Name | Value |
---|---|
INSTRUMENT | ALSFRS-R |
LAST UPDATE | 2024-07-03 16:58:02 |
ENTRY CHECKSUM | 4040626670 |
ENTRY SPECIFICATION | {"name": "ALSFRS-R", }, {"id": "c6122", "text": " 4 - Normal", "quickKey": 4}, {"id": "c6123", "text": " 3 - Clumsy but able to perform all manipulations independently", "quickKey": 3}, {"id": "c6124", "text": " 2 - Some help needed with closures and fasteners", "quickKey": 2}, {"id": "c6125", "text": " 1 - Provides minimal assistance to caregiver", "quickKey": 1}, {"id": "c6126", "text": " 0 - Unable to perform any aspect of task", "quickKey": 0} ]}, {"id": "q9522", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "6. Dressing and hygiene", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is {"id": "q9515", "type": "ChoiceQuestion", "required": true, "inline": false, scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6127", "text": " 4 - Normal function", "quickKey": 4}, {"id": "c6128", "text": " 3 - Independent and complete self-care with effort or decreased efficiency", "quickKey": 3}, {"id": "c6129", "text": " 2 - Intermittent assistance or substitute methods", "quickKey": 2}, {"id": "c6130", "text": " 1 - Needs attendant for self-care", "quickKey": 1}, {"id": "c6131", "text": " 0 - Total dependence", "quickKey": 0} ]}, "text": "1. Speech", {"id": "q9523", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "7. Turning in bed and adjusting bed clothes", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6132", "text": " 4 - Normal", "quickKey": 4}, {"id": "c6133", "text": " 3 - Somewhat slow and clumsy, but no help needed", "quickKey": 3}, "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability {"id": "c6134", "text": " 2 - Can turn alone or adjust sheets, but with great difficulty", "quickKey": 2}, {"id": "c6135", "text": " 1 - Can initiate, but not turn or adjust sheets alone", "quickKey": 1}, {"id": "c6136", "text": " 0 - Helpless", "quickKey": 0} ]}, {"id": "q9524", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "8. Walking", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", to swallow and use utensils to climbing stairs and breathing. Each function is "columns": 1, "choices":[ {"id": "c6137", "text": " 4 - Normal", "quickKey": 4}, {"id": "c6138", "text": " 3 - Early ambulation difficulties", "quickKey": 3}, {"id": "c6139", "text": " 2 - Walks with assistance", "quickKey": 2}, {"id": "c6140", "text": " 1 - Nonambulatory functional movement", "quickKey": 1}, {"id": "c6141", "text": " 0 - No purposeful leg movement", "quickKey": 0} ]}, {"id": "q9525", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "9. Climbing stairs", scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6142", "text": " 4 - Normal", "quickKey": 4}, {"id": "c6143", "text": " 3 - Slow", "quickKey": 3}, {"id": "c6144", "text": " 2 - Mild unsteadiness or fatigue", "quickKey": 2}, {"id": "c6145", "text": " 1 - Needs assistance", "quickKey": 1}, minimum total score of 0.", {"id": "c6146", "text": " 0 - Cannot do", "quickKey": 0} ]}, {"id": "q9526", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "10. Dyspnea", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ "columns": 1, {"id": "c6147", "text": " 4 - None", "quickKey": 4}, {"id": "c6148", "text": " 3 - Occurs when walking", "quickKey": 3}, {"id": "c6149", "text": " 2 - Occurs with one or more of the following: eating, bathing, dressing (ADL)", "quickKey": 2}, {"id": "c6150", "text": " 1 - Occurs at rest, difficulty breathing when either sitting or lying", "quickKey": 1}, {"id": "c6151", "text": " 0 - Significant difficulty; considering using mechanical respiratory support", "quickKey": 0} ]}, {"id": "q9527", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "11. Orthopnea", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is "choices":[ scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6152", "text": " 4 - None", "quickKey": 4}, {"id": "c6153", "text": " 3 - Some difficulty sleeping at night due to shortness of breath, does not routinely use more than two pillows", "quickKey": 3}, {"id": "c6154", "text": " 2 - Needs extra pillows in order to sleep (more than two)", "quickKey": 2}, {"id": "c6155", "text": " 1 - Can only sleep sitting up", "quickKey": 1}, {"id": "c6156", "text": " 0 - Unable to sleep", "quickKey": 0} {"id": "c6095", "text": " 4 - Normal speech process", "quickKey": 4}, ]}, {"id": "q9528", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "12. Respiratory insufficiency", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6157", "text": " 4 - None", "quickKey": 4}, "restartDays": 2, {"id": "c6096", "text": " 3 - Detectable speech disturbance", "quickKey": 3}, {"id": "c6158", "text": " 3 - Intermittent use of NIV (e.g., BiPAP)", "quickKey": 3}, {"id": "c6159", "text": " 2 - Continuous use of NIV (e.g., BiPAP) during the night", "quickKey": 2}, {"id": "c6160", "text": " 1 - Continuous use of NIV (e.g., BiPAP) during the night and day", "quickKey": 1}, {"id": "c6161", "text": " 0 - Invasive mechanical ventilation by intubation or tracheostomy", "quickKey": 0} ]}], "rules":[ {"question": "q9519", "operator": "IN", "value": ["c6115","c6116"], "validation": "multi", "skips":[ { "id": "c6115", "skip": ["q9521"] {"id": "c6097", "text": " 2 - Intelligible with repeating", "quickKey": 2}, },{ "id": "c6116", "skip": ["q9520"] }]}] } {"id": "c6098", "text": " 1 - Speech combined with nonvocal communication", "quickKey": 1}, {"id": "c6099", "text": " 0 - Loss of useful speech", "quickKey": 0} ]}, {"id": "q9516", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "2. Salivation", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a "printTitle": "ALS Functional Rating Scale Revised", minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6100", "text": " 4 - Normal", "quickKey": 4}, {"id": "c6101", "text": " 3 - Slight but definite excess of saliva in mouth; may have nighttime drooling", "quickKey": 3}, {"id": "c6102", "text": " 2 - Moderately excessive saliva; may have minimal drooling", "quickKey": 2}, {"id": "c6103", "text": " 1 - Marked excess of saliva with some drooling", "quickKey": 1}, {"id": "c6104", "text": " 0 - Marked drooling; requires constant tissue or handkerchief", "quickKey": 0} ]}, {"id": "q9517", "type": "ChoiceQuestion", "required": true, "inline": false, "content":[ "text": "3. Swallowing", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6105", "text": " 4 - Normal eating habits", "quickKey": 4}, {"id": "c6106", "text": " 3 - Early eating problems - occasional choking", "quickKey": 3}, {"id": "c6107", "text": " 2 - Dietary consistency changes", "quickKey": 2}, {"id": "i2612", "type": "IntroText", {"id": "c6108", "text": " 1 - Needs supplemental tube feedings", "quickKey": 1}, {"id": "c6109", "text": " 0 - NPO (exclusively parenteral or enteral feeding)", "quickKey": 0} ]}, {"id": "q9518", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "4. Handwriting", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "text": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability "choices":[ {"id": "c6110", "text": " 4 - Normal", "quickKey": 4}, {"id": "c6111", "text": " 3 - Slow or sloppy; all words are legible", "quickKey": 3}, {"id": "c6112", "text": " 2 - Not all words are legible", "quickKey": 2}, {"id": "c6113", "text": " 1 - Able to grip pen but unable to write", "quickKey": 1}, {"id": "c6114", "text": " 0 - Unable to grip pen", "quickKey": 0} ]}, {"id": "q9519", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "5. Veteran with gastrostomy and \u003E50% daily nutrition intake via G-tube", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6115", "text": " No", "quickKey": 0}, {"id": "c6116", "text": " Yes", "quickKey": 1} ]}, {"id": "q9520", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "5A. Cutting food and handling utensils (patients without gastrostomy)", scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ {"id": "c6117", "text": " 4 - Normal", "quickKey": 4}, {"id": "c6118", "text": " 3 - Somewhat slow and clumsy, but no help needed", "quickKey": 3}, {"id": "c6119", "text": " 2 - Can cut most foods, although slow and clumsy; some help needed", "quickKey": 2}, {"id": "c6120", "text": " 1 - Food must be cut by someone, but can still feed slowly", "quickKey": 1}, minimum total score of 0." {"id": "c6121", "text": " 0 - Needs to be fed", "quickKey": 0} ]}, {"id": "q9521", "type": "ChoiceQuestion", "required": true, "inline": false, "text": "5B. Cutting food and handling utensils (patients with gastrostomy)", "intro": "The ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.", "columns": 1, "choices":[ |