Innovation Panel Questionnaire Module
scaeq5d5llate_ip11
Self Completion EQ-5D-5L Late module
Questions 5
scaeq5d5llate_ip11.eq5lactlat
EQ-5D-5L 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 doing my usual activities. |
| 2 | I have slight problems doing my usual activities. |
| 3 | I have moderate problems doing my usual activities. |
| 4 | I have severe problems doing my usual activities. |
| 5 | I am unable to do 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 = 2 | 3 (EQ-5D condition is Ask (3L Early module and 5L Late module) OR Ask 5L Late module.)
- k_eq5lactlat (k_indresp_ip) EQ-5D-5L Activities Late
scaeq5d5llate_ip11.eq5lanxlat
EQ-5D-5L Anxiety Late
Type: choice
Source: EQ-5D
Text: Anxiety/Depression
| Option | Label |
|---|---|
| 1 | I am not anxious or depressed. |
| 2 | I am slightly anxious or depressed. |
| 3 | I am moderately anxious or depressed. |
| 4 | I am severely anxious or depressed. |
| 5 | 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 = 2 | 3 (EQ-5D condition is Ask (3L Early module and 5L Late module) OR Ask 5L Late module.)
- k_eq5lanxlat (k_indresp_ip) EQ-5D-5L Anxiety Late
scaeq5d5llate_ip11.eq5lcarelat
EQ-5D-5L Self-Care Late
Type: choice
Source: EQ-5D
Text: Self-Care
| Option | Label |
|---|---|
| 1 | I have no problems washing or dressing myself. |
| 2 | I have slight problems washing or dressing myself. |
| 3 | I have moderate problems washing or dressing myself. |
| 4 | I have severe problems washing or dressing myself. |
| 5 | 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 = 2 | 3 (EQ-5D condition is Ask (3L Early module and 5L Late module) OR Ask 5L Late module.)
- k_eq5lcarelat (k_indresp_ip) EQ-5D-5L Self-Care Late
scaeq5d5llate_ip11.eq5lmoblat
EQ-5D-5L 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 slight problems in walking about. |
| 3 | I have moderate problems in walking about |
| 4 | I have severe problems in walking about |
| 5 | I am unable to walk about |
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 = 2 | 3 (EQ-5D condition is Ask (3L Early module and 5L Late module) OR Ask 5L Late module.)
- k_eq5lmoblat (k_indresp_ip) EQ-5D-5L Mobility Late
scaeq5d5llate_ip11.eq5lpainlat
EQ-5D-5L Pain Late
Type: choice
Source: EQ-5D
Text: Pain/Discomfort
| Option | Label |
|---|---|
| 1 | I have no pain or discomfort. |
| 2 | I have slight pain or discomfort. |
| 3 | I have moderate pain or discomfort. |
| 4 | I have severe pain or discomfort. |
| 5 | 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 = 2 | 3 (EQ-5D condition is Ask (3L Early module and 5L Late module) OR Ask 5L Late module.)
- k_eq5lpainlat (k_indresp_ip) EQ-5D-5L Pain Late
