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Start of BM. Biomarkers
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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.
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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.]

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BM001_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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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?
1. Yes
2. No
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If Having a rash, cast, edema (swelling) = 2. No »
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BM003 Direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Direction of measurement = 1. Yes »
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BM004 Safe measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Safe measurement = 1. Yes »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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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.]
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BM006 Timing for first measurement in hours
1ST MEASUREMENT IN HOURS
1..12
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BM006A Timing for first measurement in minutes
1ST MEASUREMENT IN MINUTES
00..59
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BM007 Am/pm for first measurement
AM AND PM
1. AM
2. PM
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BM008 First measurement, systolic reading
FIRST MEASUREMENT
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BM009 First measurement, diastolic reading
FIRST MEASUREMENT
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BM010 First measurement, pulse
FIRST MEASUREMENT
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BM011 Timing for second measurement
2ND MEASUREMENT IN HOURS
1..12
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BM011A Timing for second measurement in minutes
2ND MEASUREMENT IN MINUTES
00..59
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BM012 Am/pm for second measurement
AM AND PM
1. AM
2. PM
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BM013 Second measurement, time of reading
SECOND MEASUREMENT
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BM014 Second measurement, diastolic reading
SECOND MEASUREMENT
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BM015 Second measurement, pulse
SECOND MEASUREMENT
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BM016 Timing for third measurement
3RD MEASUREMENT IN HOURS
1..12
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BM016A Timing for third measurement in minutes
3RD MEASUREMENT IN MINUTES
00..59
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BM017 Am/pm for third measurement
AM AND PM
1. AM
2. PM
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BM018 Third measurement, systolic reading
THIRD MEASUREMENT
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BM019 Third measurement, diastolic reading
THIRD MEASUREMENT
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BM020 Third measurement, pulse
THIRD MEASUREMENT
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BM021 Which are was used for measurement
[IWER: WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?]
1. Left arm
2. Right arm
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BM023 Respondents position for test
[IWER: WHAT WAS R'S POSITION FOR THIS TEST?]
1. Standing
2. Sitting
3. Lying down
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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?]
1. Yes
2. No
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BM022 How compliant was r during measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant
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BM005 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM005_OTHER Other reasons for not completing the blood pressure measurement
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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]
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
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BM096_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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BM097 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM098 Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Do you feel it would be safe for measurement = 1. Yes »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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BM100 First measurement, height
1ST
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BM101 Record the type of floor surface
[IWER: RECORD TYPE OF FLOOR SURFACE.]
1. Wood
2. Concrete
3. Dirt
4. Not sure
5. Other, please specify
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BM101_OTHER Othe reasons record the type of floor surface
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BM102 Was r wearing shoes during measurement
[IWER: WAS R WEARING SHOES DURING THE MEASUREMENT?]
1. Yes
2. No
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BM103 How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant
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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?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM099_OTHER Other reasons why didn't r complete the height measurement
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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.
1. Yes
2. No
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If Is r elibible for weight measurement = 1. Yes »
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BM104_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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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]
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BM106 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM107 Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Do you feel it would be safe for measurement = 1. Yes »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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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]
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BM109 First measurement
1ST
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BM110 Record the type of floor surface
[IWER: RECORD TYPE OF FLOOR SURFACE.]
1. Wood
2. Concrete
3. Dirt
4. Not sure
5. Other, please specify
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BM110_OTHER Other reasons to record the type of floor surface
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BM111 Was r wearing shoes during measurement
[IWER: WAS R WEARING SHOES DURING THE MEASUREMENT?]
1. Yes
2. No
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BM112 How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
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BM108 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM108_OTHER Other reasons why weren't you able to measure r's weight
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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.]
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BM113_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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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?]
1. Yes
2. No
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If Do you feel you are able to stand while we do this measurement = 1. Yes »
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BM115 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM116 Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Do you feel it would be safe for measurement = 1. Yes »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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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]
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BM118 First measurement
1ST
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BM119 Difficulties occured during measurement
[IWER: WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?] (CHECK ALL THAT APPLY)
1. None
2. R had breathing difficulties
3. R was unable to hold breath at the end of the exhale
4. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
5. R did not appear to give full effort, but no obvious reason for this
6. Had difficulty or unable to locate navel
7. Other, please specify
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BM119_OTHER Other reasons difficulties occured during measurement
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BM121 Who completed the measurement
[IWER: WHO COMPLETED THIS MEASUREMENT?]
1. R completed the measurement
2. IWER completed the measurement
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BM122 Was r wearing bulky clothing during measurement
[IWER: WAS THE R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?]
1. Yes
2. No
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BM117 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM117_OTHER Other reasons why weren't you able to measure r's waist
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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.]
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BM123_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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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?]
1. Yes
2. No
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If Do you feel you are able to stand while we do this measurement = 1. Yes »
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BM125 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM126 Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Do you feel it would be safe for measurement = 1. Yes »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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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]
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BM128 First measurement
1ST
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BM129 Difficulties occured during measurement
[IWER: WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?] (CHECK ALL THAT APPLY)
1. None
2. R had breathing difficulties
3. R was unable to hold breath at the end of the exhale
4. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
5. R did not appear to give full effort, but no obvious reason for this
6. Had difficulty or unable to locate navel
7. Other, please specify
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BM129_OTHER Other reasons difficulties occured during measurement
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BM131 Who completed the measurement
[IWER: WHO COMPLETED THIS MEASUREMENT?]
1. R completed the measurement
2. IWER completed the measurement
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BM132 Was r wearing bulky clothing during measurement
[IWER: WAS THE R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?]
1. Yes
2. No
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BM130 How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant
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BM127 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM127_OTHER Other reasons why weren't you able to measure r's waist
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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]
1. Yes
2. No
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If Eligibility for walking speed test = 1. Yes »
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BM076_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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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?
1. No apparent restriction
2. Yes, recent surgery
3. Yes, injury
4. Yes, other health condition
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If Very short distance comfortably = 1. No apparent restriction »
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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]
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BM079 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM080 Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Do you feel it would be safe for measurement = 1. Yes »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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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.]
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BM082 First measurement
1ST
1..60
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BM083 Second measurement
2ND
1..60
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BM084 Record the type of floor surface
[IWER: RECORD TYPE OF FLOOR SURFACE]
1. Wood
2. Concrete
3. Dirt
4. Not sure
5. Other, please specify
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BM084_OTHER Other ways to record the type of floor surface
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BM085 Record the type of aid used
[IWER: RECORD TYPE OF AID USED]
1. None
2. Walking stick or cane
3. Elbow crutches
4. Walking frame
5. Other, please specify
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BM085_OTHER Other reasons record the type of aid used
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BM086 Other reasons record the type of aid used
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant
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BM081 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM081_OTHER Other reasons why didn't r complete the walking speed test
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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. ]
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BM087_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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BM088 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM089 Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Do you feel it would be safe for measurement = 1. Yes »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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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.]
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BM091 Distance vision - left eye
DISTANCE VISION - LEFT EYE
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BM092 Distance vision - right eye
DISTANCE VISION - RIGHT EYE
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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).]
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BM093 Near vision - left eye
NEAR VISION - LEFT EYE
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BM094 Near vision - right eye
NEAR VISION - RIGHT EYE
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BM095 How compliant was r during the measurement
[IWER: HOW COMPLIANT WAS R DURING THIS MEASUREMENT?]
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant
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BM090 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM090_OTHER Other reasons why do you feel it would be safe for measurement
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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 MEASUREMENTSTAND, HOLD THE DYNAMOMETER AT A RIGHT ANGLE AND SQUEEZE THE HANDLE FOR A FEW SECONDS.]
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BM034_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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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?
1. Yes
2. No
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If Any surgery, or any swelling, inflammation, severe pain or injury in hand = 1. Yes »
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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)?
1. Both hands
2. Left hand only
3. Right hand only
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If Surgery in which hand = 2. Left hand only or Surgery in which hand = 3. Right hand only »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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BM037 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM038 Safe measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Safe measurement = 1. Yes »
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BM040 R's dominant hand
WHICH IS YOUR DOMINANT HAND?
1. Right hand
2. Left hand
3. Both hands equally dominant
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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]
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BM041 First measurement
1ST
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BM043 Second measurement
2ND
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BM045 Effort that r put in the test
[IWER: HOW MUCH EFFORT DID R GIVE TO THIS TEST?]
1. R gave full effort
2. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
3. R did not appear to give full effort, but no obvious reason for this
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BM046 R's position for test
[IWER: WHAT WAS R'S POSITION FOR THIS TEST?]
1. Standing
2. Sitting
3. Lying down
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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?]
1. Yes
2. No
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BM039 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM039_OTHER Other reasons why didn't r complete the hand strength test
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If Any surgery, or any swelling, inflammation, severe pain or injury in hand = 2. No »
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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?]
1. Yes
2. No
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If Do iwer feel it would be safe for this respondent to do this measurement = 1. Yes »
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BM037 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM038 Safe measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Safe measurement = 1. Yes »
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BM040 R's dominant hand
WHICH IS YOUR DOMINANT HAND?
1. Right hand
2. Left hand
3. Both hands equally dominant
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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]
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BM041 First measurement
1ST
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BM043 Second measurement
2ND
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BM045 Effort that r put in the test
[IWER: HOW MUCH EFFORT DID R GIVE TO THIS TEST?]
1. R gave full effort
2. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
3. R did not appear to give full effort, but no obvious reason for this
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BM046 R's position for test
[IWER: WHAT WAS R'S POSITION FOR THIS TEST?]
1. Standing
2. Sitting
3. Lying down
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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?]
1. Yes
2. No
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BM039 Problem with equipment or supplies
[IWER: WAS THERE A PROBLEM WITH EQUIPMENT OR SUPPLIES THAT PREVENTED THIS TEST FROM BEING ADMINISTERED OR COMPLETED?]
1. No problem with equipment or supplies
2. Problem with equipment or supplies
3. Other, please specify
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BM039_OTHER Other reasons why didn't r complete the hand strength test
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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.]
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BM048_SPACE Suitable space for test
[IWER: IS THERE SUITABLE SPACE TO COMPLETE THIS TEST?]
1. Yes
2. No
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If Suitable space for test = 1. Yes »
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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?
1. Yes
2. No
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If Any problem from recent surgery, injury or other health condition = 1. Yes »
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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.]
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BM050 Understand the direction of measurement
DO YOU UNDERSTAND THE DIRECTIONS FOR THIS MEASUREMENT?
1. Yes
2. No
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If Understand the direction of measurement = 1. Yes »
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BM051 Do you feel it would be safe for measurement
DO YOU FEEL IT WOULD BE SAFE FOR YOU TO DO THIS MEASUREMENT?
1. Yes
2. No
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If Do you feel it would be safe for measurement = 1. Yes »
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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?]
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