Innovation Panel Questionnaire Module
scaeq5d3llate_ip11
Self Completion EQ-5D-3L Late module
Questions 5
scaeq5d3llate_ip11.eq3lactlat
EQ-5D-3L Activities Late
Type: choice
Source: EQ-5D
Text: Usual Acticities (e.g. work, study, housework, family or leisure activities)
| Option | Label |
|---|---|
| 1 | I have no problems with performing my usual activities. |
| 2 | I have some problems with performing my usual activities. |
| 3 | I am unable to perform my usual activities. |
Universe:
if ((GRIDVARIABLES.modetype = 1 & CASISTART.SCAC = 1) | GRIDVARIABLES.modetype = 3)) (Mode is face to face and has agreed to self-completion OR mode is web)
and if EXPERIMENTALVARIABLES.EQ5DCOND = 1 (EQ-5D condition is Ask 5L Early module and 3L Late module)
- k_eq3lactlat (k_indresp_ip) EQ-5D-3L Activities Late
scaeq5d3llate_ip11.eq3lanxlat
EQ-5D-3L Anxiety Late
Type: choice
Source: EQ-5D
Text: Anxiety/Depression
| Option | Label |
|---|---|
| 1 | I am not anxious or depressed. |
| 2 | I am moderately anxious or depressed. |
| 3 | I am extremely anxious or depressed. |
Universe:
if ((GRIDVARIABLES.modetype = 1 & CASISTART.SCAC = 1) | GRIDVARIABLES.modetype = 3)) (Mode is face to face and has agreed to self-completion OR mode is web)
and if EXPERIMENTALVARIABLES.EQ5DCOND = 1 (EQ-5D condition is Ask 5L Early module and 3L Late module)
- k_eq3lanxlat (k_indresp_ip) EQ-5D-3L Anxiety Late
scaeq5d3llate_ip11.eq3lcarelat
EQ-5D-3L Self-Care Late
Type: choice
Source: EQ-5D
Text: Self-Care
| Option | Label |
|---|---|
| 1 | I have no problems with self-care. |
| 2 | I have some problems washing or dressing myself. |
| 3 | I am unable to wash or dress myself. |
Universe:
if ((GRIDVARIABLES.modetype = 1 & CASISTART.SCAC = 1) | GRIDVARIABLES.modetype = 3)) (Mode is face to face and has agreed to self-completion OR mode is web)
and if EXPERIMENTALVARIABLES.EQ5DCOND = 1 (EQ-5D condition is Ask 5L Early module and 3L Late module)
- k_eq3lcarelat (k_indresp_ip) EQ-5D-3L Self-Care Late
scaeq5d3llate_ip11.eq3lmoblat
EQ-5D-3L Mobility Late
Type: choice
Source: EQ-5D
Text: Please click the ONE box that best describes your health TODAY. Mobility
| Option | Label |
|---|---|
| 1 | I have no problems in walking about. |
| 2 | I have some problems in walking about. |
| 3 | I am confined to bed. |
Universe:
if ((GRIDVARIABLES.modetype = 1 & CASISTART.SCAC = 1) | GRIDVARIABLES.modetype = 3)) (Mode is face to face and has agreed to self-completion OR mode is web)
and if EXPERIMENTALVARIABLES.EQ5DCOND = 1 (EQ-5D condition is Ask 5L Early module and 3L Late module)
- k_eq3lmoblat (k_indresp_ip) EQ-5D-3L Mobility Late
scaeq5d3llate_ip11.eq3lpainlat
EQ-5D-3L Pain Late
Type: choice
Source: EQ-5D
Text: Pain/Discomfort
| Option | Label |
|---|---|
| 1 | I have no pain or discomfort. |
| 2 | I have moderate pain or discomfort. |
| 3 | I have extreme pain or discomfort. |
Universe:
if ((GRIDVARIABLES.modetype = 1 & CASISTART.SCAC = 1) | GRIDVARIABLES.modetype = 3)) (Mode is face to face and has agreed to self-completion OR mode is web)
and if EXPERIMENTALVARIABLES.EQ5DCOND = 1 (EQ-5D condition is Ask 5L Early module and 3L Late module)
- k_eq3lpainlat (k_indresp_ip) EQ-5D-3L Pain Late
