| ARCHETYPE ID | openEHR-EHR-OBSERVATION.iciq_ui_short.v0 |
|---|---|
| Concept | ICIQ-UI Short Form |
| Description | International Consultation on Incontinence (ICIQ) Urinary Incontinence (UI) Short Form. |
| Use | Use to record ICIQ-UI Short form answers to questions and total score. |
| Purpose | Intended to capture the result of the short form of the ICIQ (International Consultation on Incontinence Questionnaire), also referred to as ICIQ-UI Short Form. The form is used to obtain a brief yet comprehensive summary of the level, impact and perceived cause of symptoms of incontinence. |
| References | International Consultation on Incontinence Modular Questionnaire http://www.iciq.net/index.html |
| Copyright | © Clinical Models UK |
| Authors | Author name: Hildegard Franke Organisation: freshEHR Clinical Informatics Ltd. Email: hildi@freshehr.com Date originally authored: 2016-05-30 |
| Other Details Language | Author name: Hildegard Franke Organisation: freshEHR Clinical Informatics Ltd. Email: hildi@freshehr.com Date originally authored: 2016-05-30 |
| Other Details (Language Independent) |
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| Keywords | incontinence, ICIQ, score, urine, leakage, leak, questionnaire |
| Lifecycle | in_development |
| UID | 83a0625f-b654-42e4-a779-797b6281d726 |
| Language used | en |
| Citeable Identifier | 1246.145.2747 |
| Revision Number | 0.0.1-alpha |
| protocol | |
| Extension | Extension: Additional information required to capture local content or to align with other reference models/formalisms. e.g. Local information requirements or additional metadata to align with FHIR or CIMI equivalents. Include: All not explicitly excluded archetypes |
| state | |
| Confounding factors | Confounding factors: Description of any incidental factors that may have contributed to the score. |
| data | |
| Frequency | Frequency: Frequency of urine leakage over past 4 weeks. Prompt: On average over the past 4 weeks, how often do you leak urine? 0: Never [Over the past 4 weeks I have never leaked urine.] 1: About once a week or less often [Over the past 4 weeks I have leaked urine about once a week or less often on average.] 2: Two or three times a week [Over the past 4 weeks I have leaked urine two or three times a week on average.] 3: About once a day [Over the past 4 weeks I have leaked urine about once a day on average.] 4: Several times a day [Over the past 4 weeks I have leaked urine several times a day on average.] 5: All the time [Over the past 4 weeks I have leaked urine all the time.] |
| Quantity | Quantity: Perceived quantity of urine leakage. Prompt: We would like to know how much urine you think leaks. How much urine do you usually leak (whether you wear protection or not)? 0: None [Over the past 4 weeks I have not leaked any urine.] 2: A small amount [Over the past 4 weeks I have leaked a small amount of urine on average.] 4: A moderate amount [Over the past 4 weeks I have leaked a moderate amount of urine on average.] 6: A large amount [Over the past 4 weeks I have leaked a large amount of urine on average.] |
| Interference with daily life | Interference with daily life: Perceived interference of urine leakage with daily life on a scale of 0 - 10. Prompt: Overall, how much does leaking urine interfere with your everyday life? Please record a number between 0 (not at all) and 10 (a great deal) min: >=0; max: <=10 |
| ICIQ Score | ICIQ Score: Sum of scores for frequency, quantity and interference. min: >=0; max: <=21 |
| When does urine leak? | When does urine leak?: Occasions when urine leakage occurs. Prompt: When does urine leak? (Please tick all that apply to you).
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| events | |
| Point in time | Point in time: A specific date and/or time which may be explicitly defined in a template or at run-time. |
| Other contributors | |
| Translators |