crf3b_version |
|
radio |
CRF3 Version Completed |
1, Unversioned ; 2, 1.0 ; 3, 1.1 ; 4, 1.2 ; 5, 1.3 ; 6, 1.4 ; 7, 1.5 ; 8, 1.6 ; 9, 2.0 |
crf3b_date_consent |
|
text |
Date of consent |
|
crf3b_ongoing_consent_done |
|
yesno |
Ongoing consent confirmed verbally? |
1, Yes ; 0, No |
crf3b_date_visit |
|
text |
Date of visit |
|
crf3b_visit |
|
radio |
Type of this visit |
1, 3 months visit ; 2, 12 months visit |
crf3b_rest_spo2_done |
Resting observations (If no corresponding clinical visit) |
radio |
a) Pulse Oximetry (SpO2) |
1, Yes ; 0, No |
crf3b_rest_hr_done |
|
radio |
b) Heart rate |
1, Yes ; 0, No |
crf3b_rest_bp_done |
|
radio |
c) Blood pressure |
1, Yes ; 0, No |
crf3b_rest_temp_done |
|
radio |
d) Temperature |
1, Yes ; 0, No |
crf3b_rest_height_done |
|
radio |
e) Height (cm) |
1, Yes ; 0, No |
crf3b_rest_weight_done |
|
radio |
f) Weight (kg) |
1, Yes ; 0, No |
crf3b_rest_spo2 |
|
text |
a) Resting Pulse Oximetry (SpO2): |
|
crf3b_rest_hr |
|
text |
b) Resting heart rate: |
|
crf3b_rest_bp_sys |
|
text |
c) Resting blood pressure (systolic): |
|
crf3b_rest_bp_dia |
|
text |
c) Resting blood pressure (diastolic): |
|
crf3b_rest_temp |
|
text |
d) Temperature: |
|
crf3b_rest_height |
|
text |
e) Height (cm): |
|
crf3b_rest_weight |
|
text |
f) Weight (kg): |
|
crf3b_base_ecg_done |
Basic investigations (If no corresponding clinical visit) |
radio |
ECG |
1, Completed ; 0, Not done |
crf3b_ecg |
|
radio |
ECG result: |
1, Sinus rhythm ; 2, Atrial fibrillation/flutter ; 3, ST segment/T wave changes ; 4, RBBB ; 5, LBBB |
crf3b_base_ecg_hr |
|
text |
ECG heart rate: |
|
crf3b_hcare_ehv |
Healthcare utilisation |
radio |
Emergency hospital visit |
1, Yes ; 0, No |
crf3b_hcare_pacr |
|
radio |
Planned additional COVID-related review |
1, Yes ; 0, No |
crf3b_hcare_cgp |
|
radio |
Contacts with GP for a clinical review |
1, Yes ; 0, No |
crf3b_hcare_med |
|
radio |
Any changes in regular medication |
1, Yes ; 0, No |
crf3b_crfev_done |
|
yesno |
Have you completed Emergency Visit CRF for any unplanned emergency visits? |
1, Yes ; 0, No |
crf3b_crf4_done |
|
yesno |
Have you completed CRF4 for any additional planned COVID-related clinical visits? |
1, Yes ; 0, No |
crf3b_medlog_done |
|
yesno |
Have you completed or updated medication log? |
1, Yes ; 0, No |
crf3b_eq5d_done |
|
yesno |
Have you completed a EQ-5D-5L form (Pre-COVID)? |
1, Yes ; 0, No |
crf3b_mrc_done |
|
yesno |
Have you completed a MRC dyspnoea scale form (Before COVID)? |
1, Yes ; 0, No |
crf3b_social_history_done |
|
yesno |
Have you completed a Social History form? |
1, Yes ; 0, No |
crf3b_new_prob |
|
yesno |
Are you experiencing any new problems that we haven't mentioned? |
1, Yes ; 0, No |
crf3b_new_prob_detail |
|
notes |
Please provide details for these new problems |
|
crf3b_info_dis |
|
notes |
What information would have been helpful to receive at discharge? |
|
crf3b_spost_livewell |
Signposting |
radio |
https://www.nhs.uk/live-well/ |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_iapt |
|
radio |
Improving Access to Psychological Therapies (IAPT) |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_shyg |
|
radio |
Sleep hygiene |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_mental |
|
radio |
Mental wellbeing - Daylight app/weblink |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_drinkfree |
|
radio |
Alcohol - 'Drink free days' |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_phyinac |
|
radio |
Physical inactivity - 'couch to 5K' or 'Active 10' |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_smkadv |
|
radio |
Smoking Advice https://www.nhs.uk/live-well/quit-smoking/ |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_smkref |
|
radio |
Smoking cessation referral |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_smkapp |
|
radio |
'Smoke free' app |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_wmgmt |
|
radio |
Weight management: http://www.nhs.uk/live-well/healthyweight/start-the-nhs-weight-loss-plan/ |
1, Yes ; 0, No ; 2, Unsure |
crf3b_spost_heat |
|
radio |
Healthy eating: |
1, Yes ; 0, No ; 2, Unsure |
crf3b_inv_assess |
Investigator completed assessments |
checkbox |
Investigator completed assessments |
1, Montreal Cognitive Assessment (MoCA) ; 2, Clinical Frailty Scale ; 3, Fried Frailty assessment |
crf3b_assess_moca |
|
yesno |
1. Have you completed a MoCA form? |
1, Yes ; 0, No |
crf3b_assess_cfs |
|
yesno |
2. Have you completed a Rockwood Clinical Frailty Scale form? |
1, Yes ; 0, No |
crf3b_truecolours_check |
Questionnaires |
yesno |
Is the participant completing questionnaires using True Colours? |
1, Yes ; 0, No |
crf3b_quests |
|
checkbox |
Questionnaires |
12, Pre-COVID Patient Symptom Questionnaire (Only to be completed once during study) ; 13, Patient Symptom Questionnaire ; 1, MRC dyspnoea scale ; 2, EQ-5D-5L ; 3, Generalised Anxiety Disorder Assessment (GAD-7) ; 4, Patient Health Questionnaire (PHQ-9) ; 5, Sarcopenia screen (SARC-F) ; 6, General Practice Physical Activity Questionnaire (GPPAQ) ; 7, Dyspnoea-12 ; 8, Fatigue (FACIT) ; 9, Brief Pain Inventory (BPI) ; 10, Post-Traumatic Stress Disorder (PTSD) checklist (PCL-5) ; 11, Nottingham extended activity of daily living (NEADL) |
crf3b_quest_pre_psq |
|
yesno |
1. Have you completed a Pre-COVID Patient Symptom Questionnaire form? |
1, Yes ; 0, No |
crf3b_quest_psq |
|
yesno |
2. Have you completed a Patient Symptom Questionnaire form? |
1, Yes ; 0, No |
crf3b_quest_mrc |
|
yesno |
3. Have you completed a MRC dyspnoea scale form (Since COVID)? |
1, Yes ; 0, No |
crf3b_quest_eq5d5l |
|
yesno |
4. Have you completed a EQ-5D-5L form (Current visit)? |
1, Yes ; 0, No |
crf3b_quest_gad7 |
|
yesno |
5. Have you completed a GAD-7 form? |
1, Yes ; 0, No |
crf3b_quest_phq9 |
|
yesno |
6. Have you completed a PHQ-9 form? |
1, Yes ; 0, No |
crf3b_quest_sarcf |
|
yesno |
7. Have you completed a SARC-F form? |
1, Yes ; 0, No |
crf3b_quest_gppaq |
|
yesno |
8. Have you completed a GPPAQ form? |
1, Yes ; 0, No |
crf3b_quest_dys12 |
|
yesno |
9. Have you completed a Dyspnoea-12 form? |
1, Yes ; 0, No |
crf3b_quest_facit |
|
yesno |
10. Have you completed a FACIT form? |
1, Yes ; 0, No |
crf3b_quest_bpi |
|
yesno |
11. Have you completed a BPI form? |
1, Yes ; 0, No |
crf3b_quest_pcl5 |
|
yesno |
12. Have you completed a PCL-5 form? |
1, Yes ; 0, No |
crf3b_quest_neadl |
|
yesno |
13. Have you completed a NEADL form? |
1, Yes ; 0, No |
crf3b_fried_date |
Fried's Frailty Assessment Questions |
text |
Date completed |
|
crf3b_fried_shrink |
|
yesno |
1. Shrinking: In the last year, has the patient lost more than 10lb (4.5 kilograms) unintentionally? |
1, Yes ; 0, No |
crf3b_fried_energy |
|
yesno |
2. Exhaustion - Q1: Do they feel full of energy? |
1, Yes ; 0, No |
crf3b_fried_rest_day |
|
radio |
2. Exhaustion - Q2: During the last 4 weeks how often have they rested in bed during the day? |
1, Every day ; 2, Every week ; 3, Once ; 4, Not at all |
crf3b_t2_core |
Tier 2 Core Tests |
yesno |
Have you completed a Tier 2 Core Tests Checklist? |
1, Yes ; 0, No |
crf3b_t2_research |
Tier 2 Biological Research Samples |
yesno |
Have you completed a Tier 2 Biological Research Samples Checklist? |
1, Yes ; 0, No |
crf3b_pft |
Pulmonary Function Tests (PFTs) |
yesno |
Have you completed Pulmonary function tests (PFTs) forms? |
1, Yes ; 0, No |
crf3b_qrisk3 |
QRISK®3 |
yesno |
Have you completed a QRISK®3 form? |
1, Yes ; 0, No |
cr3b_waist_done |
|
yesno |
Waist circumference measurement: Completed |
1, Yes ; 0, No |
cr3b_waist_result |
|
text |
Waist circumference measurement: Result |
|
crf3b_rehab_q1 |
Post-discharge Rehabilitation Programme |
radio |
1. Has the patient been referred to a rehabilitation programme after their hospital admission with COVID-19? |
1, Yes ; 0, No ; 2, Not sure |
crf3b_rehab_q2 |
|
radio |
2. Did they attend any rehabilitation session(s)? |
1, Yes ; 0, No ; 2, Not sure |
crf3b_rehab_q3 |
|
radio |
3. What was the nature of the session(s)? |
1, Face-to-face ; 2, Virtual/remote ; 3, Both |
crf3b_rehab_q4_yn |
|
yesno |
4. Is the total number of sessions attended by the patient so far known? |
1, Yes ; 0, No |
crf3b_rehab_q4 |
|
text |
4. Total number of sessions attended by the patient so far |
|
crf3b_rehab_q5 |
|
radio |
5. Has the patient completed the programme & attended the discharge assessment? |
1, Yes ; 0, No ; 2, Not sure |
crf3b_rehab_q6 |
|
radio |
6. Did they find the programme helpful? |
1, Yes ; 0, No ; 2, Not sure |
crf3b_psych_q1 |
Post-discharge Psychology Services Review |
radio |
1. Has the patient been referred to any psychology service after their hospital admission with COVID-19? |
1, Yes ; 0, No ; 2, Not sure |
crf3b_psych_q2 |
|
checkbox |
2. Please select all that apply. |
1, Post ICU psychology service ; 2, Psychiatric liaison service ; 3, Improving Access to Psychological Therapies (IAPT) ; 4, Acute Hospital Clinical Health Psychology service ; 5, Community Mental Health Team (adult) ; 6, Community Mental Health Team (older adult) ; 7, Psychological Therapies service for serious mental illness (SMI) ; 8, Mental health Crisis Resolution and Home Treatment service ; 9, In patient mental health service ; 10, Counselling services (Third sector or primary care based) ; 11, Private providers of psychological therapy ; 12, Other ; 13, Not known |
crf3b_psych_q2_other |
|
notes |
2. Other post-discharge psychology services - Please specify |
|
crf3b_psych_q3 |
|
radio |
3. What was the nature of the session(s)? |
1, Face-to-face ; 2, Virtual/remote ; 3, Both |
crf3b_psych_q4 |
|
radio |
4. Did they find the service(s) helpful? |
1, Yes ; 0, No ; 2, Not sure |
crf3b_bodycom_bia |
Body composition measurements (BIA and DXA) |
radio |
Have you completed a BIA form? |
1, Yes ; 0, No |
crf3b_bodycom_dxa |
|
radio |
Have you completed a DXA form? |
1, Yes ; 0, No |
crf3b_muscle_strength |
Muscle Strength |
yesno |
Have you completed a muscle strength form? |
1, Yes ; 0, No |
crf3b_iswt_1 |
Incremental shuttle walk test (ISWT) Modified 15 level |
radio |
ISWT measurement 1 |
1, Yes ; 0, No |
crf3b_iswt_2 |
|
radio |
ISWT measurement 2 |
1, Yes ; 0, No |
crf3b_sppb |
Short Physical Performance Battery (SPPB) |
yesno |
Have you completed a short physical performance battery (SPPB) form? |
1, Yes ; 0, No |
crf3b_amc_inform |
Activity Monitor checklist |
yesno |
1. Has the participant been informed about the activity monitor? |
1, Yes ; 0, No |
crf3b_amc_happy |
|
yesno |
2. Is the participant happy to receive and wear the activity monitor? |
1, Yes ; 0, No |
crf3b_amc_location |
|
radio |
3. Wear location |
1, Wrist ; 2, Upper Arm |
crf3b_amc_strap |
|
radio |
4. Strap Type |
1, Plastic ; 2, Velcro |
crf3b_amc_notes |
|
notes |
5. Activity Monitor checklist - Notes |
|
crf3b_future_studies |
Future studies |
yesno |
Is the participant happy to be contacted about future studies? |
1, Yes ; 0, No |