Data Dictionary Demo - Stroke

Patient-reported Form

Please complete all required fields marked with an asterisk (*)

Varies by country and should be determined by country (not for cross country comparison)
Where were you living prior to your stroke or transient ischaemic attack (TIA)? Most recent place of residence pre stroke
Where are you living now?
Did you live alone prior to your stroke or transient ischaemic attack (TIA)?
Do you live alone now?
Were you able to walk prior to your stroke or transient ischaemic attack (TIA)?
Did you need help from anybody to go to the toilet prior to your stroke or transient ischaemic attack (TIA)?
Did you need help with dressing/undressing prior to your stroke or transient ischaemic attack (TIA)?
Do you currently smoke, or have you smoked cigarettes or tobacco over the past year? Smoking status (of cigarettes or tobacco). Item is phrased as a patient reported measure. However, if the patient is unable to answer, this information can be abstracted from the medical records.
Since your hospitalization for stroke, have you smoked tobacco or cigarettes?
Are you able to walk? This item is also measured at baseline, as PRESTROKEAMB
Do you need help from anybody to go to the toilet? This item is also measured at baseline, as PRESTROKETOILET
Do you need help with dressing/undressing? This item is also measured at baseline, as PRESTROKEDRESS
Do you need a tube for feeding? For example: a nasogastric tube or a gastrostomy tube
Do you have problems with communication or understanding?

General

In general, would you say your health is:
In general, would you say your quality of life is:
In general, how would you rate your physical health?
In general, how would you rate your mental health, including your mood and your ability to think?
In general, how would you rate your satisfaction with your social activities and relationships?
In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)
To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?
In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?
In the past 7 days, how would you rate your fatigue on average?
In the past 7 days, how would you rate your pain on average? Indicate pain level on a scale of 0-10, where 0 = No pain, and 10 = Worst imaginable pain