BM. Biomarkers

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BM. Biomarkers module of LASI pilot

item label type description
PRIM_KEY System generated Primary key
BARCODE Question Generated id used in bloodspots
RAGE Question Age r
BM_AGE Question Confirm age of r
BM001 Question Blood pressure
BM001_SPACE Question asked of interviewer Suitable space for test
BM002 Question Having a rash, cast, edema (swelling)
BM003 Question Direction of measurement
BM004 Question Safe measurement
BM004_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM005 Question asked of interviewer Problem with equipment or supplies
BM005_OTHER Question Other reasons for not completing the blood pressure measurement
BM006_INTRO Question asked of interviewer Record measurement in chart
BM006 Question Timing for first measurement in hours
BM006A Question Timing for first measurement in minutes
BM007 Question Am/pm for first measurement
BM008 Question First measurement, systolic reading
BM009 Question First measurement, diastolic reading
BM010 Question First measurement, pulse
BM011 Question Timing for second measurement
BM011A Question Timing for second measurement in minutes
BM012 Question Am/pm for second measurement
BM013 Question Second measurement, time of reading
BM014 Question Second measurement, diastolic reading
BM015 Question Second measurement, pulse
BM016 Question Timing for third measurement
BM016A Question Timing for third measurement in minutes
BM017 Question Am/pm for third measurement
BM018 Question Third measurement, systolic reading
BM019 Question Third measurement, diastolic reading
BM020 Question Third measurement, pulse
BM021 Question asked of interviewer Which are was used for measurement
BM022 Question asked of interviewer How compliant was r during measurement
BM023 Question asked of interviewer Respondents position for test
BM024 Question asked of interviewer Did r smoke, exercise, consume alcohol or food within 30 minutes
BM025 Question asked of interviewer Spirometer, disposable mouthpiece, disposable filter, nose clip
BM025_SPACE Question asked of interviewer Suitable space for test
BM026 Question Understand the direction of measurement
BM027 Question Do you feel it would be safe for measurement
BM027_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM028 Question asked of interviewer Problem with equipment or supplies
BM028_OTHER Question Other reasons why didn't r complete the breathing test
BM029_INTRO Question asked of interviewer Record measurement
BM029 Question First measurement
BM029A Question Flow volume capacity
BM029B Question Flow electronic volume
BM029C Question Flow electronic volume percentage
BM029D Question Puff electronic force
BM029E Question Fef
BM029F Question Fet
BM030 Question Second measurement
BM031 Question Third measurement
BM032 Question asked of interviewer Effort that r put in the test
BM033 Question asked of interviewer R's position for test
BM034 Question asked of interviewer Dynamometer, stopwatch
BM034_SPACE Question asked of interviewer Suitable space for test
BM035 Question Any surgery, or any swelling, inflammation, severe pain or injury in hand
BM036 Question Surgery in which hand
BM037 Question Understand the direction of measurement
BM038 Question Safe measurement
BM038_OTHER Question Other reasons why didn't r complete the breathing test
BM036_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM039 Question asked of interviewer Problem with equipment or supplies
BM039_OTHER Question Other reasons why didn't r complete the hand strength test
BM040 Question R's dominant hand
BM041_INTRO Question asked of interviewer [iwer: record measurement in table below: record measurements to the nearest 0.5 kilogram in the table below. record 993 if r tried but was un...
BM041 Question First measurement
BM042 Question First measurement
BM043 Question Second measurement
BM044 Question Second measurement
BM045 Question asked of interviewer Effort that r put in the test
BM046 Question asked of interviewer R's position for test
BM047 Question asked of interviewer Did r rest their arm on a support while performing the test
BM048 Question asked of interviewer R's standing positions
BM048_SPACE Question asked of interviewer Suitable space for test
BM049 Question Any problem from recent surgery, injury or other health condition
BM049_DISCU... Question asked of interviewer Discussion for physical problem
BM050 Question Understand the direction of measurement
BM051 Question Do you feel it would be safe for measurement
BM051_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM052 Question asked of interviewer Problem with equipment or supplies
BM052_OTHER Question asked of interviewer Other reasons why didn't r complete the hand strength test
BM053 Question asked of interviewer Did r hold semi-tandem stand for a full 10 seconds
BM053_UNABL... Question asked of interviewer Was r compliant during semi tandem stand
BM054_TIME Question asked of interviewer Time of tandem stand
BM055 Question asked of interviewer Did r use any compensatory movements during semi-tandem stand
BM056 Question asked of interviewer R able to complete the semi tandem for full 10 seconds
BM057 Question asked of interviewer Standing with feet together for 10 seconds
BM057_SPACE Question asked of interviewer Suitable space for test
BM058 Question Understand the direction of measurement
BM059 Question Do you feel it would be safe for measurement
BM059_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM060 Question asked of interviewer Problem with equipment or supplies
BM060_OTHER Question Other reason why didn't r complete the side-by-side test
BM061 Question asked of interviewer Did r hold side-by-side stand for 10 seconds
BM062_TIME Question asked of interviewer Amount of time r held stand in seconds
BM063 Question asked of interviewer Did r use any compensatory movements during side-by-side stand
BM064 Question asked of interviewer Record the type of floor surface
BM064_OTHER Question Other ways to record the type of floor surface
BM065 Question asked of interviewer How compliant was r during balance measurement
BM066 Question asked of interviewer Record eligible time
BM067_SPACE Question asked of interviewer Suitable space for test
BM067 Question Record eligible time
BM068 Question Understand the direction of measurement
BM069 Question Do you feel it would be safe for measurement
BM069_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM070 Question asked of interviewer Problem with equipment or supplies
BM070_OTHER Question Other reasons why didn't r complete the full-tandem test
BM071 Question asked of interviewer Did r hold semi-tandem stand for a full 30/60 seconds
BM072_TIME Question Amount of time r held stand in seconds
BM073 Question asked of interviewer Did r use any compensatory movements during full-tandem stand
BM074 Question asked of interviewer Record the type of floor surface
BM074_OTHER Question Record the type of floor surface
BM075 Question asked of interviewer How compliant was r during balance measurement
BM076 Question asked of interviewer Eligibility for walking speed test
BM076_SPACE Question asked of interviewer Suitable space for test
BM077 Question Very short distance comfortably
BM078 Question Very short distance comfortably
BM079 Question Understand the direction of measurement
BM080 Question Do you feel it would be safe for measurement
BM080_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM081 Question asked of interviewer Problem with equipment or supplies
BM081_OTHER Question Other reasons why didn't r complete the walking speed test
BM082_INTRO Question Walk along side you the whole time
BM082 Question First measurement
BM083 Question Second measurement
BM084 Question asked of interviewer Record the type of floor surface
BM084_OTHER Question Other ways to record the type of floor surface
BM085 Question asked of interviewer Record the type of aid used
BM085_OTHER Question Other reasons record the type of aid used
BM086 Question asked of interviewer Other reasons record the type of aid used
BM087 Question asked of interviewer Vision tests
BM087_SPACE Question asked of interviewer Suitable space for test
BM088 Question Understand the direction of measurement
BM089 Question Do you feel it would be safe for measurement
BM089_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM090 Question asked of interviewer Problem with equipment or supplies
BM090_OTHER Question Other reasons why do you feel it would be safe for measurement
BM091_INTRO Question asked of interviewer Distance vision
BM091 Question Distance vision - left eye
BM092 Question Distance vision - right eye
BM093_INTRO Question Near vision
BM093 Question Near vision - left eye
BM094 Question Near vision - right eye
BM095 Question asked of interviewer How compliant was r during the measurement
BM096 Question asked of interviewer Measurement of height
BM096_SPACE Question asked of interviewer Suitable space for test
BM097 Question Understand the direction of measurement
BM098 Question Do you feel it would be safe for measurement
BM098_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM099 Question asked of interviewer Why didn't r complete the height measurement
BM099_OTHER Question Other reasons why didn't r complete the height measurement
BM100_INTRO Question asked of interviewer Record measurement in table
BM100 Question First measurement, height
BM101 Question asked of interviewer Record the type of floor surface
BM101_OTHER Question Othe reasons record the type of floor surface
BM102 Question asked of interviewer Was r wearing shoes during measurement
BM103 Question asked of interviewer How compliant was r during the measurement
BM104 Question asked of interviewer Is r elibible for weight measurement
BM104_SPACE Question asked of interviewer Suitable space for test
BM105 Question Measuring height
BM106 Question Understand the direction of measurement
BM107 Question Do you feel it would be safe for measurement
BM107_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM108 Question asked of interviewer Problem with equipment or supplies
BM108_OTHER Question Other reasons why weren't you able to measure r's weight
BM109_INTRO Question asked of interviewer Record measurement in table
BM109 Question First measurement
BM110 Question asked of interviewer Record the type of floor surface
BM110_OTHER Question Other reasons to record the type of floor surface
BM111 Question asked of interviewer Was r wearing shoes during measurement
BM112 Question asked of interviewer How compliant was r during the measurement
BM113 Question asked of interviewer Waist measurement
BM113_SPACE Question asked of interviewer Suitable space for test
BM114 Question asked of interviewer Do you feel you are able to stand while we do this measurement
BM115 Question Understand the direction of measurement
BM116 Question Do you feel it would be safe for measurement
BM116_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM117 Question asked of interviewer Problem with equipment or supplies
BM117_OTHER Question Other reasons why weren't you able to measure r's waist
BM118_INTRO Question asked of interviewer Record measurement in table
BM118 Question First measurement
BM119 Question asked of interviewer Difficulties occured during measurement
BM119_OTHER Question Other reasons difficulties occured during measurement
BM120 Question asked of interviewer How compliant was r during the measurement
BM121 Question asked of interviewer Who completed the measurement
BM122 Question asked of interviewer Was r wearing bulky clothing during measurement
BM123 Question asked of interviewer Measurement for hip circumference
BM123_SPACE Question asked of interviewer Suitable space for test
BM124 Question asked of interviewer Do you feel you are able to stand while we do this measurement
BM125 Question Understand the direction of measurement
BM126 Question Do you feel it would be safe for measurement
BM126_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM127 Question asked of interviewer Problem with equipment or supplies
BM127_OTHER Question Other reasons why weren't you able to measure r's waist
BM128_INTRO Question asked of interviewer Record measurement in table
BM128 Question First measurement
BM129 Question asked of interviewer Difficulties occured during measurement
BM129_OTHER Question Other reasons difficulties occured during measurement
BM130 Question asked of interviewer How compliant was r during the measurement
BM131 Question asked of interviewer Who completed the measurement
BM132 Question asked of interviewer Was r wearing bulky clothing during measurement
BM133 Question asked of interviewer Blood sample collection
BM133_SPACE Question asked of interviewer Suitable space for test
BM134 Question Understand the direction of measurement
BM135 Question Do you feel it would be safe for measurement
BM135_IWER Question asked of interviewer Do iwer feel it would be safe for this respondent to do this measurement
BM136 Question asked of interviewer Problem with equipment or supplies
BM136_OTHER Question Other reasons why didn't r complete the blood sample test
BM137_INTRO Question Collecting the blood sample
BM137 Question Date
BM138 Question Month
BM139 Question Year
BM140 Question Hour
BM140A Question Minutes
BM141 Question Am/pm
BM142 Question asked of interviewer Problems occured during the collection of blood sample
BM142_OTHER Question Other problems occured during the collection of blood sample
BM143 Question asked of interviewer Who pricked the r's finger
BM143_OTHER Question Other person who pricked the r's finger
BM144 Question asked of interviewer How many circles were filled on the first card
BM146 Question asked of interviewer How many times did the r's figher need to be prick
BM147 Question asked of interviewer How compliant was r during the measurement
BM148 Question Conclusion of biomarker section
up level arrow Up to survey overview
Start of BM. Biomarkers
 
BM_AGE
Confirm age of r
WE ONLY WANT TO ASK FEW QUESTIONS RELATED TO AGE. PLEASE CONFIRM YOUR AGE FOR ME ONE MORE TIME.
 
BM001
Blood pressure
I WOULD LIKE TO MEASURE YOUR BLOOD PRESSURE USING THIS MONITOR AND CUFF WHICH I WILL SECURE AROUND YOUR LEFT ARM. I WOULD LIKE TO TAKE THREE BLOOD PRESSURE MEASURES. I WILL ASK YOU TO RELAX AND REMAIN SEATED AND QUIET DURING THE MEASUREMENTS. FIRST, I WILL PLACE THE CUFF ON YOUR LEFT ARM. ONCE THE CUFF IS PLACED APPROPRIATELY ON YOUR ARM AND WE ARE READY TO BEGIN, I'LL ASK YOU TO LAY YOUR ARM ON A FLAT SURFACE PALM FACING UP SO THAT THE CENTER OF YOUR UPPER ARM IS AT THE SAME HEIGHT AS YOUR HEART. I WILL THEN PRESS THE START BUTTON. THE CUFF WILL INFLATE AND DEFLATE AUTOMATICALLY. AFTER WE HAVE COMPLETED ALL THREE MEASURES, I WILL GIVE YOU YOUR RESULTS.

[IWER: DEMONSTRATE THE MEASUREMENT.

INSERT ARM CUFF PLUG INTO JACK ON THE SIDE OF THE MONITOR, PLACE THE CUFF ON YOUR LEFT ARM APPROXIMATELY 1/2" ABOVE THE ELBOW. POSITION THE BLUE MARKER OVER THE BRACHIAL ARTERY ON THE INSIDE OF THE ARM. PRESS THE START/STOP BUTTON TO SHOW HOW THE CUFF WITH INFLATE AUTOMATICALLY.]
 
BM001_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
 
If Suitable space for test = 1. Yes »
 
   
 
BM002
Having a rash, cast, edema (swelling)
DO YOU HAVE A RASH, A CAST, EDEMA (SWELLING) IN THE ARM, OPEN SORES OR WOUNDS, OR A SIGNIFICANT BRUISE WHERE THE BLOOD PRESSURE CUFF WILL BE IN CONTACT?
expand
   
 
If Having a rash, cast, edema (swelling) = 2. No »
 
     
   
BM003
Direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
     
   
If Direction of measurement = 1. Yes »
 
       
     
BM004
Safe measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
       
     
If Safe measurement = 1. Yes »
 
         
       
BM004_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
         
       
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
           
         
Question Combination
           
         
BM006_INTRO
Record measurement in chart
[IWER: RECORD MEASUREMENTS IN CHART:
(ENTER 993 IN FIRST SYSTOLIC READING IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.) IF THE LOWEST READING OBTAINED IS GREATER THAN 160 SYSTOLIC OR GREATER THAN 110 DIASTOLIC, FILL OUT THE HIGH-BLOOD PRESSURE CARD AND LEAVE IT WITH THE RESPONDENT.]
           
         
BM006
Timing for first measurement in hours
1ST MEASUREMENT IN HOURS
expand
           
         
BM006A
Timing for first measurement in minutes
1ST MEASUREMENT IN MINUTES
expand
           
         
BM007
Am/pm for first measurement
AM AND PM
expand
           
         
BM008
First measurement, systolic reading
FIRST MEASUREMENT
           
         
BM009
First measurement, diastolic reading
FIRST MEASUREMENT
           
         
BM010
First measurement, pulse
FIRST MEASUREMENT
           
         
BM011
Timing for second measurement
2ND MEASUREMENT IN HOURS
expand
           
         
BM011A
Timing for second measurement in minutes
2ND MEASUREMENT IN MINUTES
expand
           
         
BM012
Am/pm for second measurement
AM AND PM
expand
           
         
BM013
Second measurement, time of reading
SECOND MEASUREMENT
           
         
BM014
Second measurement, diastolic reading
SECOND MEASUREMENT
           
         
BM015
Second measurement, pulse
SECOND MEASUREMENT
           
         
BM016
Timing for third measurement
3RD MEASUREMENT IN HOURS
expand
           
         
BM016A
Timing for third measurement in minutes
3RD MEASUREMENT IN MINUTES
expand
           
         
BM017
Am/pm for third measurement
AM AND PM
expand
           
         
BM018
Third measurement, systolic reading
THIRD MEASUREMENT
           
         
BM019
Third measurement, diastolic reading
THIRD MEASUREMENT
           
         
BM020
Third measurement, pulse
THIRD MEASUREMENT
           
         

End Combination
           
         
BM021
Which are was used for measurement
[IWER: WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?]
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BM023
Respondents position for test
[IWER: WHAT WAS R'S POSITION FOR THIS TEST?]
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BM024
Did r smoke, exercise, consume alcohol or food within 30 minutes
[IWER: DID THE R SMOKE, EXERCISE, CONSUME ALCOHOL OR FOOD WITHIN THE 30 MINUTES PRIOR TO COMPLETING THE BLOOD PRESSURE TEST?]
expand
           
         
BM022
How compliant was r during measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
expand
           
         
Question Combination
           
         
BM005
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
           
         
BM005_OTHER
Other reasons for not completing the blood pressure measurement
           
         

End Combination
           
BM096
Measurement of height
[IWER: EQUIPMENT NEEDED: STADIOMETER]

NEXT, I WOULD LIKE TO MEASURE YOUR HEIGHT. TO COMPLETE THIS MEASUREMENT, I'LL BE ASKING YOU TO TAKE OFF YOUR SHOES AND STAND UP AGAINST A WALL. PLEASE STAND STRAIGHT AND STURDY, AND KEEP STEP ONTO THE BASE OF THE STADIOMETER, FEET TOGETHER, HEELS, BUTTOCKS, BACK AND HEAD AGAINST THE WALL, KNEES STRAIGHT, LOOK STRAIGHT AHEAD, CHIN TUCKED TO CHEST SLIGHTLY, AND DO NOT LOOK UP.

[IWER: DEMONSTRATE THE MEASUREMENT]
expand
 
BM096_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
 
If Suitable space for test = 1. Yes »
 
   
 
BM097
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
   
 
If Understand the direction of measurement = 1. Yes »
 
     
   
BM098
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
     
   
If Do you feel it would be safe for measurement = 1. Yes »
 
       
     
BM098_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
       
     
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
         
       
BM100
First measurement, height
1ST
         
       
Question Combination
         
       
BM101
Record the type of floor surface
[IWER: RECORD TYPE OF FLOOR SURFACE.]
expand
         
       
BM101_OTHER
Othe reasons record the type of floor surface
         
       

End Combination
         
       
BM102
Was r wearing shoes during measurement
[IWER: WAS R WEARING SHOES DURING THE MEASUREMENT?]
expand
         
       
BM103
How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
expand
         
       
Question Combination
         
       
BM099
Why didn't r complete the height measurement
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
         
       
BM099_OTHER
Other reasons why didn't r complete the height measurement
         
       

End Combination
         
BM104
Is r elibible for weight measurement
[IWER: EQUIPMENT NEEDED: SCALE]
IS R ELIGIBLE FOR WEIGHT MEASURES? WEIGHT MEASURES ARE ADMINISTERED FOR RS WHO WEIGH LESS THAN 120 KILOGRAMS.
expand
 
If Is r elibible for weight measurement = 1. Yes »
 
   
 
BM104_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
   
 
If Suitable space for test = 1. Yes »
 
     
   
BM105
Measuring height
NOW, I'D LIKE TO MEASURE YOUR WEIGHT. TO MEASURE YOUR WEIGHT, I WILL ASK YOU TO STAND ON THIS SCALE, WITH YOUR SHOES OFF, WHILE I READ THE DISPLAY.

[IWER: DEMONSTRATE THE MEASUREMENTS]
     
   
BM106
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
     
   
If Understand the direction of measurement = 1. Yes »
 
       
     
BM107
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
       
     
If Do you feel it would be safe for measurement = 1. Yes »
 
         
       
BM107_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
         
       
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
           
         
Question Combination
           
         
BM109_INTRO
Record measurement in table
[IWER: RECORD MEASUREMENT IN TABLE BELOW: ENTER 993 IF R TRIED BUT RECEIVED AN ERROR MESSAGE. RECORD R'S WEIGHT TO THE NEAREST 0.1 KG]
           
         
BM109
First measurement
1ST
           
         

End Combination
           
         
Question Combination
           
         
BM110
Record the type of floor surface
[IWER: RECORD TYPE OF FLOOR SURFACE.]
expand
           
         
BM110_OTHER
Other reasons to record the type of floor surface
           
         

End Combination
           
         
BM111
Was r wearing shoes during measurement
[IWER: WAS R WEARING SHOES DURING THE MEASUREMENT?]
expand
           
         
BM112
How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
expand
           
         
Question Combination
           
         
BM108
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
           
         
BM108_OTHER
Other reasons why weren't you able to measure r's weight
           
         

End Combination
           
BM113
Waist measurement
[IWER: EQUIPMENT NEEDED: SOFT TAPE MEASURE]

NEXT I'M GOING TO ASK YOU TO PERFORM A SIMPLE MEASUREMENT OF YOUR WAIST CIRCUMFERENCE. FOR THIS MEASUREMENT IT IS IMPORTANT FOR YOU TO BE STANDING. I WILL ASK YOU TO IDENTIFY WHERE ON YOUR BODY YOUR NAVEL (BELLY BUTTON) IS LOCATED. I WILL THEN ASK YOU TO PLACE THIS SOFT MEASURING TAPE AROUND YOUR WAIST, OVER YOUR CLOTHING, HOLDING IT SECURELY AT THE LEVEL OF YOUR NAVEL. ONCE THE TAPE MEASURE IS PLACED APPROPRIATELY AROUND YOUR WAIST THEN WE ARE READY TO BEGIN. I WILL ASK YOU TO TAKE A NORMAL BREATH AND EXHALE, HOLDING YOUR BREATH AT THE END OF THE EXHALE. I WILL THEN RECORD THE MEASUREMENT.

[IWER: DEMONSTRATE THE MEASUREMENT.

STAND AND LOCATE NAVEL. PLACE MEASURING TAPE OVER THE CLOTHING AROUND THE WAIST AT THE LEVEL OF THE NAVEL. TAKE A NORMAL BREATH AND EXHALE, HOLDING BREATH AT END OF EXHALE AND LETTING THE TAPE OUT SLIGHTLY.]
 
BM113_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
 
If Suitable space for test = 1. Yes »
 
   
 
BM114
Do you feel you are able to stand while we do this measurement
[IWER: ASK IF NECESSARY: BEFORE WE BEGIN, DO YOU FEEL YOU ARE ABLE TO STAND WHILE WE DO THIS MEASUREMENT?]
expand
   
 
If Do you feel you are able to stand while we do this measurement = 1. Yes »
 
     
   
BM115
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
     
   
If Understand the direction of measurement = 1. Yes »
 
       
     
BM116
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
       
     
If Do you feel it would be safe for measurement = 1. Yes »
 
         
       
BM116_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
         
       
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
           
         
Question Combination
           
         
BM118_INTRO
Record measurement in table
[IWER: RECORD MEASUREMENT IN TABLE BELOW: ENTER 999 IF R CHOSE NOT TO DO IT. RECORD R'S WAIST TO THE NEAREST 0.1 CM]
           
         
BM118
First measurement
1ST
           
         

End Combination
           
         
Question Combination
           
         
BM119
Difficulties occured during measurement
[IWER: WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?] (CHECK ALL THAT APPLY)
expand
           
         
BM119_OTHER
Other reasons difficulties occured during measurement
           
         

End Combination
           
         
BM121
Who completed the measurement
[IWER: WHO COMPLETED THIS MEASUREMENT?]
expand
           
         
BM122
Was r wearing bulky clothing during measurement
[IWER: WAS THE R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?]
expand
           
         
Question Combination
           
         
BM117
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
           
         
BM117_OTHER
Other reasons why weren't you able to measure r's waist
           
         

End Combination
           
BM123
Measurement for hip circumference
[IWER: EQUIPMENT NEEDED: SOFT TAPE MEASURE OR GULICK MEASURING TAPE]
NEXT I'M GOING TO ASK YOU TO PERFORM A SIMPLE MEASUREMENT OF YOUR HIP CIRCUMFERENCE. FOR THIS MEASUREMENT IT IS IMPORTANT FOR YOU TO BE STANDING. I WILL ASK YOU TO IDENTIFY WHERE THE MAXIMUM CIRCUMFERENCE OF YOUR HIP. I WILL THEN ASK YOU TO PLACE THIS SOFT MEASURING TAPE AROUND YOUR HIP, OVER YOUR CLOTHING, HOLDING IT SECURELY. ONCE THE TAPE MEASURE IS PLACED APPROPRIATELY AROUND YOUR HIP AND PARALLEL TO FLOOR THEN WE ARE READY TO BEGIN. I WILL ASK YOU TO TAKE A NORMAL BREATH AND EXHALE, HOLDING YOUR BREATH AT THE END OF THE EXHALE. I WILL THEN RECORD THE MEASUREMENT.
[IWER: DEMONSTRATE THE MEASUREMENT.

STAND AND LOCATE THE MAXIMUM CIRCUMFERENCE OF HIP. PLACE MEASURING TAPE OVER THE CLOTHING AROUND THE HIP PARALLEL TO FLOOR. TAKE A NORMAL BREATH AND EXHALE, HOLDING BREATH AT END OF EXHALE AND LETTING THE TAPE OUT SLIGHTLY.]
 
BM123_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
 
If Suitable space for test = 1. Yes »
 
   
 
BM124
Do you feel you are able to stand while we do this measurement
[IWER: ASK IF NECESSARY: BEFORE WE BEGIN, DO YOU FEEL YOU ARE ABLE TO STAND WHILE WE DO THIS MEASUREMENT?]
expand
   
 
If Do you feel you are able to stand while we do this measurement = 1. Yes »
 
     
   
BM125
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
     
   
If Understand the direction of measurement = 1. Yes »
 
       
     
BM126
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
       
     
If Do you feel it would be safe for measurement = 1. Yes »
 
         
       
BM126_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
         
       
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
           
         
Question Combination
           
         
BM128_INTRO
Record measurement in table
[IWER: RECORD MEASUREMENT IN TABLE BELOW: ENTER 999 IF R CHOSE NOT TO DO IT. RECORD R'S HIP TO THE NEAREST 0.1 CM]
           
         
BM128
First measurement
1ST
           
         

End Combination
           
         
Question Combination
           
         
BM129
Difficulties occured during measurement
[IWER: WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?] (CHECK ALL THAT APPLY)
expand
           
         
BM129_OTHER
Other reasons difficulties occured during measurement
           
         

End Combination
           
         
BM131
Who completed the measurement
[IWER: WHO COMPLETED THIS MEASUREMENT?]
expand
           
         
BM132
Was r wearing bulky clothing during measurement
[IWER: WAS THE R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?]
expand
           
         
BM130
How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
expand
           
         
Question Combination
           
         
BM127
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
           
         
BM127_OTHER
Other reasons why weren't you able to measure r's waist
           
         

End Combination
           
BM076
Eligibility for walking speed test
[IWER: EQUIPMENT NEEDED: TAPE MEASURE, STOPWATCH, MASKING TAPE]
IS R ELIGIBLE FOR WALKING SPEED TEST?
[IWER: R IS ELIGIBLE IF R'S AGE IS 60 OR OLDER]
expand
 
If Eligibility for walking speed test = 1. Yes »
 
   
 
BM076_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
   
 
If Suitable space for test = 1. Yes »
 
     
   
BM077
Very short distance comfortably
NEXT, I WOULD LIKE TO ASSESS WHETHER YOU CAN WALK A VERY SHORT DISTANCE COMFORTABLY (USING A WALKING STICK OR OTHER AID IF NECESSARY). FIRST, I WANT TO MAKE SURE IT IS SAFE TO CARRY OUT THE MEASUREMENT. DO YOU HAVE ANY PROBLEMS FROM RECENT SURGERY, INJURY, OR OTHER HEALTH CONDITIONS THAT MIGHT PREVENT YOU FROM WALKING?
expand
     
   
If Very short distance comfortably = 1. No apparent restriction »
 
       
     
BM078
Very short distance comfortably
NOW LET'S FIND A PLACE WHERE WE CAN CONDUCT THE MEASUREMENT. WE WILL NEED A CLEAR SPACE ABOUT 4 METRES LONG IN A NON-CARPETED AREA, IF POSSIBLE. I'M GOING TO PLACE THE MEASURING TAPE ALONGSIDE THE SPACE WHERE THE WALK WILL TAKE PLACE.

[IWER: SET UP THE COURSE (4 METRES)]

THIS IS OUR WALKING COURSE. I AM GOING TO TIME YOU AS YOU WALK THE COURSE. I WILL BE ASKING YOU TO WALK THE COURSE TWO TIMES. I'LL WALK ALONG SIDE YOU THE WHOLE TIME DURING THE MEASUREMENT. NOW, I'D LIKE TO DEMONSTRATE HOW TO DO THE MEASUREMENT. YOU WILL START BY LINING YOUR FEET UP AT THE STARTING POINT.

[IWER: DEMONSTRATE THE MEASUREMENT]
       
     
BM079
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
       
     
If Understand the direction of measurement = 1. Yes »
 
         
       
BM080
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
         
       
If Do you feel it would be safe for measurement = 1. Yes »
 
           
         
BM080_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
           
         
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
             
           
Question Combination
             
           
BM082_INTRO
Walk along side you the whole time
I AM GOING TO TIME YOU AS YOU WALK THE COURSE AT YOUR NORMAL PACE. I WILL BE ASKING YOU TO WALK THE COURSE AT YOUR USUAL PACE A TOTAL OF TWO TIMES. I'LL WALK ALONG SIDE YOU THE WHOLE TIME DURING THE MEASUREMENT. I'D LIKE YOU TO STAND HERE WITH YOUR FEET LINED UP. START WALKING WHEN I SAY "BEGIN". WALK ALL THE WAY PAST THE OTHER END OF THE TAPE BEFORE YOU STOP. ARE YOU READY TO GO NOW? "BEGIN."

REPEAT THE MEASUREMENT: "NOW I WANT YOU TO REPEAT THE WALK. REMEMBER TO WALK AT YOUR USUAL PACE AND GO ALL THE WAY PAST THE OTHER END OF THE COURSE. I'D LIKE YOU TO STAND HERE WITH YOUR FEET LINED UP. START WALKING WHEN I SAY "BEGIN". ARE YOU READY TO GO NOW? "BEGIN."

[IWER: RECORD MEASUREMENTS IN TABLE BELOW. RECORD 993 IF R TRIED BUT WAS UNABLE. RECORD 999 IF R CHOSE NOT TO DO IT. EXAMPLE 10.15 SECONDS.]
             
           
BM082
First measurement
1ST
expand
             
           
BM083
Second measurement
2ND
expand
             
           

End Combination
             
           
Question Combination
             
           
BM084
Record the type of floor surface
[IWER: RECORD TYPE OF FLOOR SURFACE]
expand
             
           
BM084_OTHER
Other ways to record the type of floor surface
             
           

End Combination
             
           
Question Combination
             
           
BM085
Record the type of aid used
[IWER: RECORD TYPE OF AID USED]
expand
             
           
BM085_OTHER
Other reasons record the type of aid used
             
           

End Combination
             
           
BM086
Other reasons record the type of aid used
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
expand
             
           
Question Combination
             
           
BM081
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
             
           
BM081_OTHER
Other reasons why didn't r complete the walking speed test
             
           

End Combination
             
BM087
Vision tests
[IWER: EQUIPMENT NEEDED:
FOUR METER DISTANCE VISION TUMBLING E LOGMAR CHART
40 CM NEAR VISION TUMBLING E LOGMAR CHART
FLEXIBLE STEEL MEASURING TAPE
STICKY TAPE]
I AM NOW GOING TO TEST YOUR DISTANCE VISION AND NEAR VISION.
[IWER: INVITE THE RESPONDENT TO SIT AGAIN - IN A CHAIR POSITIONED SO THAT THE RESPONDENT'S HEAD WILL BE 4 METERS FROM THE EYE CHART. MAKE SURE RESPONDENT DOES NOT LEAN IN CLOSER TO THE CHART DURING THE TEST.



DEMONSTRATE THE MEASUREMENT.

TO MEASURE ACUITY IN THE LEFT EYE, THE RIGHT EYE IS COVERED WITH RIGHT PALM OR AN EYE PATCH AND THE SUBJECT IS ASKED TO RESPOND TO EACH "E" IN A ROW SLOWLY, ROW BY ROW, WITH YOUR GUIDANCE. ONLY ONE READING OF A GIVEN "E" IS ALLOWED. ]
 
BM087_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
 
If Suitable space for test = 1. Yes »
 
   
 
BM088
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
   
 
If Understand the direction of measurement = 1. Yes »
 
     
   
BM089
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
     
   
If Do you feel it would be safe for measurement = 1. Yes »
 
       
     
BM089_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
       
     
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
         
       
Question Combination
         
       
BM091_INTRO
Distance vision
[IWER: START WITH THE DISTANCE VISION CHART - USING THE 4 METRES MEASURED OUT FOR THE TIMED WALK. IF THE RESPONDENT MAKES MORE THAN 3 ERRORS IN ONE ROW, AND READS ALL LETTERS IN THE ROW, THEIR RESULT IS READ AS THE PREVIOUS ROW. SELECT AND RECORD THE RESULT FROM THE COLUMN LABELED "DECIMAL" ON THE LEFT SIDE OF THE CHART.]

WE WILL START WITH YOUR DISTANCE VISION - AND WITH YOUR LEFT EYE. WOULD YOU PLEASE COVER YOUR RIGHT EYE WITH THE PALM OF YOUR RIGHT HAND. PLEASE READ.

NOW PLEASE COVER YOUR LEFT EYE WITH LEFT HAND SO WE CAN TEST YOUR RIGHT EYE. PLEASE READ.

[IWER: RECORD MEASUREMENTS IN TABLE BELOW. RECORD 993 IF R TRIED BUT WAS UNABLE. RECORD 999 IF R CHOSE NOT TO DO IT.]
         
       
BM091
Distance vision - left eye
DISTANCE VISION - LEFT EYE
         
       
BM092
Distance vision - right eye
DISTANCE VISION - RIGHT EYE
         
       

End Combination
         
       
Question Combination
         
       
BM093_INTRO
Near vision
OKAY, NOW WE WOULD LIKE TO TEST YOUR NEAR VISION - STARTING AGAIN WITH YOUR LEFT EYE - PLEASE COVER YOUR RIGHT EYE WITH YOUR RIGHT HAND. INDICATE IF THE "E" IS FACING UP, DOWN, LEFT OR RIGHT. PLEASE READ.

NOW COVER YOUR LEFT EYE WITH LEFT HAND SO I CAN TEST YOUR RIGHT EYE. PLEASE READ.

[IWER: HAVE THE RESPONDENT PLACE THE END OF THE CORD ATTACHED TO THE NEAR VISION CHART BETWEEN FOREFINGER AND MIDDLE FINGER. THEN PLACE THE PALM OVER THE EYE WITH THE SAME HAND. THE FREE HAND IS USED TO HOLD THE CHART. RESPONSES WILL BE VERBAL (UP, DOWN, LEFT, RIGHT).]
         
       
BM093
Near vision - left eye
NEAR VISION - LEFT EYE
         
       
BM094
Near vision - right eye
NEAR VISION - RIGHT EYE
         
       

End Combination
         
       
BM095
How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
expand
         
       
Question Combination
         
       
BM090
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
         
       
BM090_OTHER
Other reasons why do you feel it would be safe for measurement
         
       

End Combination
         
BM034
Dynamometer, stopwatch
[IWER: EQUIPMENT NEEDED: DYNAMOMETER, STOPWATCH]

NOW I WOULD LIKE TO ASSESS THE STRENGTH OF YOUR HAND IN A GRIPPING ACTION. I WILL ASK YOU TO SQUEEZE THIS HANDLE AS HARD AS YOU CAN, JUST FOR A COUPLE OF SECONDS AND THEN LET GO. I WILL TAKE ALTERNATELY TWO MEASUREMENTS FROM YOUR RIGHT AND YOUR LEFT HANDS.

[IWER: DEMONSTRATE THE MEASUREMENT

STAND, HOLD THE DYNAMOMETER AT A RIGHT ANGLE AND SQUEEZE THE HANDLE FOR A FEW SECONDS.]
 
BM034_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
 
If Suitable space for test = 1. Yes »
 
   
 
BM035
Any surgery, or any swelling, inflammation, severe pain or injury in hand
BEFORE WE BEGIN, I'D LIKE TO MAKE SURE IT IS SAFE FOR YOU TO DO THIS MEASUREMENT.

HAVE YOU HAD SURGERY OR EXPERIENCED ANY SWELLING, INFLAMMATION, SEVERE PAIN, OR INJURY IN ONE OR BOTH HANDS WITHIN THE LAST 6 MONTHS?
expand
   
 
If Any surgery, or any swelling, inflammation, severe pain or injury in hand = 1. Yes »
 
     
   
BM036
Surgery in which hand
IN WHICH HAND (HAVE YOU HAD SURGERY OR EXPERIENCED ANY SWELLING, INFLAMMATION, SEVERE PAIN, OR INJURY IN THE LAST 6 MONTHS)?
expand
     
   
If Surgery in which hand = 2. Left hand only or Surgery in which hand = 3. Right hand only »
 
       
     
BM036_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
       
     
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
         
       
BM037
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
         
       
If Understand the direction of measurement = 1. Yes »
 
           
         
BM038
Safe measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
           
         
If Safe measurement = 1. Yes »
 
             
           
BM040
R's dominant hand
WHICH IS YOUR DOMINANT HAND?
expand
             
           
Question Combination
             
           
BM041_INTRO
[iwer: record measurement in table below: record measurements to the nearest 0.5 kilogram in the table below. record 993 if r tried but was un...
[IWER: START THE MEASUREMENT FROM THE LEFT HAND FIRST.

RECORD MEASUREMENT IN TABLE BELOW:

RECORD MEASUREMENTS TO THE NEAREST KILOGRAM IN THE TABLE BELOW.

RECORD 993 IF R TRIED BUT WAS UNABLE. RECORD 999 IF R CHOSE NOT TO DO IT]
             
           
BM041
First measurement
1ST
             
           
BM042
First measurement
             
           
BM043
Second measurement
2ND
             
           
BM044
Second measurement
             
           

End Combination
             
           
BM045
Effort that r put in the test
[IWER: HOW MUCH EFFORT DID R GIVE TO THIS TEST?]
expand
             
           
BM046
R's position for test
[IWER: WHAT WAS R'S POSITION FOR THIS TEST?]
expand
             
           
BM047
Did r rest their arm on a support while performing the test
[IWER: DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THE TEST?]
expand
             
           
Question Combination
             
           
BM039
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
             
           
BM039_OTHER
Other reasons why didn't r complete the hand strength test
             
           

End Combination
             
 
If Any surgery, or any swelling, inflammation, severe pain or injury in hand = 2. No »
 
     
   
BM036_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
     
   
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
       
     
BM037
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
       
     
If Understand the direction of measurement = 1. Yes »
 
         
       
BM038
Safe measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
         
       
If Safe measurement = 1. Yes »
 
           
         
BM040
R's dominant hand
WHICH IS YOUR DOMINANT HAND?
expand
           
         
Question Combination
           
         
BM041_INTRO
[iwer: record measurement in table below: record measurements to the nearest 0.5 kilogram in the table below. record 993 if r tried but was un...
[IWER: START THE MEASUREMENT FROM THE LEFT HAND FIRST.

RECORD MEASUREMENT IN TABLE BELOW:

RECORD MEASUREMENTS TO THE NEAREST KILOGRAM IN THE TABLE BELOW.

RECORD 993 IF R TRIED BUT WAS UNABLE. RECORD 999 IF R CHOSE NOT TO DO IT]
           
         
BM041
First measurement
1ST
           
         
BM042
First measurement
           
         
BM043
Second measurement
2ND
           
         
BM044
Second measurement
           
         

End Combination
           
         
BM045
Effort that r put in the test
[IWER: HOW MUCH EFFORT DID R GIVE TO THIS TEST?]
expand
           
         
BM046
R's position for test
[IWER: WHAT WAS R'S POSITION FOR THIS TEST?]
expand
           
         
BM047
Did r rest their arm on a support while performing the test
[IWER: DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THE TEST?]
expand
           
         
Question Combination
           
         
BM039
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
           
         
BM039_OTHER
Other reasons why didn't r complete the hand strength test
           
         

End Combination
           
BM048
R's standing positions
[IWER: EQUIPMENT NEEDED: STOPWATCH, SHOW CARD]
I WOULD NOW LIKE YOU TO TRY TO STAND IN DIFFERENT POSITIONS. I WILL FIRST DESCRIBE AND SHOW EACH POSITION TO YOU. THEN, I'D LIKE YOU TO TRY TO DO IT. IF YOU CANNOT DO A PARTICULAR POSITION, OR IF YOU FEEL IT WOULD BE UNSAFE TO TRY TO DO IT, TELL ME AND WE'LL MOVE ON TO THE NEXT ONE. LET ME EMPHASIZE THAT I DO NOT WANT YOU TO TRY TO DO ANY ACTIVITY THAT YOU FEEL MIGHT BE UNSAFE.
FOR THE FIRST ONE, I WANT YOU TO TRY TO STAND WITH THE SIDE OF THE HEEL OF ONE FOOT TOUCHING THE BIG TOE OF THE OTHER FOOT FOR ABOUT 10 SECONDS. YOU MAY PUT EITHER FOOT IN FRONT, WHICHEVER IS MORE COMFORTABLE FOR YOU. LIKE THIS...

[IWER: DEMONSTRATE THE MEASUREMENT.

STAND AND PLACE THE HEEL OF ONE FOOT TOUCHING THE BIG TOE OF THE OTHER FOOT.]
 
BM048_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
expand
 
If Suitable space for test = 1. Yes »
 
   
 
BM049
Any problem from recent surgery, injury or other health condition
BEFORE WE BEGIN, DO YOU HAVE ANY PROBLEMS FROM RECENT SURGERY, INJURY OR OTHER HEALTH CONDITIONS THAT MIGHT PREVENT YOU FROM STANDING UP FROM A CHAIR AND BALANCING?
expand
   
 
If Any problem from recent surgery, injury or other health condition = 1. Yes »
 
     
   
BM049_DISCUSS
Discussion for physical problem
[IWER: DISCUSS WITH HIM/HER WHETHER S/HE SHOULD ATTEMPT EACH MEASUREMENT GIVEN HIS/HER PHYSICAL PROBLEMS AFTER DESCRIBING EACH MEASUREMENT. DO NOT ASSUME A RESPONDENT IS TOO PHYSICALLY LIMITED TO ATTEMPT A MEASUREMENT WITHOUT DISCUSSING IT WITH HIM/HER.]
     
 
BM050
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
expand
   
 
If Understand the direction of measurement = 1. Yes »
 
     
   
BM051
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
expand
     
   
If Do you feel it would be safe for measurement = 1. Yes »
 
       
     
BM051_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
expand
       
     
If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
         
       
Question Combination
         
       
BM053
Did r hold semi-tandem stand for a full 10 seconds
[IWER: DID R HOLD SEMI-TANDEM STAND FOR A FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?]
expand
         
       
BM054_TIME
Time of tandem stand
[IWER: ENTER AMOUNT OF TIME R HELD STAND IN SECONDS TO TWO DECIMAL PLACES]
         
       

End Combination
         
       
If Did r hold semi-tandem stand for a full 10 seconds = 2. No (Time in seconds to 2 decimal places):  »
 
           
         
BM053_UNABLE
Was r compliant during semi tandem stand
[IWER: HOW COMPLIANT WAS R DURING THE SEMI-TANDEM STAND? (CLICK ONE)]
expand
           
       
BM055
Did r use any compensatory movements during semi-tandem stand
[IWER: DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SEMI-TANDEM STAND?]
expand
         
       
Question Combination
         
       
BM052
Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
expand
         
       
BM052_OTHER
Other reasons why didn't r complete the hand strength test
[IWER: WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST?]
         
       

End Combination
         
If Did r hold semi-tandem stand for a full 10 seconds <> 1. Yes or Did r use any compensatory movements during semi-tandem stand <> 2. No »
 
   
 
BM057
Standing with feet together for 10 seconds
[IWER: EQUIPMENT NEEDED: STOPWATCH, SHOW CARD]
NOW I WILL SHOW YOU NEXT MOVEMENT. I WANT YOU TO TRY TO STAND WITH YOUR FEET TOGETHER, SIDE-BY-SIDE FOR ABOUT 10 SECONDS. YOU MAY USE YOUR ARMS, BEND YOUR KNEES, OR MOVE YOUR BODY TO MAINTAIN YOUR BALANCE, BUT TRY NOT TO MOVE YOUR FEET. TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP. LIKE THIS...
[IWER: DEMONSTRATE THE MEASUREMENT

STAND WITH FEET TOGETHER.]
   
 
BM057_SPACE
Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
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If Suitable space for test = 1. Yes »
 
     
   
BM058
Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
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If Understand the direction of measurement = 1. Yes »
 
       
     
BM059
Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
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If Do you feel it would be safe for measurement = 1. Yes »
 
         
       
BM059_IWER
Do iwer feel it would be safe for this respondent to do this measurement
[IWER: DO YOU THE IWER FEEL IT WOULD BE SAFE FOR THIS RESPONDENT TO DO THIS MEASUREMENT?]
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
 
           
         
Question Combination
           
         
BM061
Did r hold side-by-side stand for 10 seconds
[IWER: DID R HOLD SIDE-BY-SIDE STAND FOR A FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?]
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BM062_TIME
Amount of time r held stand in seconds
[IWER: ENTER AMOUNT OF TIME R HELD STAND IN SECONDS TO TWO DECIMAL PLACES]
           
         

End Combination
           
         
BM063
Did r use any compensatory movements during side-by-side stand
[IWER: DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SIDE-BY-SIDE STAND?]
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Question Combination
           
         
BM064
Record the type of floor surface
[IWER: RECORD THE TYPE OF FLOOR SURFACE THAT THE BALANCE MEASURES WERE CONDUCTED ON.]
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BM064_OTHER
Other ways to record the type of floor surface
           
         

End Combination
           
         
BM065
How compliant was r during balance measurement
[IWER: HOW COMPLIANT WAS R DURING THE BALANCE MEASUREMENT?]
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If How compliant was r during balance measurement = 3. R was not fully compliant »
 
             
           
Question Combination