Back pain prevention questionnaire
Resource status: Draft
Canonical URL: http://fhir.smart4health.eu/Questionnaire/back-pain-prevention
Questionnaire resource representing the questionnaires used for back pain prevention.
Link to raw resource: Back pain prevention questionnaire
| Questionnaire |
| language : en |
| url : http://fhir.smart4health.eu/Questionnaire/back-pain-prevention |
| version : 1.0.0 |
| name : Smart4Health_back_pain_prevention_questionnaire |
| title : Back pain prevention questionnaire |
| status : draft |
| subjectType : Patient |
| date : 2022-03-10 |
| publisher : D4L data4life gGmbH |
| contact |
| name : ITTM Solutions |
| telecom |
| system : url |
| value : https://www.ittm-solutions.com/ |
| contact |
| name : D4L data4life gGmbH |
| telecom |
| system : url |
| value : https://www.data4life.care |
| description : Back pain prevention questionnaire |
| item |
| linkId : questionnaire_timing |
| text : When is this questionnaire being administered? |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-questionnaire-timing |
| item |
| linkId : back_pain_frequency |
| text : How often do you suffer from back pain? |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-back-pain-frequency |
| item |
| linkId : back_pain_duration |
| text : How long has this pain been occurring? |
| type : choice |
| required : True |
| enableWhen |
| question : back_pain_frequency |
| operator : != |
| answer |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-back-pain-duration |
| item |
| linkId : back_pain_location |
| text : In which body part does the pain appear? |
| type : choice |
| required : True |
| repeats : True |
| enableWhen |
| question : back_pain_frequency |
| operator : != |
| answer |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-back-pain-location |
| item |
| linkId : back_pain_impact |
| text : What are the consequences of your back pain and how does it impact your life situation? |
| type : choice |
| required : True |
| repeats : True |
| enableWhen |
| question : back_pain_frequency |
| operator : != |
| answer |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-pain-impact |
| item |
| linkId : influence_on_health |
| text : To what extent do you think you can influence your state of health? |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-influence-degree |
| item |
| linkId : state_of_health |
| text : How do you assess your state of health? |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-health-state |
| item |
| linkId : physical_activity_freq |
| text : How often are you physically active in your free time? |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-physical-activity-frequency |
| item |
| linkId : workout_reason |
| text : What are the reasons you work out? |
| type : choice |
| required : True |
| repeats : True |
| enableWhen |
| question : physical_activity_freq |
| operator : != |
| answer |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-activity-reason |
| item |
| linkId : workout_hindrance |
| text : What hinders you from taking part in sports activities? |
| type : choice |
| required : True |
| repeats : True |
| enableWhen |
| question : physical_activity_freq |
| operator : = |
| answer |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-activity-hindrance |
| item |
| linkId : physical_burden_tense_posture |
| text : Physical burden at your workplace: Unilateral/tense posture |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-physical-burden-frequency |
| item |
| linkId : physical_burden_standing |
| text : Physical burden at your workplace: Primarily in standing position |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-physical-burden-frequency |
| item |
| linkId : physical_burden_sitting |
| text : Physical burden at your workplace: Primarily in sitting position |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-physical-burden-frequency |
| item |
| linkId : physical_burden_leaning |
| text : Physical burden at your workplace: Upper body leans forward |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-physical-burden-frequency |
| item |
| linkId : physical_burden_lifting |
| text : Physical burden at your workplace: Heavy lifting |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-physical-burden-frequency |
| item |
| linkId : ergonomic_advice_impact |
| text : Do you think ergonomic advice can reduce your physical stress at your workplace? |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-perceived-likelihood |
| item |
| linkId : training_goals |
| text : What are your goals in participating in the training? |
| type : choice |
| required : True |
| repeats : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-back-pain-prevention-goal |
Example questionnaire responses
Response reporting back pain
Link to raw resource: Response for questionnaire back-pain-prevention|1.0.0: s4h-back-pain-prevention-with-pain-response-example-en
| QuestionnaireResponse |
| id : s4h-back-pain-prevention-with-pain-response-example |
| identifier |
| system : urn:ietf:rfc:3986 |
| value : urn:uuid:d4879af2-9925-4224-b972-3cbf3fff2124 |
| language : en |
| questionnaire : http://fhir.smart4health.eu/Questionnaire/back-pain-prevention|1.0.0 |
| status : completed |
| authored : 2020-05-04T14:15:00-05:00 |
| subject |
| display : Marie Lux-Brennard |
| item |
| linkId : questionnaire_timing |
| text : When is this questionnaire being administered? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-questionnaire-timing |
| code : pre |
| display : Before session begin |
| item |
| linkId : back_pain_frequency |
| text : How often do you suffer from back pain? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : freq1wk |
| display : Frequently (at least once a week) |
| item |
| linkId : back_pain_duration |
| text : How long has this pain been occurring? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-duration |
| code : ov3mon |
| display : More than 3 months |
| item |
| linkId : back_pain_location |
| text : In which body part does the pain appear? |
| answer |
| value |
| system : http://snomed.info/sct |
| code : 122495006 |
| display : Thoracic spine (TS) |
| answer |
| value |
| system : http://snomed.info/sct |
| code : 122496007 |
| display : Lumbar spine (LS) |
| item |
| linkId : back_pain_impact |
| text : What are the consequences of your back pain and how does it impact your life situation? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-pain-impact |
| code : leisure |
| display : Limitations during leisure time |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-pain-impact |
| code : absence |
| display : Periods of absence at work |
| item |
| linkId : influence_on_health |
| text : To what extent do you think you can influence your state of health? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-influence-degree |
| code : str |
| display : Strongly |
| item |
| linkId : state_of_health |
| text : How do you assess your state of health? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-health-state |
| code : goo |
| display : Good |
| item |
| linkId : physical_activity_freq |
| text : How often are you physically active in your free time? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : 1xwk |
| display : 1x per week |
| item |
| linkId : workout_reason |
| text : What are the reasons you work out? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-activity-reason |
| code : fun |
| display : Fun |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-activity-reason |
| code : hea |
| display : Health promotion |
| item |
| linkId : physical_burden_tense_posture |
| text : Physical burden at your workplace: Unilateral/tense posture |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : freq |
| display : Frequently |
| item |
| linkId : physical_burden_standing |
| text : Physical burden at your workplace: Primarily in standing position |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : occ |
| display : Occasionally |
| item |
| linkId : physical_burden_sitting |
| text : Physical burden at your workplace: Primarily in sitting position |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : vfreq |
| display : Very frequently |
| item |
| linkId : physical_burden_leaning |
| text : Physical burden at your workplace: Upper body leans forward |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : occ |
| display : Occasionally |
| item |
| linkId : physical_burden_lifting |
| text : Physical burden at your workplace: Heavy lifting |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| display : Never |
| item |
| linkId : ergonomic_advice_impact |
| text : Do you think ergonomic advice can reduce your physical stress at your workplace? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-perceived-likelihood |
| code : img |
| display : Yes, I could imagine it |
| item |
| linkId : training_goals |
| text : What are your goals in participating in the training? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-back-pain-prevention-goal |
| code : pmd |
| display : Prevention of muscular and skeletal disorders |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-back-pain-prevention-goal |
| code : sth |
| display : Stabilize health |
Response reporting no back pain
Link to raw resource: Response for questionnaire back-pain-prevention|1.0.0: s4h-back-pain-prevention-no-pain-response-example-en
| QuestionnaireResponse |
| id : s4h-back-pain-prevention-no-pain-response-example |
| identifier |
| system : urn:ietf:rfc:3986 |
| value : urn:uuid:d4879af2-9925-4224-b972-3cbf3fff2124 |
| language : en |
| questionnaire : http://fhir.smart4health.eu/Questionnaire/back-pain-prevention|1.0.0 |
| status : completed |
| authored : 2022-01-04T14:15:00-05:00 |
| subject |
| display : John Hanson |
| item |
| linkId : questionnaire_timing |
| text : When is this questionnaire being administered? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-questionnaire-timing |
| code : post |
| display : After completed session |
| item |
| linkId : back_pain_frequency |
| text : How often do you suffer from back pain? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| display : Never |
| item |
| linkId : influence_on_health |
| text : To what extent do you think you can influence your state of health? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-influence-degree |
| code : str |
| display : Strongly |
| item |
| linkId : state_of_health |
| text : How do you assess your state of health? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-health-state |
| code : goo |
| display : Good |
| item |
| linkId : physical_activity_freq |
| text : How often are you physically active in your free time? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| display : Never |
| item |
| linkId : workout_hindrance |
| text : What hinders you from taking part in sports activities? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-activity-hindrance |
| code : off |
| display : Unsuitable offers |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-activity-hindrance |
| code : inf |
| display : Missing information |
| item |
| linkId : physical_burden_tense_posture |
| text : Physical burden at your workplace: Unilateral/tense posture |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : freq |
| display : Frequently |
| item |
| linkId : physical_burden_standing |
| text : Physical burden at your workplace: Primarily in standing position |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : occ |
| display : Occasionally |
| item |
| linkId : physical_burden_sitting |
| text : Physical burden at your workplace: Primarily in sitting position |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : vfreq |
| display : Very frequently |
| item |
| linkId : physical_burden_leaning |
| text : Physical burden at your workplace: Upper body leans forward |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : occ |
| display : Occasionally |
| item |
| linkId : physical_burden_lifting |
| text : Physical burden at your workplace: Heavy lifting |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-event-frequency |
| code : nev |
| display : Never |
| item |
| linkId : ergonomic_advice_impact |
| text : Do you think ergonomic advice can reduce your physical stress at your workplace? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-perceived-likelihood |
| code : img |
| display : Yes, I could imagine it |
| item |
| linkId : training_goals |
| text : What are your goals in participating in the training? |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-back-pain-prevention-goal |
| code : pmd |
| display : Prevention of muscular and skeletal disorders |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-back-pain-prevention-goal |
| code : sth |
| display : Stabilize health |