Questionnaires...
The questionnaires below are for use by physicians.
If you are trying to enroll in the NDB, please
see the NDB enrollment page.
If you are already enrolled and are having trouble locating your
questionnaire please contact the NDB.
A Guide To Questionnaires
Available Through The NDB
The NDB offers questionnaires without charge, for your clinical practice
or for research. You can choose which questionnaire you need. These forms
can be utilized as the basis of a mailed or faxback report to you.
The NDB offers several general
types of questionnaires.
Modification of the questionnaires to include or exclude items is possible.
When used in the clinic, these questionnaires
are not meant to be sufficient in and of themselves. Usually clinicians
collect physical examination, laboratory and treatment data separately,
although it is possible to collect them with NDB forms, too.
Most questionnaires are also available in Spanish and International English.
Questionnaires are available for download in Adobe Acrobat
PDF format for use by rheumatologists. Click here for the free
Adobe Acrobat Reader
Click to see complete table of questionnaire details.
- Arthritis and Rheumatology Clinics of Kansas clinical questionnaire, ARCK .
View the ARCK
-
The CLINHAQ
is a one-page questionnaire designed to collect basic visit information
as well as contact information. With this form, the goal is to
enroll patients into the NDB so they will receive NDB Comprehensive
questionnaires
View the CLINHAQ.
View the Spanish CLINHAQ.
-
The CLINHAQ II
is based on the HAQ and HAQ-II functional assessments. It also
contains additional scales. In exchange
for the increased length, these questionnaires handle more
dimensions of health and provide more clinical information.
View the CLINHAQ
II questionnaire.
-
The NDB Comprehensive Survey Questionnaire (CSQ)
is a 28 page comprehensive assessment administered by mail,
Web entry or email PDF format at 6 month intervals to NDB study participants.
The CSQ documents all treatments, SF-36, direct and indirect medical cost,
adverse events, symptoms, utilities and all other key rheumatic disease outcomes.
The CSQ includes single item scales for sleep, anxiety and depression. It also
includes review of systems and a self-report joint count.
View the CSQ questionnaire.
View the Spanish CSQ questionnaire.
-
BSQ: Brief survey questionnaire is a shorter version
of the CSQ questionnaire for patients with rheumatic diseases. It
is designed for patients who are unable to complete the CSQ.
View the BSQ.
View the Spanish BSQ.
Need help with the questionnaire options available? Contact
the NDB for more information.
Data Entry Methods for Above Questionnaires
- PAPER QUESTIONNAIRE: The easiest option for
use in the clinic. After completion of forms by patients, they can
be scored by the physician or physician’s staff and/or mailed to the
NDB in postage paid envelopes, or faxed to the NDB for automatic scoring.
The data is then reported back to the physician within minutes in
a longitudinal flow sheet format that incorporates all of the patient’s
previous data. Click here to see faxback report.
Questionnaires can also be scored by rheumatologists themselves for
immediate use in the clinic. If forwarded to the NDB, data will be
entered into a longitudinal data bank for use by the rheumatologist.
- DIRECT INTERNET ENTRY: All questionnaires are available through
the web for easy data entry.
- OFF-LINE ELECTRONIC ENTRY: All questionnaires are available as programmed
PDF forms.
Please note: all of these forms are
HIPPA compliant and have been approved by IRBs.
IRB Documents
NDB Protocol Summary
NDB HIPPA Questionnaire Approval
NDB Annual Approval
NDB HIPPA Approval
SLEC HIPPA Approval
SLEC Ammendments to HIPPA Approval
