Name | Value |
---|---|
INSTRUMENT | PROMIS29 V2.1 |
LAST UPDATE | 2022-04-08 13:44:07 |
ENTRY CHECKSUM | 2568346570 |
ENTRY SPECIFICATION | {"name": "PROMIS29 V2.1", "text": "1. Physical Function: Are you able to do chores such as vacuuming or yard work?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5172", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8592", "type": "ChoiceQuestion", "required": true, "inline": false, "intro": "Please respond to each question or statement by selecting one answer.", "text": "10. Depression: IN THE PAST 7 DAYS I felt helpless.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5172", "text": "5. Always", "quickKey": 5} ]}, "columns": 1, {"id": "q8593", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "11. Depression: IN THE PAST 7 DAYS I felt depressed.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5172", "text": "5. Always", "quickKey": 5} "choices":[ ]}, {"id": "q8594", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "12. Depression: IN THE PAST 7 DAYS I felt hopeless.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5163", "text": "1. Without any difficulty", "quickKey": 1}, {"id": "c5172", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8595", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "13. Fatigue: DURING THE PAST 7 DAYS I feel fatigued.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5164", "text": "2. With a little difficulty", "quickKey": 2}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8596", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "14. Fatigue: DURING THE PAST 7 DAYS I have trouble starting things because I am tired.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5165", "text": "3. With some difficulty", "quickKey": 3}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8597", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "15. Fatigue: DURING THE PAST 7 DAYS how run-down did you feel on average?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5166", "text": "4. With much difficulty", "quickKey": 4}, {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8598", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "16. Fatigue: DURING THE PAST 7 DAYS how fatigued were you on average?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, {"id": "c5167", "text": "5. Unable to do", "quickKey": 5} "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8599", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "17. Sleep Disturbance: IN THE PAST 7 DAYS my sleep quality was", "intro": "Please respond to each question or statement by selecting one answer.", ]}, "columns": 1, "choices":[ {"id": "c5178", "text": "1. Very Poor", "quickKey": 1}, {"id": "c5179", "text": "2. Poor", "quickKey": 2}, {"id": "c5180", "text": "3. Fair", "quickKey": 3}, {"id": "c5181", "text": "4. Good", "quickKey": 4}, {"id": "c5182", "text": "5. Very good", "quickKey": 5} ]}, {"id": "q8600", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "18. Sleep Disturbance: IN THE PAST 7 DAYS my sleep was refreshing.", "copyright": "2008-2020 PROMIS Health Organization (PHO)", {"id": "q8584", "type": "ChoiceQuestion", "required": true, "inline": false, "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5183", "text": "1. Not at all", "quickKey": 1}, {"id": "c5184", "text": "2. A little bit", "quickKey": 2}, {"id": "c5185", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5186", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5187", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8601", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "2. Physical Function: Are you able to go up and down stairs at a normal pace?", "text": "19. Sleep Disturbance: IN THE PAST 7 DAYS I had a problem with my sleep.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, "intro": "Please respond to each question or statement by selecting one answer.", {"id": "q8602", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "20. Sleep Disturbance: IN THE PAST 7 DAYS I had difficulty falling asleep.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} "columns": 1, ]}, {"id": "q8603", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "21. Ability to Participate in Social Roles and Activities: I have trouble doing all of my regular leisure activities with others.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5188", "text": "1. Never", "quickKey": 1}, {"id": "c5189", "text": "2. Rarely", "quickKey": 2}, {"id": "c5190", "text": "3. Sometimes", "quickKey": 3}, "choices":[ {"id": "c5191", "text": "4. Usually", "quickKey": 4}, {"id": "c5192", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8604", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "22. Ability to Participate in Social Roles and Activities: I have trouble doing all of the family activities that I want to do.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5188", "text": "1. Never", "quickKey": 1}, {"id": "c5163", "text": "1. Without any difficulty", "quickKey": 1}, {"id": "c5189", "text": "2. Rarely", "quickKey": 2}, {"id": "c5190", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5191", "text": "4. Usually", "quickKey": 4}, {"id": "c5192", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8605", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "23. Ability to Participate in Social Roles and Activities: I have trouble doing all of my usual work (include work at home).", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, {"id": "c5164", "text": "2. With a little difficulty", "quickKey": 2}, "choices":[ {"id": "c5188", "text": "1. Never", "quickKey": 1}, {"id": "c5189", "text": "2. Rarely", "quickKey": 2}, {"id": "c5190", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5191", "text": "4. Usually", "quickKey": 4}, {"id": "c5192", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8606", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "24. Ability to Participate in Social Roles and Activities: I have trouble doing all of the activities with friends that I want to do.", {"id": "c5165", "text": "3. With some difficulty", "quickKey": 3}, "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5188", "text": "1. Never", "quickKey": 1}, {"id": "c5189", "text": "2. Rarely", "quickKey": 2}, {"id": "c5190", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5191", "text": "4. Usually", "quickKey": 4}, {"id": "c5192", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8607", "type": "ChoiceQuestion", "required": true, "inline": false, {"id": "c5166", "text": "4. With much difficulty", "quickKey": 4}, "text": "25. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your day to day activities?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} {"id": "c5167", "text": "5. Unable to do", "quickKey": 5} ]}, {"id": "q8608", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "26. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with work around the home?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, "restartDays": 2, ]}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8609", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "27. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your ability to participate in social activities?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "q8585", "type": "ChoiceQuestion", "required": true, "inline": false, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8610", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "28. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your household chores?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "text": "3. Physical Function: Are you able to go for a walk of at least 15 minutes?", "choices":[ {"id": "c5173", "text": "1. Not at all", "quickKey": 1}, {"id": "c5174", "text": "2. A little bit", "quickKey": 2}, {"id": "c5175", "text": "3. Somewhat", "quickKey": 3}, {"id": "c5176", "text": "4. Quite a bit", "quickKey": 4}, {"id": "c5177", "text": "5. Very much", "quickKey": 5} ]}, {"id": "q8613", "type": "SliderQuestion", "required": true, "text": "29. Pain Intensity: IN THE PAST 7 DAYS how would you rate your pain on average?", "intro": "Please respond to each question or statement by selecting one answer.", "intro": "Please respond to each question or statement by selecting one answer.", "min": 0, "max": 10, "legend":["No pain", "Worst pain imaginable"]}] } "columns": 1, "choices":[ {"id": "c5163", "text": "1. Without any difficulty", "quickKey": 1}, {"id": "c5164", "text": "2. With a little difficulty", "quickKey": 2}, {"id": "c5165", "text": "3. With some difficulty", "quickKey": 3}, {"id": "c5166", "text": "4. With much difficulty", "quickKey": 4}, "printTitle": "Patient Reported Outcome Measurement Information System (PROMIS) 29 Profile v2.1", {"id": "c5167", "text": "5. Unable to do", "quickKey": 5} ]}, {"id": "q8586", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "4. Physical Function: Are you able to run errands and shop?", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5163", "text": "1. Without any difficulty", "quickKey": 1}, {"id": "c5164", "text": "2. With a little difficulty", "quickKey": 2}, {"id": "c5165", "text": "3. With some difficulty", "quickKey": 3}, "content":[ {"id": "c5166", "text": "4. With much difficulty", "quickKey": 4}, {"id": "c5167", "text": "5. Unable to do", "quickKey": 5} ]}, {"id": "q8587", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "5. Anxiety: IN THE PAST 7 DAYS I felt fearful.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "i2455", "type": "IntroText", {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5172", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8588", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "6. Anxiety: IN THE PAST 7 DAYS I found it hard to focus on anything other than my anxiety.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, "choices":[ "text": "Please respond to each question or statement by selecting one answer." {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5172", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8589", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "7. Anxiety: IN THE PAST 7 DAYS my worries overwhelmed me.", "intro": "Please respond to each question or statement by selecting one answer.", "columns": 1, }, "choices":[ {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5172", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8590", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "8. Anxiety: IN THE PAST 7 DAYS I felt uneasy.", "intro": "Please respond to each question or statement by selecting one answer.", {"id": "q8583", "type": "ChoiceQuestion", "required": true, "inline": false, "columns": 1, "choices":[ {"id": "c5168", "text": "1. Never", "quickKey": 1}, {"id": "c5169", "text": "2. Rarely", "quickKey": 2}, {"id": "c5170", "text": "3. Sometimes", "quickKey": 3}, {"id": "c5171", "text": "4. Often", "quickKey": 4}, {"id": "c5172", "text": "5. Always", "quickKey": 5} ]}, {"id": "q8591", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "9. Depression: IN THE PAST 7 DAYS I felt worthless.", |