| ENTRY SPECIFICATION |
{"name": "EQ-5D-5L",
},
{"id": "q9049", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "MOBILITY",
"intro": "Under each heading, please check the ONE choice that best describes your health
<strong>TODAY</strong>.",
"columns": 1,
"choices":[
{"id": "c5582", "text": "1. I have no problems walking", "quickKey": 1},
{"id": "c5583", "text": "2. I have slight problems walking", "quickKey": 2},
{"id": "c5584", "text": "3. I have moderate problems walking", "quickKey": 3},
"copyright": "EuroQol Research Foundation. EQ-5D(tm) is a trade mark of the EuroQol Research
{"id": "c5585", "text": "4. I have severe problems walking", "quickKey": 4},
{"id": "c5586", "text": "5. I am unable to walk", "quickKey": 5}
]},
{"id": "q9050", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "SELF-CARE",
"intro": "Under each heading, please check the ONE choice that best describes your health
<strong>TODAY</strong>.",
"columns": 1,
"choices":[
{"id": "c5587", "text": "1. I have no problems washing or dressing myself", "quickKey": 1},
Foundation",
{"id": "c5588", "text": "2. I have slight problems washing or dressing myself", "quickKey": 2},
{"id": "c5589", "text": "3. I have moderate problems washing or dressing myself", "quickKey": 3},
{"id": "c5590", "text": "4. I have severe problems washing or dressing myself", "quickKey": 4},
{"id": "c5591", "text": "5. I am unable to wash or dress myself", "quickKey": 5}
]},
{"id": "q9051", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "USUAL ACTIVITIES <i>(e.g. work, study, housework, family or leisure activities)",
"intro": "Under each heading, please check the ONE choice that best describes your health
<strong>TODAY</strong></i>.",
"columns": 1,
"restartDays": 2,
"choices":[
{"id": "c5592", "text": "1. I have no problems doing my usual activities", "quickKey": 1},
{"id": "c5593", "text": "2. I have slight problems doing my usual activities", "quickKey": 2},
{"id": "c5594", "text": "3. I have moderate problems doing my usual activities", "quickKey": 3},
{"id": "c5595", "text": "4. I have severe problems doing my usual activities", "quickKey": 4},
{"id": "c5596", "text": "5. I am unable to do my usual activities", "quickKey": 5}
]},
{"id": "q9052", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "PAIN / DISCOMFORT",
"intro": "Under each heading, please check the ONE choice that best describes your health
"printTitle": "EuroQol Group 5-Dimension 5-Level Health Questionnaire",
<strong>TODAY</strong>.",
"columns": 1,
"choices":[
{"id": "c5597", "text": "1. I have no pain or discomfort", "quickKey": 1},
{"id": "c5598", "text": "2. I have slight pain or discomfort", "quickKey": 2},
{"id": "c5599", "text": "3. I have moderate pain or discomfort", "quickKey": 3},
{"id": "c5600", "text": "4. I have severe pain or discomfort", "quickKey": 4},
{"id": "c5601", "text": "5. I have extreme pain or discomfort", "quickKey": 5}
]},
{"id": "q9053", "type": "ChoiceQuestion", "required": false, "inline": false,
"content":[
"text": "ANXIETY / DEPRESSION",
"intro": "Under each heading, please check the ONE choice that best describes your health
<strong>TODAY</strong>.",
"columns": 1,
"choices":[
{"id": "c5602", "text": "1. I am not anxious or depressed", "quickKey": 1},
{"id": "c5603", "text": "2. I am slightly anxious or depressed", "quickKey": 2},
{"id": "c5604", "text": "3. I am moderately anxious or depressed", "quickKey": 3},
{"id": "c5605", "text": "4. I am severely anxious or depressed", "quickKey": 4},
{"id": "c5606", "text": "5. I am extremely anxious or depressed", "quickKey": 5}
{"id": "i2518", "type": "IntroText",
]},
{"id": "i2519", "type": "IntroText",
"text": "We would like to know how good or bad your health is <strong>TODAY</strong>. <br />• Try to
picture in your mind a scale that looks like a themometer. <br />• The best
health you can imagine is marked 100 at the top of the scale. The worst health
you can imagine is marked 0 at the bottom. <br />• Picture an X on the scale
to indicate how your health is TODAY. <br />• Please enter the number from 0
through 100 where you picture the X on the scale."
},
{"id": "q9054", "type": "IntegerQuestion", "required": false,
"text": "Under each heading, please check the ONE choice that best describes your health
"text": "YOUR HEALTH TODAY",
"intro": "We would like to know how good or bad your health is <strong>TODAY</strong>. <br />• Try to
picture in your mind a scale that looks like a themometer. <br />• The best
health you can imagine is marked 100 at the top of the scale. The worst health
you can imagine is marked 0 at the bottom. <br />• Picture an X on the scale
to indicate how your health is TODAY. <br />• Please enter the number from 0
through 100 where you picture the X on the scale.",
"controlWidth": 662, "min": 0, "max": 100}]
}
<strong>TODAY</strong>."
|
