
Country of birth
Data type

text

Alias
UMLS CUI-1
C1300001
Do You smoke cigarettes, pipes or cigars?
Description

Smoking behaviour

Data type

integer

Alias
UMLS CUI-1
C1519386
Cigarettes per day
Data type

integer

Measurement units
  • Stück pro Tag
Alias
UMLS CUI-1
C3694146
Stück pro Tag
Smoking pipes per day
Data type

integer

Measurement units
  • Stück pro Tag
Alias
UMLS CUI-1
C0240766
UMLS CUI-2
C0439505
Stück pro Tag
Cigars per day
Data type

integer

Measurement units
  • Stück pro Tag
Alias
UMLS CUI-1
C0678446
UMLS CUI-2
C0439505
Stück pro Tag
Smoking history
Data type

integer

Measurement units
  • Jahre
Alias
UMLS CUI-1
C1519384
Jahre
Smoking cessation age
Data type

integer

Measurement units
  • Jahre
Alias
UMLS CUI-1
C3172720
Jahre
Smoking history
Data type

integer

Alias
UMLS CUI-1
C1519384
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Similar models

Multiple Sclerosis - Patient Questionnaire (REGIMS)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General information
C1508263 (UMLS CUI-1)
Birth Year
Item
Birth Year
integer
C2826771 (UMLS CUI-1)
Age at disease onset
Item
integer
C0001779 (UMLS CUI-1)
C0277793 (UMLS CUI-2)
Age at diagnosis
Item
Wie alt waren Sie als die Diagnose MS gestellt wurde?
integer
C1828181 (UMLS CUI-1)
Item
integer
C0037778 (UMLS CUI-1)
undefined item
Code List
Medical Speciality
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
text
C0037778 (UMLS CUI-1)
Item Group
First Symptoms
C0205435 (UMLS CUI-1)
C1457887 (UMLS CUI-2)
Item
Welche Erstsymptome sind bei Ihnen aufgetreten?
integer
C0205435 (UMLS CUI-1)
C1457887 (UMLS CUI-2)
First symptoms
Code List
Welche Erstsymptome sind bei Ihnen aufgetreten?
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
Erstsymptome: Andere
text
C0205435 (UMLS CUI-1)
C1457887 (UMLS CUI-2)
Item Group
Diagnostic procedure within the past 12 months
C0430022 (UMLS CUI-1)
C3843288 (UMLS CUI-2)
MRT Brain
Item
Kernspintomographie Gehirn
boolean
C0024485 (UMLS CUI-1)
C0006104 (UMLS CUI-2)
MRT Spinal Cord
Item
boolean
C0024485 (UMLS CUI-1)
C0037925 (UMLS CUI-2)
CT scan of brain
Item
boolean
C0412585 (UMLS CUI-1)
Lumbar Puncture
Item
boolean
C0037943 (UMLS CUI-1)
Echocardiography
Item
boolean
C0013516 (UMLS CUI-1)
ECG
Item
Elektrokardiogram (EKG)
boolean
C1623258 (UMLS CUI-1)
Item Group
Fatigability Multiple Sclerosis
C0231230 (UMLS CUI-1)
C0026769 (UMLS CUI-2)
Item
integer
C0231230 (UMLS CUI-1)
C0026606 (UMLS CUI-2)
undefined item
Code List
Fatigability Physical activity
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)
Fatigue interferes Work, Family, or Social Life
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)
Item
integer
C0015676 (UMLS CUI-1)
undefined item
Code List
Mental Fatigue
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (5)
CL Item
 (6)
CL Item
 (7)
Item Group
C0750729 (UMLS CUI-1)
Number of Hospital Stays
Item
integer
C0237753 (UMLS CUI-1)
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)
Item Group
C0449435 (UMLS CUI-1)
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)
Car modification
Item
boolean
C0004381 (UMLS CUI-1)
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)
Item
integer
Medical benefits
Code List
Medical benefits
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)
Item
integer
C0680272 (UMLS CUI-1)
C2348482 (UMLS CUI-2)
Copayment exemption
Code List
Copayment exemption
CL Item
 (1)
CL Item
 (0)
CL Item
 (-1)
Item Group
C3476649 (UMLS CUI-1)
Item
Wie zufrieden sind Sie mit dem Erfolg lhrer derzeitigen MS-Therapie?
integer
C0679864 (UMLS CUI-1)
undefined item
Code List
Wie zufrieden sind Sie mit dem Erfolg lhrer derzeitigen MS-Therapie?
CL Item
Sehr zufrieden (1)
CL Item
Eher zufrieden (2)
CL Item
Eher unzufrieden (3)
CL Item
Sehr unzufrieden (4)
Item
integer
C3476649 (UMLS CUI-1)
C0879626 (UMLS CUI-2)
undefined item
Code List
Treatment satisfaction side effects
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)
Item Group
C0241889 (UMLS CUI-1)
Item
integer
C0086282 (UMLS CUI-1)
Family member
Code List
Family member
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
Item Group
C1457887 (UMLS CUI-1)
C3843288 (UMLS CUI-2)
Item
integer
C1457887 (UMLS CUI-1)
Symptoms
Code List
Symptoms
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)
Medication name
Item
text
C2360065 (UMLS CUI-1)
Dose
Item
text
C1960417 (UMLS CUI-1)
Daily
Item
boolean
C0332173 (UMLS CUI-1)
Item
integer
C0439603 (UMLS CUI-1)
undefined item
Code List
Frequency
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
Payment source patient
Item
boolean
C3263709 (UMLS CUI-1)
Item Group
Demographics
C1704791 (UMLS CUI-1)
Item
integer
C0237640 (UMLS CUI-1)
School graduation
Code List
School graduation
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (0)
Item
integer
C0013647 (UMLS CUI-1)
Education, professional
Code List
Education, professional
CL Item
 (0)
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (5)
Item
integer
C0028811 (UMLS CUI-1)
Occupation
Code List
Occupation
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)
Item
integer
C0028811 (UMLS CUI-1)
Occupation
Code List
Occupation
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)
Retirement due to Multiple Sclerosis
Item
boolean
Item
integer
C0079399 (UMLS CUI-1)
Gender
Code List
Gender
CL Item
 (1)
CL Item
 (2)
Item
integer
C0024819 (UMLS CUI-1)
Marital status
Code List
Marital status
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)
Item
Do You smoke cigarettes, pipes or cigars?
integer
C1519386 (UMLS CUI-1)
Smoking status
Code List
Do You smoke cigarettes, pipes or cigars?
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)
Cigars per day
Item
integer
C0678446 (UMLS CUI-1)
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)
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