5222 lines
206 KiB
JSON
5222 lines
206 KiB
JSON
{
|
||
"name": "Schmerzfragebogen",
|
||
"units": [
|
||
{
|
||
"type": "Survey",
|
||
"description": "DSF Teil1",
|
||
"position": 10,
|
||
"special": null,
|
||
"survey_data": {
|
||
"name": "dsf1",
|
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"items": [
|
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{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_intro",
|
||
"label": "Sehr geehrte Patientin, sehr geehrter Patient, sicher haben Sie selbst schon erlebt wie schwierig es ist, Ihrem Arzt eine genaue Beschreibung Ihrer Schmerzen zu geben. Er ist jedoch darauf angewiesen, zu erfahren, wie Ihre Schmerzen beschaffen sind und wie Sie auf die Schmerzbehandlung ansprechen. \n\nIhre Angaben in diesem Fragebogen dienen der Vorbereitung des ersten ärztlichen Gespräches und der Basisuntersuchung. In Ihrem eigenen Interesse möchten wir Sie deshalb bitten, alle Fragen in Ruhe und mit Sorgfalt zu beantworten. \n\nBitte beantworten Sie **alle** Fragen, auch die, die Ihnen unwichtig erscheinen. \nIhre Daten unterliegen der Schweigepflicht. Die Bearbeitung Ihrer Angaben in unserer Einrichtung entspricht den Bestimmungen des Bundesdatenschutzgesetzes. \nIhre Fragebogendaten werden in einen EDV-Dokumentationssystem gespeichert, das nur berechtigten Mitarbeitern unserer Abteilung zugänglich ist. Diese sind zur Verschwiegenheit verpflichtet.",
|
||
"label_parsed": "<p>Sehr geehrte Patientin, sehr geehrter Patient, sicher haben Sie selbst schon erlebt wie schwierig es ist, Ihrem Arzt eine genaue Beschreibung Ihrer Schmerzen zu geben. Er ist jedoch darauf angewiesen, zu erfahren, wie Ihre Schmerzen beschaffen sind und wie Sie auf die Schmerzbehandlung ansprechen. <\/p>\n<p>Ihre Angaben in diesem Fragebogen dienen der Vorbereitung des ersten ärztlichen Gespräches und der Basisuntersuchung. In Ihrem eigenen Interesse möchten wir Sie deshalb bitten, alle Fragen in Ruhe und mit Sorgfalt zu beantworten. <\/p>\n<p>Bitte beantworten Sie <strong>alle<\/strong> Fragen, auch die, die Ihnen unwichtig erscheinen.<br />\nIhre Daten unterliegen der Schweigepflicht. Die Bearbeitung Ihrer Angaben in unserer Einrichtung entspricht den Bestimmungen des Bundesdatenschutzgesetzes.<br />\nIhre Fragebogendaten werden in einen EDV-Dokumentationssystem gespeichert, das nur berechtigten Mitarbeitern unserer Abteilung zugänglich ist. Diese sind zur Verschwiegenheit verpflichtet.<\/p>",
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"optional": 1,
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"class": "",
|
||
"showif": "",
|
||
"value": null,
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"block_order": null,
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"item_order": 1
|
||
},
|
||
{
|
||
"type": "Text",
|
||
"choice_list": null,
|
||
"type_options": "([0-2][0-9]|3[01])\\.(0[1-9]|1[0-2])\\.[0-9]{4}",
|
||
"name": "dsf_geburtsdatum",
|
||
"label": "Geburtsdatum (TT.MM.JJJJ)",
|
||
"label_parsed": "Geburtsdatum (TT.MM.JJJJ)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 2
|
||
},
|
||
{
|
||
"type": "number",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_alter",
|
||
"label": "Alter (Jahre)",
|
||
"label_parsed": "Alter (Jahre)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 3
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_geschlecht",
|
||
"type_options": null,
|
||
"name": "dsf_geschlecht",
|
||
"label": "Geschlecht",
|
||
"label_parsed": "Geschlecht",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 4,
|
||
"choices": {
|
||
"1": "männlich",
|
||
"2": "weiblich"
|
||
}
|
||
},
|
||
{
|
||
"type": "number",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_groesse",
|
||
"label": "Körpergröße (cm)",
|
||
"label_parsed": "Körpergröße (cm)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
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"block_order": null,
|
||
"item_order": 5
|
||
},
|
||
{
|
||
"type": "number",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_gewicht",
|
||
"label": "Körpergewicht (kg)",
|
||
"label_parsed": "Körpergewicht (kg)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 6
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_submit0",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 7
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "paingrid_intro",
|
||
"label": "Bitte zeichnen Sie im Körperschema ein, an welchen Körperstellen Ihre Schmerzen auftreten.\n\n*Mehrere Felder können gleichzeitig markiert werden. Ein erneuter Klick entfernt die Markierung.*",
|
||
"label_parsed": "<p>Bitte zeichnen Sie im Körperschema ein, an welchen Körperstellen Ihre Schmerzen auftreten.<\/p>\n<p><em>Mehrere Felder können gleichzeitig markiert werden. Ein erneuter Klick entfernt die Markierung.<\/em><\/p>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 8
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "paingrid_widget",
|
||
"label": "<div id=\"paingrid-widget\" style=\"max-width:760px;margin:0 auto;\">\n <div style=\"margin:10px 0 12px 0;\">\n <span id=\"paingrid-counter\" aria-live=\"polite\" style=\"font-size:0.95em;\">0 Felder markiert<\/span>\n <\/div>\n\n <div id=\"paingrid-stage\" style=\"position:relative;width:100%;max-width:620px;margin:0 auto;border:1px solid #bbb;background:#fff;\">\n <img id=\"paingrid-body\" src=\"https://diagnostik.karneboge.de/assets/tmp/admin/MBqCbfliAAteNdq14C0u/Zeichenfläche1.png?v=1784493842\" alt=\"Körperschema Vorder- und Rückansicht mit Kopfansichten\"\n style=\"display:block;width:100%;height:auto;user-select:none;-webkit-user-drag:none;\">\n <div id=\"paingrid-overlay\"\n style=\"position:absolute;inset:0;z-index:20;display:grid;grid-template-columns:repeat(48,1fr);grid-template-rows:repeat(60,1fr);pointer-events:auto;touch-action:none;user-select:none;\"><\/div>\n <\/div>\n<\/div>\n\n<script>\n(function() {\n function initPainGrid() {\n var overlay = document.getElementById(\"paingrid-overlay\");\n var counter = document.getElementById(\"paingrid-counter\");\n var storage = document.querySelector('[name=\"paingrid_data\"]');\n var countField = document.querySelector('[name=\"paingrid_n\"]');\n\n if (!overlay || !storage || overlay.dataset.initialised === \"1\") return;\n overlay.dataset.initialised = \"1\";\n\n function hideField(field) {\n if (!field) return;\n var container = field.closest(\".form-group, .formr-item, .item, .controls\");\n if (container) {\n container.style.display = \"none\";\n } else {\n field.style.display = \"none\";\n }\n }\n\n hideField(storage);\n hideField(countField);\n\n var rows = 60;\n var cols = 48;\n var selected = new Set();\n var bodyMask = new Set();\n\n function addRect(r1, r2, c1, c2) {\n for (var r = r1; r <= r2; r++) {\n for (var c = c1; c <= c2; c++) {\n bodyMask.add(\"r\" + r + \"_c\" + c);\n }\n }\n }\n\n addRect(2, 18, 16, 24);\n addRect(6, 27, 13, 27);\n addRect(8, 18, 7, 12);\n addRect(8, 18, 28, 33);\n addRect(19, 30, 8, 12);\n addRect(19, 30, 28, 32);\n addRect(28, 39, 15, 20);\n addRect(28, 39, 21, 26);\n\n function cellId(r, c) {\n return \"r\" + String(r).padStart(2, \"0\") + \"_c\" + String(c).padStart(2, \"0\");\n }\n\n function isBodyCell(r, c) {\n return true;\n }\n\n function updateCounter() {\n var n = selected.size;\n counter.textContent = n + (n === 1 ? \" Feld markiert\" : \" Felder markiert\");\n if (countField) countField.value = String(n);\n }\n\n function save() {\n var values = Array.from(selected).sort();\n var payload = {\n version: 1,\n grid_rows: rows,\n grid_cols: cols,\n selected_cells: values\n };\n storage.value = JSON.stringify(payload);\n storage.dispatchEvent(new Event(\"input\", { bubbles: true }));\n storage.dispatchEvent(new Event(\"change\", { bubbles: true }));\n if (countField) {\n countField.dispatchEvent(new Event(\"input\", { bubbles: true }));\n countField.dispatchEvent(new Event(\"change\", { bubbles: true }));\n }\n updateCounter();\n }\n\n function paintCell(cell, active) {\n if (!cell) return;\n if (active) {\n cell.style.background = \"rgba(139, 38, 53, 0.58)\";\n cell.style.outline = \"1px solid #8B2635\";\n } else if (cell.dataset.body === \"1\") {\n cell.style.background = \"rgba(0, 0, 0, 0.02)\";\n cell.style.outline = \"0.5px solid rgba(80, 80, 80, 0.14)\";\n } else {\n cell.style.background = \"transparent\";\n cell.style.outline = \"0.5px solid rgba(120, 120, 120, 0.08)\";\n }\n }\n\n function toggle(cell) {\n var id = cell.dataset.cell;\n if (selected.has(id)) {\n selected.delete(id);\n paintCell(cell, false);\n } else {\n selected.add(id);\n paintCell(cell, true);\n }\n save();\n }\n\n overlay.innerHTML = \"\";\n for (var r = 1; r <= rows; r++) {\n for (var c = 1; c <= cols; c++) {\n var div = document.createElement(\"div\");\n var id = cellId(r, c);\n div.dataset.cell = id;\n div.dataset.body = isBodyCell(r, c) ? \"1\" : \"0\";\n div.style.boxSizing = \"border-box\";\n div.style.minWidth = \"0\";\n div.style.minHeight = \"0\";\n div.style.cursor = isBodyCell(r, c) ? \"pointer\" : \"default\";\n div.style.touchAction = \"manipulation\";\n paintCell(div, false);\n\n if (isBodyCell(r, c)) {\n div.title = id;\n div.style.pointerEvents = \"auto\";\n }\n overlay.appendChild(div);\n }\n }\n\n overlay.addEventListener(\"pointerdown\", function(event) {\n var cell = event.target.closest(\"[data-cell]\");\n if (!cell || !overlay.contains(cell)) return;\n event.preventDefault();\n event.stopPropagation();\n toggle(cell);\n }, true);\n\n overlay.addEventListener(\"click\", function(event) {\n event.preventDefault();\n event.stopPropagation();\n }, true);\n\n function restore() {\n if (!storage.value) {\n save();\n return;\n }\n try {\n var payload = JSON.parse(storage.value);\n if (payload && Array.isArray(payload.selected_cells)) {\n selected = new Set(payload.selected_cells);\n selected.forEach(function(id) {\n var cell = overlay.querySelector('[data-cell=\"' + id + '\"]');\n if (cell) paintCell(cell, true);\n });\n }\n } catch (e) {\n selected = new Set();\n }\n save();\n }\n\n restore();\n\n }\n\n if (document.readyState === \"loading\") {\n document.addEventListener(\"DOMContentLoaded\", initPainGrid);\n } else {\n initPainGrid();\n }\n window.setTimeout(initPainGrid, 400);\n})();\n<\/script>",
|
||
"label_parsed": "<div id=\"paingrid-widget\" style=\"max-width:760px;margin:0 auto;\">\n <div style=\"margin:10px 0 12px 0;\">\n <span id=\"paingrid-counter\" aria-live=\"polite\" style=\"font-size:0.95em;\">0 Felder markiert<\/span>\n <\/div>\n\n <div id=\"paingrid-stage\" style=\"position:relative;width:100%;max-width:620px;margin:0 auto;border:1px solid #bbb;background:#fff;\">\n <img id=\"paingrid-body\" src=\"https://diagnostik.karneboge.de/assets/tmp/admin/MBqCbfliAAteNdq14C0u/Zeichenfl%C3%A4che1.png?v=1784493842\" alt=\"Körperschema Vorder- und Rückansicht mit Kopfansichten\" style=\"display:block;width:100%;height:auto;user-select:none;-webkit-user-drag:none;\">\n <div id=\"paingrid-overlay\" style=\"position:absolute;inset:0;z-index:20;display:grid;grid-template-columns:repeat(48,1fr);grid-template-rows:repeat(60,1fr);pointer-events:auto;touch-action:none;user-select:none;\"><\/div>\n <\/div><\/div>\n<p><\/div><\/p>\n<script>\n(function() {\n function initPainGrid() {\n var overlay = document.getElementById(\"paingrid-overlay\");\n var counter = document.getElementById(\"paingrid-counter\");\n var storage = document.querySelector('[name=\"paingrid_data\"]');\n var countField = document.querySelector('[name=\"paingrid_n\"]');\n\n if (!overlay || !storage || overlay.dataset.initialised === \"1\") return;\n overlay.dataset.initialised = \"1\";\n\n function hideField(field) {\n if (!field) return;\n var container = field.closest(\".form-group, .formr-item, .item, .controls\");\n if (container) {\n container.style.display = \"none\";\n } else {\n field.style.display = \"none\";\n }\n }\n\n hideField(storage);\n hideField(countField);\n\n var rows = 60;\n var cols = 48;\n var selected = new Set();\n var bodyMask = new Set();\n\n function addRect(r1, r2, c1, c2) {\n for (var r = r1; r <= r2; r++) {\n for (var c = c1; c <= c2; c++) {\n bodyMask.add(\"r\" + r + \"_c\" + c);\n }\n }\n }\n\n addRect(2, 18, 16, 24);\n addRect(6, 27, 13, 27);\n addRect(8, 18, 7, 12);\n addRect(8, 18, 28, 33);\n addRect(19, 30, 8, 12);\n addRect(19, 30, 28, 32);\n addRect(28, 39, 15, 20);\n addRect(28, 39, 21, 26);\n\n function cellId(r, c) {\n return \"r\" + String(r).padStart(2, \"0\") + \"_c\" + String(c).padStart(2, \"0\");\n }\n\n function isBodyCell(r, c) {\n return true;\n }\n\n function updateCounter() {\n var n = selected.size;\n counter.textContent = n + (n === 1 ? \" Feld markiert\" : \" Felder markiert\");\n if (countField) countField.value = String(n);\n }\n\n function save() {\n var values = Array.from(selected).sort();\n var payload = {\n version: 1,\n grid_rows: rows,\n grid_cols: cols,\n selected_cells: values\n };\n storage.value = JSON.stringify(payload);\n storage.dispatchEvent(new Event(\"input\", { bubbles: true }));\n storage.dispatchEvent(new Event(\"change\", { bubbles: true }));\n if (countField) {\n countField.dispatchEvent(new Event(\"input\", { bubbles: true }));\n countField.dispatchEvent(new Event(\"change\", { bubbles: true }));\n }\n updateCounter();\n }\n\n function paintCell(cell, active) {\n if (!cell) return;\n if (active) {\n cell.style.background = \"rgba(139, 38, 53, 0.58)\";\n cell.style.outline = \"1px solid #8B2635\";\n } else if (cell.dataset.body === \"1\") {\n cell.style.background = \"rgba(0, 0, 0, 0.02)\";\n cell.style.outline = \"0.5px solid rgba(80, 80, 80, 0.14)\";\n } else {\n cell.style.background = \"transparent\";\n cell.style.outline = \"0.5px solid rgba(120, 120, 120, 0.08)\";\n }\n }\n\n function toggle(cell) {\n var id = cell.dataset.cell;\n if (selected.has(id)) {\n selected.delete(id);\n paintCell(cell, false);\n } else {\n selected.add(id);\n paintCell(cell, true);\n }\n save();\n }\n\n overlay.innerHTML = \"\";\n for (var r = 1; r <= rows; r++) {\n for (var c = 1; c <= cols; c++) {\n var div = document.createElement(\"div\");\n var id = cellId(r, c);\n div.dataset.cell = id;\n div.dataset.body = isBodyCell(r, c) ? \"1\" : \"0\";\n div.style.boxSizing = \"border-box\";\n div.style.minWidth = \"0\";\n div.style.minHeight = \"0\";\n div.style.cursor = isBodyCell(r, c) ? \"pointer\" : \"default\";\n div.style.touchAction = \"manipulation\";\n paintCell(div, false);\n\n if (isBodyCell(r, c)) {\n div.title = id;\n div.style.pointerEvents = \"auto\";\n }\n overlay.appendChild(div);\n }\n }\n\n overlay.addEventListener(\"pointerdown\", function(event) {\n var cell = event.target.closest(\"[data-cell]\");\n if (!cell || !overlay.contains(cell)) return;\n event.preventDefault();\n event.stopPropagation();\n toggle(cell);\n }, true);\n\n overlay.addEventListener(\"click\", function(event) {\n event.preventDefault();\n event.stopPropagation();\n }, true);\n\n function restore() {\n if (!storage.value) {\n save();\n return;\n }\n try {\n var payload = JSON.parse(storage.value);\n if (payload && Array.isArray(payload.selected_cells)) {\n selected = new Set(payload.selected_cells);\n selected.forEach(function(id) {\n var cell = overlay.querySelector('[data-cell=\"' + id + '\"]');\n if (cell) paintCell(cell, true);\n });\n }\n } catch (e) {\n selected = new Set();\n }\n save();\n }\n\n restore();\n\n }\n\n if (document.readyState === \"loading\") {\n document.addEventListener(\"DOMContentLoaded\", initPainGrid);\n } else {\n initPainGrid();\n }\n window.setTimeout(initPainGrid, 400);\n})();\n<\/script>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 9
|
||
},
|
||
{
|
||
"type": "textarea",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "paingrid_data",
|
||
"label": "Technisches Speicherfeld der Rasterauswahl",
|
||
"label_parsed": "Technisches Speicherfeld der Rasterauswahl",
|
||
"optional": 0,
|
||
"class": "hidden",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 10
|
||
},
|
||
{
|
||
"type": "number",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "paingrid_n",
|
||
"label": "Anzahl markierter Rasterfelder",
|
||
"label_parsed": "Anzahl markierter Rasterfelder",
|
||
"optional": 0,
|
||
"class": "hidden",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 11
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_submit1",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 12
|
||
},
|
||
{
|
||
"type": "textarea",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_schmerzbeschreibung_frei",
|
||
"label": "Bitte beschreiben Sie Ihre Schmerzen mit eigenen Worten:",
|
||
"label_parsed": "Bitte beschreiben Sie Ihre Schmerzen mit eigenen Worten:",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 13
|
||
},
|
||
{
|
||
"type": "textarea",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_06",
|
||
"label": "Wegen welcher Schmerzen kommen Sie hauptsächlich zur Behandlung?",
|
||
"label_parsed": "Wegen welcher Schmerzen kommen Sie hauptsächlich zur Behandlung?",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 14
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_07a",
|
||
"type_options": null,
|
||
"name": "dsf_07a",
|
||
"label": "Seit wann bestehen diese Schmerzen?",
|
||
"label_parsed": "Seit wann bestehen diese Schmerzen?",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 15,
|
||
"choices": {
|
||
"1": "weniger als 1 Monat",
|
||
"2": "1 Monat bis ½ Jahr",
|
||
"3": "½ Jahr bis 1 Jahr",
|
||
"4": "1 bis 2 Jahre",
|
||
"5": "2 bis 5 Jahre",
|
||
"6": "mehr als 5 Jahre"
|
||
}
|
||
},
|
||
{
|
||
"type": "Text",
|
||
"choice_list": null,
|
||
"type_options": "([0-2][0-9]|3[01])\\.(0[1-9]|1[0-2])\\.[0-9]{4}",
|
||
"name": "dsf_07b",
|
||
"label": "Können Sie ein genaues Datum angeben? (TT.MM.JJJJ)",
|
||
"label_parsed": "Können Sie ein genaues Datum angeben? (TT.MM.JJJJ)",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 16
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_08a",
|
||
"type_options": null,
|
||
"name": "dsf_08a",
|
||
"label": "Welche der Aussagen trifft auf Ihre **Schmerzen** in den letzten 4 Wochen am besten zu? (Bitte nur **eine** Angabe machen!)",
|
||
"label_parsed": "Welche der Aussagen trifft auf Ihre <strong>Schmerzen<\/strong> in den letzten 4 Wochen am besten zu? (Bitte nur <strong>eine<\/strong> Angabe machen!)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 17,
|
||
"choices": {
|
||
"1": "<div> <img src=\"https://diagnostik.karneboge.de/assets/tmp/admin/pemBfHjyyV7Ni1n50B94/Dauerschmerzen%20mit%20leichten%20Schwankungen.png?v=1784617696\" alt=\"Dauerschmerzen mit leichten Schwankungen\" style=\"max-width:20%; height:auto;\" > <div>Dauerschmerzen mit leichten Schwankungen<\/div> <\/div>",
|
||
"2": "<div> <img src=\"https://diagnostik.karneboge.de/assets/tmp/admin/pemBfHjyyV7Ni1n50B94/Dauerschmerzen%20mit%20starken%20Schwankungen.png?v=1784617696\" alt=\"Dauerschmerzen mit starken Schwankungen\" style=\"max-width:20%; height:auto; display:block;\" > <div>Dauerschmerzen mit starken Schwankungen<\/div> <\/div>",
|
||
"3": "<div> <img src=\"https://diagnostik.karneboge.de/assets/tmp/admin/pemBfHjyyV7Ni1n50B94/Schmerzattacken%2C%20dazwischen%20schmerzfrei.png?v=1784617695\" alt=\"Schmerzattacken, dazwischen schmerzfrei\" style=\"max-width:20%; height:auto; display:block;\" > <div>Schmerzattacken, dazwischen schmerzfrei<\/div> <\/div>",
|
||
"4": "<div> <img src=\"https://diagnostik.karneboge.de/assets/tmp/admin/pemBfHjyyV7Ni1n50B94/Schmerzattacken%2C%20auch%20dazwischen%20Schmerzen.png?v=1784617695\" alt=\"Schmerzattacken, auch dazwischen Schmerzen\" style=\"max-width:20%; height:auto; display:block;\" > <div>Schmerzattacken, auch dazwischen Schmerzen<\/div> <\/div>"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_08b",
|
||
"type_options": null,
|
||
"name": "dsf_08b",
|
||
"label": "**Wie oft** treten diese Attacken durchschnittlich auf?",
|
||
"label_parsed": "<strong>Wie oft<\/strong> treten diese Attacken durchschnittlich auf?",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_08a == 3 | dsf_08a == 4",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 18,
|
||
"choices": {
|
||
"1": "mehrfach täglich",
|
||
"2": "einmal täglich",
|
||
"3": "mehrfach wöchentlich",
|
||
"4": "einmal wöchentlich",
|
||
"5": "mehrfach monatlich",
|
||
"6": "einmal monatlich",
|
||
"7": "seltener"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_08b_frei",
|
||
"label": "seltener, und zwar:",
|
||
"label_parsed": "seltener, und zwar:",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_08b == 7",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 19
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_08c",
|
||
"type_options": null,
|
||
"name": "dsf_08c",
|
||
"label": "**Wie lange** dauern diese Attacken durchschnittlich?",
|
||
"label_parsed": "<strong>Wie lange<\/strong> dauern diese Attacken durchschnittlich?",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_08a == 3 | dsf_08a == 4",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 20,
|
||
"choices": {
|
||
"1": "Sekunden",
|
||
"2": "Minuten",
|
||
"3": "Stunden",
|
||
"4": "bis zu drei Tagen",
|
||
"5": "länger als drei Tage"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_09_ja",
|
||
"type_options": null,
|
||
"name": "dsf_09_ja",
|
||
"label": "Sind Ihre Schmerzen zu bestimmten Tageszeiten besonders stark?",
|
||
"label_parsed": "Sind Ihre Schmerzen zu bestimmten Tageszeiten besonders stark?",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 21,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc_multiple",
|
||
"choice_list": "dsf_09_zeiten",
|
||
"type_options": null,
|
||
"name": "dsf_09_zeiten",
|
||
"label": "Zu welchen Tageszeiten? (Mehrfachauswahl möglich)",
|
||
"label_parsed": "Zu welchen Tageszeiten? (Mehrfachauswahl möglich)",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_09_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 22,
|
||
"choices": {
|
||
"1": "morgens",
|
||
"2": "mittags",
|
||
"3": "nachmittags",
|
||
"4": "abends",
|
||
"5": "nachts"
|
||
}
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_09_submit",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 23
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_10_intro",
|
||
"label": "Mit der folgenden Liste von Eigenschaftsworten können Sie genauer beschreiben, **wie Sie Ihre Schmerzen empfinden**. Denken Sie bei der Beantwortung an Ihre **typischen Schmerzen in der letzten Zeit**. Bitte lassen Sie keine der Beschreibungen aus und machen Sie **für jedes Wort ein Kreuz**, inwieweit die Aussage für Sie zutrifft.\n\nIch empfinde meine Schmerzen als …",
|
||
"label_parsed": "<p>Mit der folgenden Liste von Eigenschaftsworten können Sie genauer beschreiben, <strong>wie Sie Ihre Schmerzen empfinden<\/strong>. Denken Sie bei der Beantwortung an Ihre <strong>typischen Schmerzen in der letzten Zeit<\/strong>. Bitte lassen Sie keine der Beschreibungen aus und machen Sie <strong>für jedes Wort ein Kreuz<\/strong>, inwieweit die Aussage für Sie zutrifft.<\/p>\n<p>Ich empfinde meine Schmerzen als …<\/p>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 24
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_01",
|
||
"type_options": null,
|
||
"name": "dsf_10_01",
|
||
"label": "dumpf",
|
||
"label_parsed": "dumpf",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 25,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_02",
|
||
"type_options": null,
|
||
"name": "dsf_10_02",
|
||
"label": "drückend",
|
||
"label_parsed": "drückend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 26,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_03",
|
||
"type_options": null,
|
||
"name": "dsf_10_03",
|
||
"label": "pochend",
|
||
"label_parsed": "pochend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 27,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_04",
|
||
"type_options": null,
|
||
"name": "dsf_10_04",
|
||
"label": "klopfend",
|
||
"label_parsed": "klopfend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 28,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_05",
|
||
"type_options": null,
|
||
"name": "dsf_10_05",
|
||
"label": "stechend",
|
||
"label_parsed": "stechend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 29,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_06",
|
||
"type_options": null,
|
||
"name": "dsf_10_06",
|
||
"label": "ziehend",
|
||
"label_parsed": "ziehend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 30,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_07",
|
||
"type_options": null,
|
||
"name": "dsf_10_07",
|
||
"label": "heiß",
|
||
"label_parsed": "heiß",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 31,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_08",
|
||
"type_options": null,
|
||
"name": "dsf_10_08",
|
||
"label": "brennend",
|
||
"label_parsed": "brennend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 32,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_09",
|
||
"type_options": null,
|
||
"name": "dsf_10_09",
|
||
"label": "elend",
|
||
"label_parsed": "elend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 33,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_10",
|
||
"type_options": null,
|
||
"name": "dsf_10_10",
|
||
"label": "schauderhaft",
|
||
"label_parsed": "schauderhaft",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 34,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_11",
|
||
"type_options": null,
|
||
"name": "dsf_10_11",
|
||
"label": "scheußlich",
|
||
"label_parsed": "scheußlich",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 35,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_10_12",
|
||
"type_options": null,
|
||
"name": "dsf_10_12",
|
||
"label": "furchtbar",
|
||
"label_parsed": "furchtbar",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 36,
|
||
"choices": {
|
||
"1": "3 – trifft genau zu",
|
||
"2": "2 – trifft weitgehend zu",
|
||
"3": "1 – trifft ein wenig zu",
|
||
"4": "0 – trifft nicht zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_11_intro",
|
||
"label": "Geben Sie im Folgenden die **Stärke Ihrer Schmerzen** an. Kreuzen Sie **auf den unten aufgeführten Linien** an, wie stark Sie Ihre Schmerzen empfinden (unter Ihrer üblichen Medikation). Die Zahlen können Ihnen bei der Einteilung helfen: Ein Wert von 0 bedeutet, Sie haben keine Schmerzen, ein Wert von 10 bedeutet, Sie leiden unter Schmerzen, wie sie für Sie nicht stärker vorstellbar sind. Die Zahlen dazwischen geben Abstufungen der Schmerzstärke an.",
|
||
"label_parsed": "Geben Sie im Folgenden die <strong>Stärke Ihrer Schmerzen<\/strong> an. Kreuzen Sie <strong>auf den unten aufgeführten Linien<\/strong> an, wie stark Sie Ihre Schmerzen empfinden (unter Ihrer üblichen Medikation). Die Zahlen können Ihnen bei der Einteilung helfen: Ein Wert von 0 bedeutet, Sie haben keine Schmerzen, ein Wert von 10 bedeutet, Sie leiden unter Schmerzen, wie sie für Sie nicht stärker vorstellbar sind. Die Zahlen dazwischen geben Abstufungen der Schmerzstärke an.",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 37
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_11a",
|
||
"type_options": "0,10,1",
|
||
"name": "dsf_11a",
|
||
"label": "Geben Sie bitte zunächst **Ihre momentane Schmerzstärke** an:",
|
||
"label_parsed": "Geben Sie bitte zunächst <strong>Ihre momentane Schmerzstärke<\/strong> an:",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 38,
|
||
"choices": {
|
||
"1": "0 – kein Schmerz",
|
||
"2": "10 – stärkster vorstellbarer Schmerz"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_11b",
|
||
"type_options": "0,10,1",
|
||
"name": "dsf_11b",
|
||
"label": "Geben Sie jetzt bitte Ihre **durchschnittliche Schmerzstärke** während der letzten 4 Wochen an:",
|
||
"label_parsed": "Geben Sie jetzt bitte Ihre <strong>durchschnittliche Schmerzstärke<\/strong> während der letzten 4 Wochen an:",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 39,
|
||
"choices": {
|
||
"1": "0 – kein Schmerz",
|
||
"2": "10 – stärkster vorstellbarer Schmerz"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_11c",
|
||
"type_options": "0,10,1",
|
||
"name": "dsf_11c",
|
||
"label": "Geben Sie jetzt bitte Ihre **größte Schmerzstärke** während der letzten 4 Wochen an:",
|
||
"label_parsed": "Geben Sie jetzt bitte Ihre <strong>größte Schmerzstärke<\/strong> während der letzten 4 Wochen an:",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 40,
|
||
"choices": {
|
||
"1": "0 – kein Schmerz",
|
||
"2": "10 – stärkster vorstellbarer Schmerz"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_11d",
|
||
"type_options": "0,10,1",
|
||
"name": "dsf_11d",
|
||
"label": "Geben Sie jetzt an, welche **Schmerzstärke** für Sie bei erfolgreicher Behandlung **erträglich** wäre:",
|
||
"label_parsed": "Geben Sie jetzt an, welche <strong>Schmerzstärke<\/strong> für Sie bei erfolgreicher Behandlung <strong>erträglich<\/strong> wäre:",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 41,
|
||
"choices": {
|
||
"1": "0 – kein Schmerz",
|
||
"2": "10 – stärkster vorstellbarer Schmerz"
|
||
}
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_12_submit",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 42
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_12_intro",
|
||
"label": "In den folgenden Fragen geht es um Ihre Schmerzen während der **letzten 3 Monate**. Für diesen Zeitraum möchten wir Genaueres über die **Auswirkungen der Schmerzen** erfahren.",
|
||
"label_parsed": "In den folgenden Fragen geht es um Ihre Schmerzen während der <strong>letzten 3 Monate<\/strong>. Für diesen Zeitraum möchten wir Genaueres über die <strong>Auswirkungen der Schmerzen<\/strong> erfahren.",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 43
|
||
},
|
||
{
|
||
"type": "number",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_12a",
|
||
"label": "**An wie vielen Tagen** konnten Sie in den letzten 3 Monaten aufgrund von Schmerzen nicht Ihren üblichen Aktivitäten nachgehen (z. B. Beruf, Schule, Haushalt)? \n(Anzahl Tage)",
|
||
"label_parsed": "<p><strong>An wie vielen Tagen<\/strong> konnten Sie in den letzten 3 Monaten aufgrund von Schmerzen nicht Ihren üblichen Aktivitäten nachgehen (z. B. Beruf, Schule, Haushalt)?<br />\n(Anzahl Tage)<\/p>",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 44
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_12b",
|
||
"type_options": "0,10,1",
|
||
"name": "dsf_12b",
|
||
"label": "In welchem Maße haben die Schmerzen in den letzten 3 Monaten Ihren **Alltag** (Ankleiden, Waschen, Essen, Einkaufen etc.) beeinträchtigt?",
|
||
"label_parsed": "In welchem Maße haben die Schmerzen in den letzten 3 Monaten Ihren <strong>Alltag<\/strong> (Ankleiden, Waschen, Essen, Einkaufen etc.) beeinträchtigt?",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 45,
|
||
"choices": {
|
||
"1": "0 – keine Beeinträchtigung",
|
||
"2": "10 – völlige Beeinträchtigung"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_12c",
|
||
"type_options": "0,10,1",
|
||
"name": "dsf_12c",
|
||
"label": "In welchem Maße haben die Schmerzen in den letzten 3 Monaten Ihre **Freizeitaktivitäten** oder Unternehmungen im **Familien- oder Freundeskreis** beeinträchtigt?",
|
||
"label_parsed": "In welchem Maße haben die Schmerzen in den letzten 3 Monaten Ihre <strong>Freizeitaktivitäten<\/strong> oder Unternehmungen im <strong>Familien- oder Freundeskreis<\/strong> beeinträchtigt?",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 46,
|
||
"choices": {
|
||
"1": "0 – keine Beeinträchtigung",
|
||
"2": "10 – völlige Beeinträchtigung"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_12d",
|
||
"type_options": "0,10,1",
|
||
"name": "dsf_12d",
|
||
"label": "In welchem Maße haben die Schmerzen in den letzten 3 Monaten Ihre **Arbeitsfähigkeit** (einschließlich Hausarbeit) beeinträchtigt?",
|
||
"label_parsed": "In welchem Maße haben die Schmerzen in den letzten 3 Monaten Ihre <strong>Arbeitsfähigkeit<\/strong> (einschließlich Hausarbeit) beeinträchtigt?",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 47,
|
||
"choices": {
|
||
"1": "0 – keine Beeinträchtigung",
|
||
"2": "10 – völlige Beeinträchtigung"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc_multiple",
|
||
"choice_list": "dsf_13a",
|
||
"type_options": null,
|
||
"name": "dsf_13a",
|
||
"label": "Auf welche **Ursachen** führen Sie Ihre **Schmerzen** zurück? (Mehrfachnennungen sind möglich)",
|
||
"label_parsed": "Auf welche <strong>Ursachen<\/strong> führen Sie Ihre <strong>Schmerzen<\/strong> zurück? (Mehrfachnennungen sind möglich)",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 48,
|
||
"choices": {
|
||
"1": "für mich ist keine Ursache erkennbar",
|
||
"2": "auf eine bestimmte Krankheit",
|
||
"3": "auf eine Operation",
|
||
"4": "auf einen Unfall",
|
||
"5": "auf körperliche Belastung",
|
||
"6": "auf seelische Belastung",
|
||
"7": "auf eine andere Ursache"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_13a_krankheit_frei",
|
||
"label": "wenn ja, welche Krankheit?",
|
||
"label_parsed": "wenn ja, welche Krankheit?",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_13a %contains_word% \"2\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 49
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_13a_operation_frei",
|
||
"label": "wenn ja, welche Operation?",
|
||
"label_parsed": "wenn ja, welche Operation?",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_13a %contains_word% \"3\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 50
|
||
},
|
||
{
|
||
"type": "Text",
|
||
"choice_list": null,
|
||
"type_options": "([0-2][0-9]|3[01])\\.(0[1-9]|1[0-2])\\.[0-9]{4}",
|
||
"name": "dsf_13a_operation_datum",
|
||
"label": "Datum der Operation (TT.MM.JJJJ)",
|
||
"label_parsed": "Datum der Operation (TT.MM.JJJJ)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_13a %contains_word% \"3\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 51
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_13a_unfall_frei",
|
||
"label": "wenn ja, welcher Unfall?",
|
||
"label_parsed": "wenn ja, welcher Unfall?",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_13a %contains_word% \"4\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 52
|
||
},
|
||
{
|
||
"type": "Text",
|
||
"choice_list": null,
|
||
"type_options": "([0-2][0-9]|3[01])\\.(0[1-9]|1[0-2])\\.[0-9]{4}",
|
||
"name": "dsf_13a_unfall_datum",
|
||
"label": "Datum des Unfalls (TT.MM.JJJJ)",
|
||
"label_parsed": "Datum des Unfalls (TT.MM.JJJJ)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_13a %contains_word% \"4\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 53
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_13a_andere_frei",
|
||
"label": "welche andere Ursache?",
|
||
"label_parsed": "welche andere Ursache?",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_13a %contains_word% \"7\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 54
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_13b",
|
||
"type_options": null,
|
||
"name": "dsf_13b",
|
||
"label": "Falls Ihre Schmerzen im Zusammenhang mit einem Unfall, einer berufsbedingten Erkrankung oder Ersatzansprüchen (z.B. nach Operationen) stehen:\nSind alle diesbezüglichen **rechtlichen oder versicherungsrechtlichen Fragen** abgeschlossen (z. B. Schmerzensgeld)?",
|
||
"label_parsed": "<p>Falls Ihre Schmerzen im Zusammenhang mit einem Unfall, einer berufsbedingten Erkrankung oder Ersatzansprüchen (z.B. nach Operationen) stehen:<br />\nSind alle diesbezüglichen <strong>rechtlichen oder versicherungsrechtlichen Fragen<\/strong> abgeschlossen (z. B. Schmerzensgeld)?<\/p>",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_13a %contains_word% \"4\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 55,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_14_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 56
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_14_frei",
|
||
"label": "Was machen Sie selbst, um Ihre **Schmerzen günstig zu beeinflussen**? \nBitte machen Sie genaue Angaben, z. B. spazieren gehen, schlafen, Ablenkung, …",
|
||
"label_parsed": "<p>Was machen Sie selbst, um Ihre <strong>Schmerzen günstig zu beeinflussen<\/strong>?<br />\nBitte machen Sie genaue Angaben, z. B. spazieren gehen, schlafen, Ablenkung, …<\/p>",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 57
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_14_kann_nicht",
|
||
"label": "Ich kann meine Schmerzen nicht beeinflussen.",
|
||
"label_parsed": "Ich kann meine Schmerzen nicht beeinflussen.",
|
||
"optional": 1,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 58
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_15_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 59
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_15_frei",
|
||
"label": "**Was löst** Ihrer Erfahrung nach **die Schmerzen aus oder verschlimmert** sie?",
|
||
"label_parsed": "<strong>Was löst<\/strong> Ihrer Erfahrung nach <strong>die Schmerzen aus oder verschlimmert<\/strong> sie?",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 60
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_15_weiss_nicht",
|
||
"label": "Ich weiß es nicht.",
|
||
"label_parsed": "Ich weiß es nicht.",
|
||
"optional": 1,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 61
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_16_intro",
|
||
"label": "---\n\nBitte schätzen Sie Ihr derzeitiges allgemeines Wohlbefinden ein. Geben Sie bitte an, wie Sie sich in den letzten 14 Tagen meistens gefühlt haben.\n\n**Trotz der Schmerzen würde ich sagen:**",
|
||
"label_parsed": "<hr />\n<p>Bitte schätzen Sie Ihr derzeitiges allgemeines Wohlbefinden ein. Geben Sie bitte an, wie Sie sich in den letzten 14 Tagen meistens gefühlt haben.<\/p>\n<p><strong>Trotz der Schmerzen würde ich sagen:<\/strong><\/p>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 62
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_16_01",
|
||
"type_options": "0,5,1",
|
||
"name": "dsf_16_01",
|
||
"label": "Ich habe meine alltäglichen Anforderungen im Griff gehabt.",
|
||
"label_parsed": "Ich habe meine alltäglichen Anforderungen im Griff gehabt.",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 63,
|
||
"choices": {
|
||
"1": "0 – trifft gar nicht zu",
|
||
"2": "5 – trifft vollkommen zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_16_02",
|
||
"type_options": "0,5,1",
|
||
"name": "dsf_16_02",
|
||
"label": "Ich bin innerlich erfüllt gewesen.",
|
||
"label_parsed": "Ich bin innerlich erfüllt gewesen.",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 64,
|
||
"choices": {
|
||
"1": "0 – trifft gar nicht zu",
|
||
"2": "5 – trifft vollkommen zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_16_03",
|
||
"type_options": "0,5,1",
|
||
"name": "dsf_16_03",
|
||
"label": "Ich habe mich behaglich gefühlt.",
|
||
"label_parsed": "Ich habe mich behaglich gefühlt.",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 65,
|
||
"choices": {
|
||
"1": "0 – trifft gar nicht zu",
|
||
"2": "5 – trifft vollkommen zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_16_04",
|
||
"type_options": "0,5,1",
|
||
"name": "dsf_16_04",
|
||
"label": "Ich habe mein Leben genießen können.",
|
||
"label_parsed": "Ich habe mein Leben genießen können.",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 66,
|
||
"choices": {
|
||
"1": "0 – trifft gar nicht zu",
|
||
"2": "5 – trifft vollkommen zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_16_05",
|
||
"type_options": "0,5,1",
|
||
"name": "dsf_16_05",
|
||
"label": "Ich bin mit meiner Arbeitsleistung zufrieden gewesen.",
|
||
"label_parsed": "Ich bin mit meiner Arbeitsleistung zufrieden gewesen.",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 67,
|
||
"choices": {
|
||
"1": "0 – trifft gar nicht zu",
|
||
"2": "5 – trifft vollkommen zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_16_06",
|
||
"type_options": "0,5,1",
|
||
"name": "dsf_16_06",
|
||
"label": "Ich war mit meinem körperlichen Zustand einverstanden.",
|
||
"label_parsed": "Ich war mit meinem körperlichen Zustand einverstanden.",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 68,
|
||
"choices": {
|
||
"1": "0 – trifft gar nicht zu",
|
||
"2": "5 – trifft vollkommen zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "range_ticks",
|
||
"choice_list": "dsf_16_07",
|
||
"type_options": "0,5,1",
|
||
"name": "dsf_16_07",
|
||
"label": "Ich habe mich richtig freuen können.",
|
||
"label_parsed": "Ich habe mich richtig freuen können.",
|
||
"optional": 0,
|
||
"class": "answer_below_label",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 69,
|
||
"choices": {
|
||
"1": "0 – trifft gar nicht zu",
|
||
"2": "5 – trifft vollkommen zu"
|
||
}
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_16_submit",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 70
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_17_intro",
|
||
"label": "Zur vollständigen Beurteilung ihrer Erkrankung bitten wir Sie nun um einige persönliche Angaben. Man weiß heute, dass körperliche Krankheit und seelisches Befinden oft eng zusammenhängen. Deshalb beziehen sich die Fragen ausdrücklich auf Ihre **allgemeine und seelische Verfassung**.\nWir bitten Sie, jede Frage zu beantworten, und zwar so, wie es für Sie persönlich **in den letzten 14 Tagen (inklusive heute)** am ehesten zutraf bzw. zutrifft. Machen Sie bitte ein Kreuz für jede Feststellung und lassen Sie bitte keine aus. Überlegen Sie nicht lange, sondern wählen Sie die Antwort aus, die Ihnen auf Anhieb am zutreffendsten erscheint.",
|
||
"label_parsed": "<p>Zur vollständigen Beurteilung ihrer Erkrankung bitten wir Sie nun um einige persönliche Angaben. Man weiß heute, dass körperliche Krankheit und seelisches Befinden oft eng zusammenhängen. Deshalb beziehen sich die Fragen ausdrücklich auf Ihre <strong>allgemeine und seelische Verfassung<\/strong>.<br />\nWir bitten Sie, jede Frage zu beantworten, und zwar so, wie es für Sie persönlich <strong>in den letzten 14 Tagen (inklusive heute)<\/strong> am ehesten zutraf bzw. zutrifft. Machen Sie bitte ein Kreuz für jede Feststellung und lassen Sie bitte keine aus. Überlegen Sie nicht lange, sondern wählen Sie die Antwort aus, die Ihnen auf Anhieb am zutreffendsten erscheint.<\/p>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 71
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_01",
|
||
"type_options": null,
|
||
"name": "dsf_17_01",
|
||
"label": "Ich fühle mich angespannt oder überreizt",
|
||
"label_parsed": "Ich fühle mich angespannt oder überreizt",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 72,
|
||
"choices": {
|
||
"1": "meistens",
|
||
"2": "oft",
|
||
"3": "von Zeit zu Zeit, gelegentlich",
|
||
"4": "überhaupt nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_02",
|
||
"type_options": null,
|
||
"name": "dsf_17_02",
|
||
"label": "Ich fühle mich in meinen Aktivitäten gebremst",
|
||
"label_parsed": "Ich fühle mich in meinen Aktivitäten gebremst",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 73,
|
||
"choices": {
|
||
"1": "fast immer",
|
||
"2": "sehr oft",
|
||
"3": "manchmal",
|
||
"4": "überhaupt nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_03",
|
||
"type_options": null,
|
||
"name": "dsf_17_03",
|
||
"label": "Ich kann mich heute noch so freuen wie früher",
|
||
"label_parsed": "Ich kann mich heute noch so freuen wie früher",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 74,
|
||
"choices": {
|
||
"1": "ganz genau so",
|
||
"2": "nicht ganz so sehr",
|
||
"3": "nur noch ein wenig",
|
||
"4": "kaum oder gar nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_04",
|
||
"type_options": null,
|
||
"name": "dsf_17_04",
|
||
"label": "Ich habe manchmal ein ängstliches Gefühl in der Magengegend",
|
||
"label_parsed": "Ich habe manchmal ein ängstliches Gefühl in der Magengegend",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 75,
|
||
"choices": {
|
||
"1": "überhaupt nicht",
|
||
"2": "gelegentlich",
|
||
"3": "ziemlich oft",
|
||
"4": "sehr oft"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_05",
|
||
"type_options": null,
|
||
"name": "dsf_17_05",
|
||
"label": "Mich überkommt eine ängstliche Vorahnung, dass etwas Schreckliches passieren könnte",
|
||
"label_parsed": "Mich überkommt eine ängstliche Vorahnung, dass etwas Schreckliches passieren könnte",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 76,
|
||
"choices": {
|
||
"1": "ja, sehr stark",
|
||
"2": "ja, aber nicht allzu stark",
|
||
"3": "etwas, aber es macht mir keine Sorgen",
|
||
"4": "überhaupt nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_06",
|
||
"type_options": null,
|
||
"name": "dsf_17_06",
|
||
"label": "Ich habe das Interesse an meiner äußeren Erscheinung verloren",
|
||
"label_parsed": "Ich habe das Interesse an meiner äußeren Erscheinung verloren",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 77,
|
||
"choices": {
|
||
"1": "ja, stimmt genau",
|
||
"2": "ich kümmere mich nicht so sehr darum, wie ich sollte",
|
||
"3": "möglicherweise kümmere ich mich zu wenig darum",
|
||
"4": "ich kümmere mich so viel darum wie immer"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_07",
|
||
"type_options": null,
|
||
"name": "dsf_17_07",
|
||
"label": "Ich kann lachen und die lustige Seite der Dinge sehen",
|
||
"label_parsed": "Ich kann lachen und die lustige Seite der Dinge sehen",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 78,
|
||
"choices": {
|
||
"1": "ja, so viel wie immer",
|
||
"2": "nicht mehr ganz so viel",
|
||
"3": "inzwischen viel weniger",
|
||
"4": "überhaupt nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_08",
|
||
"type_options": null,
|
||
"name": "dsf_17_08",
|
||
"label": "Ich fühle mich rastlos, muss immer in Bewegung sein",
|
||
"label_parsed": "Ich fühle mich rastlos, muss immer in Bewegung sein",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 79,
|
||
"choices": {
|
||
"1": "ja, tatsächlich sehr",
|
||
"2": "ziemlich",
|
||
"3": "nicht sehr",
|
||
"4": "überhaupt nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_09",
|
||
"type_options": null,
|
||
"name": "dsf_17_09",
|
||
"label": "Mir gehen beunruhigende Gedanken durch den Kopf",
|
||
"label_parsed": "Mir gehen beunruhigende Gedanken durch den Kopf",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 80,
|
||
"choices": {
|
||
"1": "einen Großteil der Zeit",
|
||
"2": "verhältnismäßig oft",
|
||
"3": "von Zeit zu Zeit, aber nicht allzu oft",
|
||
"4": "nur gelegentlich"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_10",
|
||
"type_options": null,
|
||
"name": "dsf_17_10",
|
||
"label": "Ich blicke mit Freude in die Zukunft",
|
||
"label_parsed": "Ich blicke mit Freude in die Zukunft",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 81,
|
||
"choices": {
|
||
"1": "ja, sehr",
|
||
"2": "eher weniger als früher",
|
||
"3": "viel weniger als früher",
|
||
"4": "kaum bis gar nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_11",
|
||
"type_options": null,
|
||
"name": "dsf_17_11",
|
||
"label": "Ich fühle mich glücklich",
|
||
"label_parsed": "Ich fühle mich glücklich",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 82,
|
||
"choices": {
|
||
"1": "überhaupt nicht",
|
||
"2": "selten",
|
||
"3": "manchmal",
|
||
"4": "meistens"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_12",
|
||
"type_options": null,
|
||
"name": "dsf_17_12",
|
||
"label": "Mich überkommt plötzlich ein panikartiger Zustand",
|
||
"label_parsed": "Mich überkommt plötzlich ein panikartiger Zustand",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 83,
|
||
"choices": {
|
||
"1": "ja, tatsächlich sehr oft",
|
||
"2": "ziemlich oft",
|
||
"3": "nicht sehr oft",
|
||
"4": "überhaupt nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_13",
|
||
"type_options": null,
|
||
"name": "dsf_17_13",
|
||
"label": "Ich kann behaglich dasitzen und mich entspannen",
|
||
"label_parsed": "Ich kann behaglich dasitzen und mich entspannen",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 84,
|
||
"choices": {
|
||
"1": "ja, natürlich",
|
||
"2": "gewöhnlich schon",
|
||
"3": "nicht oft",
|
||
"4": "überhaupt nicht"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_17_14",
|
||
"type_options": null,
|
||
"name": "dsf_17_14",
|
||
"label": "Ich kann mich an einem guten Buch, einer Radio- oder Fernsehsendung erfreuen",
|
||
"label_parsed": "Ich kann mich an einem guten Buch, einer Radio- oder Fernsehsendung erfreuen",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 85,
|
||
"choices": {
|
||
"1": "oft",
|
||
"2": "manchmal",
|
||
"3": "eher selten",
|
||
"4": "sehr selten"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_18",
|
||
"type_options": null,
|
||
"name": "dsf_18",
|
||
"label": "Ich denke des öfteren daran, mir das Leben zu nehmen.",
|
||
"label_parsed": "Ich denke des öfteren daran, mir das Leben zu nehmen.",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 86,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_18_submit",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 87
|
||
}
|
||
],
|
||
"settings": {
|
||
"maximum_number_displayed": 0,
|
||
"displayed_percentage_maximum": 100,
|
||
"add_percentage_points": 0,
|
||
"enable_instant_validation": 0,
|
||
"expire_after": 0,
|
||
"google_file_id": null,
|
||
"unlinked": 0,
|
||
"expire_invitation_after": 0,
|
||
"expire_invitation_grace": 0,
|
||
"hide_results": 0,
|
||
"use_paging": 0
|
||
}
|
||
}
|
||
},
|
||
{
|
||
"type": "SkipForward",
|
||
"description": "Suizidalitäts-Check",
|
||
"position": 11,
|
||
"special": null,
|
||
"condition": "dsf1$dsf_18!=1",
|
||
"if_true": 13,
|
||
"automatically_jump": 1,
|
||
"automatically_go_on": 1
|
||
},
|
||
{
|
||
"type": "Email",
|
||
"description": "Alarm Suizidalität",
|
||
"position": 12,
|
||
"special": null,
|
||
"subject": "SUIZIDALITÄT - DSF - Diagnostik",
|
||
"account_id": 1,
|
||
"recipient_field": "\"psychotherapie@karneboge.de\"",
|
||
"body": "{{login_code}} \n\n**berichtete Suizidalität im DSF!**\n\nUmgehend überprüfen und kontaktieren!",
|
||
"cron_only": 0
|
||
},
|
||
{
|
||
"type": "Survey",
|
||
"description": "DSF Teil2",
|
||
"position": 13,
|
||
"special": null,
|
||
"survey_data": {
|
||
"name": "dsf2",
|
||
"items": [
|
||
{
|
||
"type": "mc_multiple",
|
||
"choice_list": "dsf_19a",
|
||
"type_options": null,
|
||
"name": "dsf_19a",
|
||
"label": "**Von wem** wurden Sie bisher wegen Ihrer Schmerzen **untersucht oder behandelt**? (Mehrfachnennungen möglich)",
|
||
"label_parsed": "<strong>Von wem<\/strong> wurden Sie bisher wegen Ihrer Schmerzen <strong>untersucht oder behandelt<\/strong>? (Mehrfachnennungen möglich)",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 1,
|
||
"choices": {
|
||
"1": "Keine Behandlung",
|
||
"2": "Allgemeinarzt",
|
||
"3": "Chirurg",
|
||
"4": "Heilpraktiker",
|
||
"5": "Internist",
|
||
"6": "Neurochirurg",
|
||
"7": "Neurologe",
|
||
"8": "Orthopäde",
|
||
"9": "Psychiater",
|
||
"10": "Psychotherapeut",
|
||
"11": "Radiologe",
|
||
"12": "Schmerztherapeut",
|
||
"13": "Andere"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_19a_frei",
|
||
"label": "Andere, und zwar:",
|
||
"label_parsed": "Andere, und zwar:",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_19a %contains_word% \"13\"",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 2
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_19b_ja",
|
||
"type_options": null,
|
||
"name": "dsf_19b_ja",
|
||
"label": "Wurde bei Ihnen bereits eine Schmerzdiagnose gestellt?",
|
||
"label_parsed": "Wurde bei Ihnen bereits eine Schmerzdiagnose gestellt?",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 3,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_19b_frei",
|
||
"label": "wenn ja, welche?",
|
||
"label_parsed": "wenn ja, welche?",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_19b_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 4
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_intro",
|
||
"label": "---\n\n**Wie** wurden Ihre Schmerzen **bisher behandelt**? \nKreuzen Sie bitte an, welche der unten aufgeführten Behandlungsmaßnahmen Sie erhalten haben. Geben Sie bitte auch an, ob Ihre **Schmerzen** durch diese Maßnahmen zumindest zeitweise gelindert wurden.",
|
||
"label_parsed": "<hr />\n<p><strong>Wie<\/strong> wurden Ihre Schmerzen <strong>bisher behandelt<\/strong>?<br />\nKreuzen Sie bitte an, welche der unten aufgeführten Behandlungsmaßnahmen Sie erhalten haben. Geben Sie bitte auch an, ob Ihre <strong>Schmerzen<\/strong> durch diese Maßnahmen zumindest zeitweise gelindert wurden.<\/p>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 5
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_keine",
|
||
"label": "Bisher keine Schmerzbehandlung",
|
||
"label_parsed": "Bisher keine Schmerzbehandlung",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 6
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_01_erhalten",
|
||
"label": "Medikamente",
|
||
"label_parsed": "Medikamente",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 7
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_20_01_wirksam",
|
||
"type_options": null,
|
||
"name": "dsf_20_01_wirksam",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_01_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 8,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_02_erhalten",
|
||
"label": "Infusionen",
|
||
"label_parsed": "Infusionen",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 9
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_20_02_wirksam",
|
||
"type_options": null,
|
||
"name": "dsf_20_02_wirksam",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_02_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 10,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_03_erhalten",
|
||
"label": "Einspritzungen in das Schmerzgebiet, Nervenblockaden",
|
||
"label_parsed": "Einspritzungen in das Schmerzgebiet, Nervenblockaden",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 11
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_20_03_wirksam",
|
||
"type_options": null,
|
||
"name": "dsf_20_03_wirksam",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_03_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 12,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_04_erhalten",
|
||
"label": "Einspritzungen am Rückenmark (z. B. epidural)",
|
||
"label_parsed": "Einspritzungen am Rückenmark (z. B. epidural)",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 13
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_20_04_wirksam",
|
||
"type_options": null,
|
||
"name": "dsf_20_04_wirksam",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_04_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 14,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_05_erhalten",
|
||
"label": "Rückenmarksnahe Sonden- (SCS) oder Pumpensysteme",
|
||
"label_parsed": "Rückenmarksnahe Sonden- (SCS) oder Pumpensysteme",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 15
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_20_05_wirksam",
|
||
"type_options": null,
|
||
"name": "dsf_20_05_wirksam",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_05_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 16,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_06_erhalten",
|
||
"label": "Krankengymnastik",
|
||
"label_parsed": "Krankengymnastik",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 17
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_20_06_wirksam",
|
||
"type_options": null,
|
||
"name": "dsf_20_06_wirksam",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_06_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 18,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_07_erhalten",
|
||
"label": "Massagen, Bäder, Kälte-/Wärmetherapie",
|
||
"label_parsed": "Massagen, Bäder, Kälte-/Wärmetherapie",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 19
|
||
},
|
||
{
|
||
"type": "mc",
|
||
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|
||
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|
||
"name": "dsf_20_07_wirksam",
|
||
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|
||
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|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_07_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 20,
|
||
"choices": {
|
||
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|
||
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|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
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|
||
"type_options": null,
|
||
"name": "dsf_20_08_erhalten",
|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 21
|
||
},
|
||
{
|
||
"type": "mc",
|
||
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|
||
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|
||
"name": "dsf_20_08_wirksam",
|
||
"label": "wirksam?",
|
||
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|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_08_erhalten == 1",
|
||
"value": null,
|
||
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|
||
"item_order": 22,
|
||
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|
||
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|
||
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|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
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|
||
"name": "dsf_20_09_erhalten",
|
||
"label": "Akupunktur",
|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 23
|
||
},
|
||
{
|
||
"type": "mc",
|
||
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|
||
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|
||
"name": "dsf_20_09_wirksam",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_09_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 24,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_10_erhalten",
|
||
"label": "Chiropraktik",
|
||
"label_parsed": "Chiropraktik",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 25
|
||
},
|
||
{
|
||
"type": "mc",
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_10_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 26,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
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|
||
"name": "dsf_20_11_erhalten",
|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 27
|
||
},
|
||
{
|
||
"type": "mc",
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_11_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 28,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
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|
||
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|
||
"name": "dsf_20_12_erhalten",
|
||
"label": "Entspannungsverfahren, Hypnose, Biofeedback",
|
||
"label_parsed": "Entspannungsverfahren, Hypnose, Biofeedback",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 29
|
||
},
|
||
{
|
||
"type": "mc",
|
||
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|
||
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|
||
"name": "dsf_20_12_wirksam",
|
||
"label": "wirksam?",
|
||
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|
||
"optional": 0,
|
||
"class": "left400",
|
||
"showif": "dsf_20_12_erhalten == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 30,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "vorübergehend",
|
||
"3": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "check",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_20_13_erhalten",
|
||
"label": "Medikamenten-Entzug",
|
||
"label_parsed": "Medikamenten-Entzug",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 31
|
||
},
|
||
{
|
||
"type": "mc",
|
||
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|
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|
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|
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|
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|
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|
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|
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"label": "**Aktuelle Medikamenten-Einnahme.** \nBitte tragen Sie alle Medikamente ein, die Sie zur Zeit nehmen (Schmerzmedikamente, Blutdruckmittel u. s. w.), inkl. Dosierung/Einnahmezeitpunkt bzw. Bedarfshäufigkeit:\n\n### Beispiele\n\n| | |\n| ------------------------------------------------------------ | ------------------------------------------------ |\n| **Medikament**: Beispiel: Ibuprofen 600 | **Medikament**: Beispiel: Ibuprofen 200 |\n| ***Ich nehme das Medikament regelmäßig*** | ***Ich nehme das Medikament regelmäßig*** |\n| **früh**: 1Tbl. | **früh**: |\n| **mittags**: 1Tbl. | **mittags**: |\n| **abends**: 0 | **abends**: |\n| **spät abends**: 0 | **spät abends**: |\n| ***Ich nehme das Medikament nur bei Bedarf*** | ***Ich nehme das Medikament nur bei Bedarf*** |\n| **Ungefähr wie oft pro Monat?**: | **Ungefähr wie oft pro Monat?**: Ca. 7 mal 1 Tbl |",
|
||
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||
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|
||
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|
||
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||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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||
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|
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|
||
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|
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|
||
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|
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|
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|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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||
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|
||
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|
||
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|
||
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|
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|
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|
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|
||
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|
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|
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|
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|
||
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|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400",
|
||
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|
||
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|
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|
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|
||
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|
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
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|
||
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||
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|
||
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|
||
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|
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|
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|
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|
||
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|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400",
|
||
"showif": "typeof dsf_22_med9 !== \"undefined\" && dsf_22_med9 != \"\" //js_only",
|
||
"value": null,
|
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|
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|
||
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|
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{
|
||
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|
||
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|
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|
||
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|
||
"label": "Ich nehme das Medikament **nur bei Bedarf**",
|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "typeof dsf_22_med9 !== \"undefined\" && dsf_22_med9 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 127
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
||
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|
||
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|
||
"label": "ungefähr **wie oft** pro Monat?",
|
||
"label_parsed": "ungefähr <strong>wie oft<\/strong> pro Monat?",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left space_bottom_40",
|
||
"showif": "dsf_22_med9_bed_c == 1&& typeof dsf_22_med9 !== \"undefined\" && dsf_22_med9 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 128
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_22_submit",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 129
|
||
},
|
||
{
|
||
"type": "note",
|
||
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|
||
"type_options": null,
|
||
"name": "dsf_23_intro",
|
||
"label": "**Frühere Schmerzmedikamente**: \nBitte tragen Sie hier Ihre früher genommenen Schmerzmedikamente ein, inkl. Wirksamkeit und eventueller Nebenwirkungen:",
|
||
"label_parsed": "<p><strong>Frühere Schmerzmedikamente<\/strong>:<br />\nBitte tragen Sie hier Ihre früher genommenen Schmerzmedikamente ein, inkl. Wirksamkeit und eventueller Nebenwirkungen:<\/p>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
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|
||
"item_order": 130
|
||
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|
||
{
|
||
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|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
||
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|
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|
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|
||
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|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"item_order": 133
|
||
},
|
||
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|
||
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|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"block_order": null,
|
||
"item_order": 135,
|
||
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|
||
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|
||
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|
||
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|
||
}
|
||
},
|
||
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|
||
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|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"value": null,
|
||
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|
||
"item_order": 136
|
||
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|
||
{
|
||
"type": "text",
|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"value": null,
|
||
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|
||
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|
||
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|
||
{
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 138,
|
||
"choices": {
|
||
"1": "nein",
|
||
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|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "typeof dsf_23_med3 !== \"undefined\" && dsf_23_med3 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 139
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
||
"type_options": null,
|
||
"name": "dsf_23_med4",
|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "typeof dsf_23_med3 !== \"undefined\" && dsf_23_med3 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 140
|
||
},
|
||
{
|
||
"type": "mc_button",
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"showif": "typeof dsf_23_med4 !== \"undefined\" && dsf_23_med4 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 141,
|
||
"choices": {
|
||
"1": "nein",
|
||
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|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
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|
||
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|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "typeof dsf_23_med4 !== \"undefined\" && dsf_23_med4 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 142
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
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|
||
"name": "dsf_23_med5",
|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "typeof dsf_23_med4 !== \"undefined\" && dsf_23_med4 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 143
|
||
},
|
||
{
|
||
"type": "mc_button",
|
||
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|
||
"type_options": null,
|
||
"name": "dsf_23_med5_wirk",
|
||
"label": "wirksam?",
|
||
"label_parsed": "wirksam?",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left mc_equal_widths",
|
||
"showif": "typeof dsf_23_med5 !== \"undefined\" && dsf_23_med5 != \"\" //js_only",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 144,
|
||
"choices": {
|
||
"1": "nein",
|
||
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|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
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|
||
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|
||
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|
||
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|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "typeof dsf_23_med5 !== \"undefined\" && dsf_23_med5 != \"\" //js_only",
|
||
"value": null,
|
||
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|
||
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|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
||
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|
||
"name": "dsf_23_med6",
|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
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|
||
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|
||
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|
||
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|
||
"type": "mc_button",
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"value": null,
|
||
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|
||
"item_order": 148
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_24_ja",
|
||
"type_options": null,
|
||
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|
||
"label": "Haben Sie Allergien gegen bestimmte Medikamente?",
|
||
"label_parsed": "Haben Sie Allergien gegen bestimmte Medikamente?",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
}
|
||
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|
||
{
|
||
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|
||
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|
||
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|
||
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|
||
"label": "wenn ja, gegen welche?",
|
||
"label_parsed": "wenn ja, gegen welche?",
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"item_order": 150
|
||
},
|
||
{
|
||
"type": "note",
|
||
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|
||
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|
||
"name": "dsf_25_intro",
|
||
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|
||
"label_parsed": "<p>Leiden Sie neben Ihren Schmerzen an <strong>weiteren Krankheiten oder Krankheitsfolgen<\/strong>?<br />\nIm Folgenden sind Krankheitsgruppen mit Beispielen aufgeführt. Wenn eines der Beispiele zutrifft, unterstreichen Sie es bitte. Dann schätzen Sie bitte ein, wie stark Sie durch diese Erkrankung in Ihrem Alltagsleben beeinträchtigt sind. „0“ bedeutet, Sie erleben keine Beeinträchtigung, „3“ besagt, dass Sie eine starke Beeinträchtigung erleben.<\/p>",
|
||
"optional": 1,
|
||
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|
||
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|
||
"value": null,
|
||
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|
||
"item_order": 151
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_01_ja",
|
||
"type_options": null,
|
||
"name": "dsf_25_01_ja",
|
||
"label": "**Bösartige Erkrankungen, Tumorleiden, Krebs**",
|
||
"label_parsed": "<strong>Bösartige Erkrankungen, Tumorleiden, Krebs<\/strong>",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 152,
|
||
"choices": {
|
||
"1": "ja",
|
||
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|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
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|
||
"label": "Welche Erkrankung",
|
||
"label_parsed": "Welche Erkrankung",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "dsf_25_01_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 153
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_01_beeintr",
|
||
"type_options": null,
|
||
"name": "dsf_25_01_beeintr",
|
||
"label": "Beeinträchtigung im Alltagsleben",
|
||
"label_parsed": "Beeinträchtigung im Alltagsleben",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_25_01_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 154,
|
||
"choices": {
|
||
"1": "0 – keine",
|
||
"2": "1",
|
||
"3": "2",
|
||
"4": "3 – starke"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_01_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 155
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_02_ja",
|
||
"type_options": null,
|
||
"name": "dsf_25_02_ja",
|
||
"label": "**Erkrankungen des Nervensystems, Gehirns und Rückenmarks** (z. B. Epilepsie, Multiple Sklerose, Parkinson, Schlaganfall, Nervenverletzung, Nervenlähmung, Nervenentzündung, Polyneuropathie; Zustand nach Rückenmarkverletzung, Schädel-Hirn-Trauma oder Schlaganfall)",
|
||
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"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_09_andere",
|
||
"label": "Andere:",
|
||
"label_parsed": "Andere:",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 185
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_09_beeintr",
|
||
"type_options": null,
|
||
"name": "dsf_25_09_beeintr",
|
||
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|
||
"label_parsed": "Beeinträchtigung im Alltagsleben",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_25_09_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 186,
|
||
"choices": {
|
||
"1": "0 – keine",
|
||
"2": "1",
|
||
"3": "2",
|
||
"4": "3 – starke"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_09_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 187
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_10_ja",
|
||
"type_options": null,
|
||
"name": "dsf_25_10_ja",
|
||
"label": "**Erkrankungen des Muskel-Skelett-Systems / des Bindegewebes** (z. B. Chronische Polyarthritis, M. Bechterew; rheumatische Muskelentzündung, Skoliose; Osteoporose; Arthrose von Knie-, Hüft-, oder Schultergelenk; Zustand nach Bruch eines Wirbelkörpers)",
|
||
"label_parsed": "<strong>Erkrankungen des Muskel-Skelett-Systems / des Bindegewebes<\/strong> (z. B. Chronische Polyarthritis, M. Bechterew; rheumatische Muskelentzündung, Skoliose; Osteoporose; Arthrose von Knie-, Hüft-, oder Schultergelenk; Zustand nach Bruch eines Wirbelkörpers)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 188,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
||
"type_options": null,
|
||
"name": "dsf_25_10_andere",
|
||
"label": "Andere:",
|
||
"label_parsed": "Andere:",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 189
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_10_beeintr",
|
||
"type_options": null,
|
||
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|
||
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|
||
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|
||
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|
||
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|
||
"showif": "dsf_25_10_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 190,
|
||
"choices": {
|
||
"1": "0 – keine",
|
||
"2": "1",
|
||
"3": "2",
|
||
"4": "3 – starke"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_10_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 191
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_11_ja",
|
||
"type_options": null,
|
||
"name": "dsf_25_11_ja",
|
||
"label": "**Seelische Leiden** (z. B. Depression, schwere Angstzustände, Panikattacke, Magersucht, chronische Müdigkeit und Erschöpfung, Sucht oder Abhängigkeit, Psychose)",
|
||
"label_parsed": "<strong>Seelische Leiden<\/strong> (z. B. Depression, schwere Angstzustände, Panikattacke, Magersucht, chronische Müdigkeit und Erschöpfung, Sucht oder Abhängigkeit, Psychose)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 192,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
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|
||
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|
||
"name": "dsf_25_11_andere",
|
||
"label": "Andere:",
|
||
"label_parsed": "Andere:",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 193
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_11_beeintr",
|
||
"type_options": null,
|
||
"name": "dsf_25_11_beeintr",
|
||
"label": "Beeinträchtigung im Alltagsleben",
|
||
"label_parsed": "Beeinträchtigung im Alltagsleben",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_25_11_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 194,
|
||
"choices": {
|
||
"1": "0 – keine",
|
||
"2": "1",
|
||
"3": "2",
|
||
"4": "3 – starke"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_11_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 195
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_12_ja",
|
||
"type_options": null,
|
||
"name": "dsf_25_12_ja",
|
||
"label": "**Andere Erkrankungen**",
|
||
"label_parsed": "<strong>Andere Erkrankungen<\/strong>",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 196,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_12_andere",
|
||
"label": "Andere:",
|
||
"label_parsed": "Andere:",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 197
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_12_beeintr",
|
||
"type_options": null,
|
||
"name": "dsf_25_12_beeintr",
|
||
"label": "Beeinträchtigung im Alltagsleben",
|
||
"label_parsed": "Beeinträchtigung im Alltagsleben",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "dsf_25_12_ja == 1",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 198,
|
||
"choices": {
|
||
"1": "0 – keine",
|
||
"2": "1",
|
||
"3": "2",
|
||
"4": "3 – starke"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_12_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 199
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_13_ja",
|
||
"type_options": null,
|
||
"name": "dsf_25_13_ja",
|
||
"label": "**Risikofaktoren**: Blutgerinnungsstörung, Hepatitis, HIV",
|
||
"label_parsed": "<strong>Risikofaktoren<\/strong>: Blutgerinnungsstörung, Hepatitis, HIV",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 200,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "text",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_13_andere",
|
||
"label": "Andere:",
|
||
"label_parsed": "Andere:",
|
||
"optional": 1,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 201
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_25_13_line",
|
||
"label": "---",
|
||
"label_parsed": "<hr />",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 202
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_25_14_ja",
|
||
"type_options": null,
|
||
"name": "dsf_25_14_ja",
|
||
"label": "**Unverträglichkeiten, Allergien** (z. B. Pflaster, Lebensmittel, Wasch-/Putzmittel, Blütenstaub, Hausstaub)",
|
||
"label_parsed": "<strong>Unverträglichkeiten, Allergien<\/strong> (z. B. Pflaster, Lebensmittel, Wasch-/Putzmittel, Blütenstaub, Hausstaub)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 203,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "submit",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_submit_basisbogen",
|
||
"label": "Weiter",
|
||
"label_parsed": "Weiter",
|
||
"optional": 0,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 204
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_l_intro",
|
||
"label": "Bei diesen Fragen geht es um die **Beurteilung Ihres allgemeinen Gesundheitszustandes**. Ihre Antworten ermöglichen, im Zeitverlauf nachzuvollziehen, wie Sie sich fühlen und wie Sie im Alltag zurechtkommen.\nBitte beantworten Sie jede der folgenden Fragen, indem Sie bei den Antwortmöglichkeiten die Antwort ankreuzen, die am besten auf Sie zutrifft.",
|
||
"label_parsed": "<p>Bei diesen Fragen geht es um die <strong>Beurteilung Ihres allgemeinen Gesundheitszustandes<\/strong>. Ihre Antworten ermöglichen, im Zeitverlauf nachzuvollziehen, wie Sie sich fühlen und wie Sie im Alltag zurechtkommen.<br />\nBitte beantworten Sie jede der folgenden Fragen, indem Sie bei den Antwortmöglichkeiten die Antwort ankreuzen, die am besten auf Sie zutrifft.<\/p>",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 205
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_l01",
|
||
"type_options": null,
|
||
"name": "dsf_l01",
|
||
"label": "Wie würden Sie Ihren **Gesundheitszustand im Allgemeinen** beschreiben?",
|
||
"label_parsed": "Wie würden Sie Ihren <strong>Gesundheitszustand im Allgemeinen<\/strong> beschreiben?",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 206,
|
||
"choices": {
|
||
"1": "ausgezeichnet",
|
||
"2": "sehr gut",
|
||
"3": "gut",
|
||
"4": "weniger gut",
|
||
"5": "schlecht"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_l02_intro",
|
||
"label": "Im Folgenden sind einige Tätigkeiten beschrieben, die Sie vielleicht an einem normalen Tag ausüben. Sind Sie **durch Ihren derzeitigen Gesundheitszustand bei diesen Tätigkeiten eingeschränkt**? Wenn ja, wie stark?",
|
||
"label_parsed": "Im Folgenden sind einige Tätigkeiten beschrieben, die Sie vielleicht an einem normalen Tag ausüben. Sind Sie <strong>durch Ihren derzeitigen Gesundheitszustand bei diesen Tätigkeiten eingeschränkt<\/strong>? Wenn ja, wie stark?",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 207
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_l02",
|
||
"type_options": null,
|
||
"name": "dsf_l02",
|
||
"label": "Mittelschwere Tätigkeiten, z. B. einen Tisch verschieben, staubsaugen, kegeln, Tennis spielen",
|
||
"label_parsed": "Mittelschwere Tätigkeiten, z. B. einen Tisch verschieben, staubsaugen, kegeln, Tennis spielen",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 208,
|
||
"choices": {
|
||
"1": "ja, stark eingeschränkt",
|
||
"2": "ja, etwas eingeschränkt",
|
||
"3": "nein, überhaupt nicht eingeschränkt"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_l03",
|
||
"type_options": null,
|
||
"name": "dsf_l03",
|
||
"label": "Mehrere Treppenabsätze steigen",
|
||
"label_parsed": "Mehrere Treppenabsätze steigen",
|
||
"optional": 0,
|
||
"class": "mc_vertical left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 209,
|
||
"choices": {
|
||
"1": "ja, stark eingeschränkt",
|
||
"2": "ja, etwas eingeschränkt",
|
||
"3": "nein, überhaupt nicht eingeschränkt"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_l04_intro",
|
||
"label": "Hatten Sie in den vergangenen 4 Wochen **aufgrund Ihrer körperlichen Gesundheit** irgendwelche Schwierigkeiten bei der Arbeit oder anderen alltäglichen Tätigkeiten im Beruf bzw. zu Hause?",
|
||
"label_parsed": "Hatten Sie in den vergangenen 4 Wochen <strong>aufgrund Ihrer körperlichen Gesundheit<\/strong> irgendwelche Schwierigkeiten bei der Arbeit oder anderen alltäglichen Tätigkeiten im Beruf bzw. zu Hause?",
|
||
"optional": 1,
|
||
"class": "",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 210
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_l04",
|
||
"type_options": null,
|
||
"name": "dsf_l04",
|
||
"label": "Ich habe weniger geschafft als ich wollte. (körperlich bedingt)",
|
||
"label_parsed": "Ich habe weniger geschafft als ich wollte. (körperlich bedingt)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 211,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "mc",
|
||
"choice_list": "dsf_l05",
|
||
"type_options": null,
|
||
"name": "dsf_l05",
|
||
"label": "Ich konnte nur bestimmte Dinge tun. (körperlich bedingt)",
|
||
"label_parsed": "Ich konnte nur bestimmte Dinge tun. (körperlich bedingt)",
|
||
"optional": 0,
|
||
"class": "left400 label_align_left",
|
||
"showif": "",
|
||
"value": null,
|
||
"block_order": null,
|
||
"item_order": 212,
|
||
"choices": {
|
||
"1": "ja",
|
||
"2": "nein"
|
||
}
|
||
},
|
||
{
|
||
"type": "note",
|
||
"choice_list": null,
|
||
"type_options": null,
|
||
"name": "dsf_l06_intro",
|
||
"label": "Hatten Sie in den vergangenen vier Wochen **aufgrund seelischer Probleme** irgendwelche Schwierigkeiten bei der Arbeit oder anderen alltäglichen Tätigkeiten im Beruf bzw. zu Hause (z.B. weil Sie sich niedergeschlagen oder ängstlich fühlten)?",
|
||
"label_parsed": "Hatten Sie in den vergangenen vier Wochen <strong>aufgrund seelischer Probleme<\/strong> irgendwelche Schwierigkeiten bei der Arbeit oder anderen alltäglichen Tätigkeiten im Beruf bzw. zu Hause (z.B. weil Sie sich niedergeschlagen oder ängstlich fühlten)?",
|
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|
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|
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|
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
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|
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|
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|
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|
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|
||
"label_parsed": "Inwieweit haben die Schmerzen Sie in den vergangenen 4 Wochen <strong>bei der Ausübung Ihrer Alltagstätigkeiten zuhause und im Beruf behindert<\/strong>?",
|
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
||
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|
||
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|
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|
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|
||
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|
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|
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|
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|
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
||
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|
||
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|
||
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|
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|
||
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|
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|
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|
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|
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
||
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|
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|
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|
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|
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|
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
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|
||
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|
||
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|
||
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|
||
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|
||
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|
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|
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|
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|
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|
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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"label": "**Die folgenden Fragen beziehen sich auf die letzten 14 Tage**:",
|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
||
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
||
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|
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|
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|
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|
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|
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|
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|
||
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|
||
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|
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|
||
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
||
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|
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|
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|
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|
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|
||
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|
||
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|
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|
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|
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|
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"type": "mc",
|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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|
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