Spine Tango form for conservative treatment (Spine Tango Conservative treatment)

Version: from 01/09/2019 - 31/03/2021
Status: inactive
How to create a CSV file for this data collection?

Start date: 06/04/2020
End date creation: 31/12/2023
End date submission: 31/12/2023
End date comments: 31/12/2023

Full view CSV column names Validation rules Reference lists Computed expressions Additional information CSV extract

1 Patient identification

patient identificator

National registry ID

Help

Please encode a social security identification number (SSIN). Please note that the patient ID is always pseudonymised before being transferred to Healthdata.

Technical specs

CSV column name:

patient_id

Required:

false

Stable:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

PatientIdentificationNumber

Validation

The validity of the national register number is checked with the mod97 check.

Fields

Section help

Please encode a social security identification number (SSIN). Please note that the patient ID is always pseudonymised before being transferred to Healthdata.

text

Internal patient ID

Help

This field can be used to enter an internal ID or reference number. It is available for internal use only and is not transferred to Healthdata. If there is an integration between HD4DP and your organisation's patient administration system, additional patient identification information such as date of birth, sex and SSIN can be automatically enriched based on this internal patient ID. Please do not encode the social security identification number (SSIN) in this field. The SSIN must be encoded in the field 'National registry ID of the patient'.

Technical specs

CSV column name:

patient_id|internal_patient_id

Length:

Required:

false

boolean

Generated

Help

The patient_id|generated column can be set to 'TRUE' for an automatically generated patient_id.This column should only be added in case the patient_id is empty. If the column is set to 'TRUE', a patient_id is automatically generated based on the name, first name, date of birth and sex of the patient.

Technical specs

CSV column name:

patient_id|generated

Required:

false

Options

Label	Value
Yes	TRUE
No	FALSE

text

Name

Help

The name of the patient is never transferred to Healthdata and is available for your information only.

Technical specs

CSV column name:

patient_id|name

Length:

Required:

noSSIN(Needed only if no national register number is entered)

Stable:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

LastName

text

First name

Help

The first name of the patient is never transferred and is available for your information only.

Technical specs

CSV column name:

patient_id|first_name

Length:

Required:

noSSIN(Needed only if no national register number is entered)

Stable:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

FirstNames

date

Date of birth

Technical specs

Format:

DD/MM/YYYY

CSV column name:

patient_id|date_of_birth

Required:

noSSIN(Needed only if no national register number is entered)

Stable:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

DateOfBirth

Validation

The date of birth cannot be in the future (error)
The date of birth cannot be after the date of death (error)
The date of birth cannot be after the start of therapy (error)
The date of birth cannot be after the end of therapy (error)
The date of birth needs to be after 1900 (error)

choice

Sex

Technical specs

CSV column name:

patient_id|sex

Required:

noSSIN(Needed only if no national register number is entered)

Stable:

true

Options

Label	Value
Female	F
Male	M
Unkown	U

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

Gender

text

Place of residence

Technical specs

CSV column name:

patient_id|place_of_residence

Length:

Reference list:

POSTAL_CODE

Required:

false

Stable:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

Postcode

boolean

Deceased?

Technical specs

CSV column name:

patient_id|deceased

Required:

false

Stable:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

DeathIndicator

Options

Label	Value
Yes	TRUE
No	FALSE

date

Date of death

Technical specs

Format:

DD/MM/YYYY

CSV column name:

patient_id|date_of_death

Only when:

Required:

false

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Patient

Data element:

DateOfDeath

Validation

The date of death cannot be in the future (error)
The date of birth cannot be after the date of death (error)
The start of therapy cannot be after the date of death (error)
The end of therapy cannot be after the date of death (error)

2 Caregiver

text

RIZIV/INAMI-code of the treating physician

Technical specs

CSV column name:

CD_RIZIV_TREAT_PHYS

Length:

100

Reference list:

PHYSICIAN

Required:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.HealthProfessional

Data element:

HealthProfessionalIdentificationNumber

3 Admission / pathology

date

Admission date

Technical specs

Format:

DD/MM/YYYY

CSV column name:

DT_ADMI_START

Only when:

Required:

false

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Encounter

Data element:

StartDateTime

choice

Region of main condition

Technical specs

CSV column name:

CD_REGIO_MAIN_PATH

Required:

true

Options

Label	Value
Cervical	1
Cervicothoracic	2
Thoracic	3
Thoracolumbar	4
Lumbar/lumbosacral	5
Ilio-sacral	6
Coccyx	7
Cervico-thoraco-lumbar	8
Other	9

Nested option fields

When 9 Is selected:
text
Specify other region of main condition
Technical specs
CSV column name:
CD_REGIO_MAIN_PATH|TX_REGIO_MAIN_PATH_OTH
Required:
true

multichoice

Symptoms

Technical specs

CSV column name:

CD_SYMP

Required:

true

Options

Label	Value
Axial pain	FL_SYMP_AXI_PAIN
Radiating pain: radicular	FL_SYMP_PAIN_RADIC
Radiating pain: non-radicular	FL_SYMP_PAIN_NONRADIC
Widespread pain	FL_SYMP_PAIN_WIDESPR
Motor deficit	FL_SYMP_MOTDYS
Sensory deficit	FL_SYMP_SENDODYS
Deformity	FL_SYMP_DEFRMY
Other	FL_SYMP_OTH

Nested option fields

When FL_SYMP_OTH Is selected:
text
Specify other symptoms
Technical specs
CSV column name:
CD_SYMP|TX_SYMP_OTH
Required:
true

choice

Duration of symptoms

Technical specs

CSV column name:

CD_SYMP_DURA

Required:

true

Options

Label	Value
	1
3 - 12 mo	2
> 12 mo	3

multichoice

Diagnosis supported by

Technical specs

CSV column name:

CD_DIAGS_SUPP

Required:

true

Options

Label	Value
X-ray	FL_DIAGS_SUPP_XR
MRI	FL_DIAGS_SUPP_MRI
CT	FL_DIAGS_SUPP_CT
SPECT/scintigraphy	FL_DIAGS_SUPP_SPECT
Electrophysiology	FL_DIAGS_SUPP_EP
Ultrasound	FL_DIAGS_SUPP_ULTRSND
Infiltration	FL_DIAGS_SUPP_INFIL
Laboratory	FL_DIAGS_SUPP_LAB
History/clinical evaluation	FL_DIAGS_SUPP_EVAL
Other	FL_DIAGS_SUPP_OTH

Nested option fields

When FL_DIAGS_SUPP_OTH Is selected:
text
Please specify
Technical specs
CSV column name:
CD_DIAGS_SUPP|TX_DIAGS_SUPP_OTH
Required:
true

choice

Main condition (supported by imaging/labs/other tests)

Technical specs

CSV column name:

CD_MAIN_PATH_TST

Only when:

Required:

true

Options

Label	Value
Degenerative disease	1
Non-degenerative deformity	2
Fracture/trauma	3
Pathological fracture	4
Spondylolisthesis (non-degenerative)	5
Chiari	6
Infection	7
Inflammation	8
Other	9

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When 9 Is selected:
text
Specify other main condition (supported by imaging/labs/other tests)
Technical specs
CSV column name:
CD_MAIN_PATH_TST|TX_MAIN_PATH_TST_OTH
Length:
100
Required:
true

choice

Main condition (supported by history/clinical evaluation only)

Technical specs

CSV column name:

CD_MAIN_PATH_EVAL

Only when:

Required:

true

Options

Label	Value
Spinal pain - axial	1
Spinal pain with peripheral radiation	2
Spinal pain with peripheral radiation and neurological deficit	3
Pelvic pain	4
Other	5

Nested option fields

When 5 Is selected:
text
Specify other main condition (supported by history/clinical evaluation only)
Technical specs
CSV column name:
CD_MAIN_PATH_EVAL|TX_MAIN_PATH_EVAL_OTH
Required:
true

choice

Type of primary degeneration

Technical specs

CSV column name:

CD_PRM_DEGNRTN

Only when:

Required:

true

Options

Label	Value
Disc herniation	1
Central stenosis	2
Lateral stenosis	3
Foraminal stenosis	4
Degenerative disc disease	5
Degenerative deformity	6
Degenerative spondylolisthesis	7
Other instability	8
Myelopathy	9
Facet joint arthrosis	10
Synovial cyst	11
SI joint	12
Other	13

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Validation

Type of primary degeneration cannot be the same as type of secondary degeneration (error)

Nested option fields

When 13 Is selected:
text
Specify other type of primary degeneration
Technical specs
CSV column name:
CD_PRM_DEGNRTN|TX_PRM_DEGNRTN_OTH
Length:
100
Only when:
Required:
true

multichoice

Type of secondary degeneration

Technical specs

CSV column name:

CD_SEC_DEGNRTN

Only when:

Required:

true

Options

Label	Value
None	FL_SEC_DEGNRTN_NONE
Disc herniation	FL_SEC_DEGNRTN_DISC
Central stenosis	FL_SEC_DEGNRTN_CS
Lateral stenosis	FL_SEC_DEGNRTN_LS
Foraminal stenosis	FL_SEC_DEGNRTN_FST
Degenerative disc disease	FL_SEC_DEGNRTN_DDD
Degenerative deformity	FL_SEC_DEGNRTN_DEFRMY
Degenerative spondylolisthesis	FL_SEC_DEGNRTN_SPLT
Other instability	FL_SEC_DEGNRTN_OI
Myelopathy	FL_SEC_DEGNRTN_MP
Facet joint arthrosis	FL_SEC_DEGNRTN_FJA
Synovial cyst	FL_SEC_DEGNRTN_CYST
SI joint	FL_SEC_DEGNRTN_SI
Other	FL_SEC_DEGNRTN_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When FL_SEC_DEGNRTN_OTH Is selected:
text
Specify other type of secondary degeneration
Technical specs
CSV column name:
CD_SEC_DEGNRTN|TX_SEC_DEGNRTN_OTH
Length:
100
Required:
true

Validation

Type of secondary degeneration: the option 'None' cannot be combined with other options (error)
Type of primary degeneration cannot be the same as type of secondary degeneration (error)

multichoice

Type of deformity

Technical specs

CSV column name:

CD_DEFRMY

Only when:

Required:

true

Options

Label	Value
Scoliosis	FL_DEFRMY_SCOL
Kyphosis	FL_DEFRMY_KYPH
Frontal imbalance	FL_DEFRMY_FRONTL_IMBAL
Sagittal imbalance	FL_DEFRMY_SAGIT_IMBAL
Other	FL_DEFRMY_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When FL_DEFRMY_OTH Is selected:
text
Specify other type of deformity
Technical specs
CSV column name:
CD_DEFRMY|TX_DEFRMY_OTH
Length:
100
Required:
true

choice

Predominant etiology

Technical specs

CSV column name:

CD_PREDOMI_ETIO

Only when:

Required:

true

Options

Label	Value
Idiopathic	1
Congenital	2
Neuromuscular	3
Posttraumatic	4
M. Scheuermann	5
Syndromic	6
Other	7

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When 7 Is selected:
text
Specify other predominant etiology
Technical specs
CSV column name:
CD_PREDOMI_ETIO|TX_PREDOMI_ETIO_OTH
Length:
100
Required:
true

choice

Type of spondylolisthesis

Technical specs

CSV column name:

CD_SPL

Only when:

Required:

true

Options

Label	Value
Type I (congenital or dysplastic spondylolisthesis)	1
Type II (isthmic spondylolisthesis)	2
Type IV (traumatic spondylolisthesis)	3
Type V (pathologic spondylolisthesis)	4
Type VI (postsurgical spondylolisthesis)	5

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

choice

Grade of spondylolisthesis

Technical specs

CSV column name:

CD_GRD_SPLT

Only when:

Required:

true

Options

Label	Value
Grade 0	0
Grade I	1
Grade II	2
Grade III	3
Grade IV	4
Spondyloptosis (V)	5

choice

Type of (pathological) fracture/trauma

Technical specs

CSV column name:

CD_FRACT_TRAUM

Only when:

Required:

true

Options

Label	Value
Condylar (C0)	1
C0/1 dissociation	2
C1 fracture	3
C1/2 instability	4
C2 dens fracture	5
C2 other fracture	6
Soft tissue injury neck	7
Fracture C3-C7	8
Fracture Th1-L5/S1	9
Sacrum fracture	10
Other	11

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When 11 Is selected:
text
Specify other type of fracture/trauma
Technical specs
CSV column name:
CD_FRACT_TRAUM|TX_FRACT_TRAUM_OTH
Length:
100
Required:
true

choice

Fracture age

Technical specs

CSV column name:

CD_FRAC_AGE

Only when:

Required:

true

Options

Label	Value
Fresh fracture	1
Old fracture	2

choice

Dens fracture type

Technical specs

CSV column name:

CD_DENS_FRAC

Only when:

Required:

true

Options

Label	Value
Type I fracture of dens	1
Type II fracture of dens	2
Type III fracture of dens	3

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

choice

C3-L5/S1 AO fracture type

Help

AO Classification applies to the most severely affected VB

Technical specs

CSV column name:

CD_AO_FRAC

Only when:

Required:

true

Options

Label	Value
A0	1
A1	2
A2	3
A3	4
A4	5
B1	6
B2	7
B3	8
C	9

choice

AO Neurologic injury

Help

AO Classification applies to the most severely affected VB

Technical specs

CSV column name:

CD_AO_NEURO_INJRY

Only when:

Required:

true

Options

Label	Value
N0	1
N1	2
N2	3
N3	4
N4	5
NX	6

multichoice

AO Modifiers

Technical specs

CSV column name:

CD_AO_MODS_TH1L5S1

Only when:

Required:

true

Options

Label	Value
No modifiers	FL_AO_MODS_TH1L5S1_NO
M1	FL_AO_MODS_TH1L5S1_M1
M2	FL_AO_MODS_TH1L5S1_M2

multichoice

AO Modifiers

Technical specs

CSV column name:

CD_AO_MODS_C3C7

Only when:

Required:

true

Options

Label	Value
No modifiers	FL_AO_MODS_C3C7_NO
M3	FL_AO_MODS_C3C7_M3
M4	FL_AO_MODS_C3C7_M4
F1	FL_AO_MODS_C3C7_F1
F2	FL_AO_MODS_C3C7_F2
F3	FL_AO_MODS_C3C7_F3
F4	FL_AO_MODS_C3C7_F4
BL	FL_AO_MODS_C3C7_BL

choice

Pathological fracture due to...

Technical specs

CSV column name:

CD_FRAC_REAS

Only when:

Required:

true

Options

Label	Value
Osteoporosis	1
Tumour	2
Other	3

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When 3 Is selected:
text
Specify
Technical specs
CSV column name:
CD_FRAC_REAS|TX_FRAC_REAS_OTH
Length:
100
Required:
true

choice

Osteoporotic vertebral fracture classification type

Help

Additional fractures w/different treatments require separate forms

Technical specs

CSV column name:

CD_OSTEOPR_VERTBRL_FRAC

Only when:

Required:

true

Options

Label	Value
OF1	1
OF2	2
OF3	3
OF4	4
OF5	5

multichoice

Inflammation

Technical specs

CSV column name:

CD_INFL

Only when:

Required:

true

Options

Label	Value
Ca-pyrophosphate deposition disease	FL_INFL_CPPD
Other spondyloarthropathy, incl. psoriatic arthritis	FL_INFL_OTH_SA
Ankylosing spondylitis	FL_INFL_AS
Gout	FL_INFL_GOUT
Rheumatoid arthritis	FL_INFL_RA
Other	FL_INFL_OTH

Nested option fields

When FL_INFL_OTH Is selected:
text
Specify other inflammation
Technical specs
CSV column name:
CD_INFL|TX_INFL_OTH
Required:
true

multichoice

Infection specification

Technical specs

CSV column name:

CD_INFECT_SPEC

Only when:

Required:

true

Options

Label	Value
Pyogenic	FL_INFECT_SPEC_PYOGEN
Tuberculotic	FL_INFECT_SPEC_TUBERC
Multi-resistant	FL_INFECT_SPEC_MR
Unknown	FL_INFECT_SPEC_UNK
Other	FL_INFECT_SPEC_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When FL_INFECT_SPEC_OTH Is selected:
text
Specify other type of infection
Technical specs
CSV column name:
CD_INFECT_SPEC|TX_INFECT_SPEC_OTH
Length:
100
Required:
true

multichoice

Affected structure(s)

Technical specs

CSV column name:

CD_AFFECT_STRUCT

Only when:

Required:

true

Options

Label	Value
Spondylitis	FL_AFFECT_STRUCT_SPLT
Discitis	FL_AFFECT_STRUCT_DISC
Epidural space	FL_AFFECT_STRUCT_ES
Paravertebral	FL_AFFECT_STRUCT_PV
Other	FL_AFFECT_STRUCT_OTH

Nested option fields

When FL_AFFECT_STRUCT_OTH Is selected:
text
Specify other type of affected structure
Technical specs
CSV column name:
CD_AFFECT_STRUCT|TX_AFFECT_STRUCT_OTH
Length:
100
Required:
true

choice

Most severely affected segment / vertebral body

Help

For segments, indicate cranial vertebral body only SA = sacrum (S2-5) CO = coccyx

Technical specs

CSV column name:

CD_SEVLY_AFFECT

Only when:

Required:

true

Options

Label	Value
Entire occipital bone	1
Bone structure of atlas	2
Bone structure of axis	3
Bone structure of C3	4
Bone structure of C4	5
Bone structure of C5	6
Bone structure of C6	7
Bone structure of C7	8
Bone structure of T1	9
Bone structure of T2	10
Bone structure of T3	11
Bone structure of T4	12
Bone structure of T5	13
Bone structure of T6	14
Bone structure of T7	15
Bone structure of T8	16
Bone structure of T9	17
Bone structure of T10	18
Bone structure of T11	19
Bone structure of T12	20
Bone structure of L1	21
Bone structure of L2	22
Bone structure of L3	23
Bone structure of L4	24
Bone structure of L5	25
Structure of first sacral vertebra	26
Entire sacrum	27
Bone structure of coccyx	28
Bone structure of ilium	29

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureAnatomicalLocation

choice

Extent of lesion (segments/vertebral bodies)

Technical specs

CSV column name:

CD_EXTEN_LES

Only when:

Required:

true

Options

Label	Value
1	1
2	2
3	3
4	4
>4	5

multichoice

Additional conditions (supported by imaging/labs/other investigations - main condition excluded)

Help

Answer to question "Main pathology" is excluded.

Technical specs

CSV column name:

CD_ADD_PATH_TST

Only when:

Required:

true

Options

Label	Value
None	FL_ADD_PATH_TST_NONE
Degenerative disease	FL_ADD_PATH_TST_DEGNRTN
Non-degenerative deformity	FL_ADD_PATH_TST_DEFRMY
Fracture/trauma	FL_ADD_PATH_TST_FRACTRAUM
Pathological fracture	FL_ADD_PATH_TST_PATHO
Spondylolisthesis (non-degenerative)	FL_ADD_PATH_TST_SPLT
Chiari	FL_ADD_PATH_TST_CHIARI
Infection	FL_ADD_PATH_TST_INFCT
Tumour	FL_ADD_PATH_TST_TUMOR
Inflammation	FL_ADD_PATH_TST_INFL
Other	FL_ADD_PATH_TST_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When FL_ADD_PATH_TST_OTH Is selected:
text
Specify other additional condition (supported by imaging/labs/other investigations - main condition excluded)
Technical specs
CSV column name:
CD_ADD_PATH_TST|TX_ADD_PATH_TST_OTH
Length:
100
Required:
true

Validation

Additional conditions (supported by imaging/labs/other investigations - main condition excluded): the option 'None' cannot be combined with other options (error)

multichoice

Additional conditions (supported by history/clinical evaluation only)

Technical specs

CSV column name:

CD_ADD_PATH_EVAL

Only when:

Required:

true

Options

Label	Value
None	FL_ADD_PATH_EVAL_NONE
Spinal pain - axial	FL_ADD_PATH_EVAL_SPIN_AXI
Spinal pain with peripheral radiation	FL_ADD_PATH_EVAL_SPIN_PERI
Spinal pain with peripheral radiation and neurological deficit	FL_ADD_PATH_EVAL_SPIN_PERI_ND
Pelvic pain	FL_ADD_PATH_EVAL_PELV
Other	FL_ADD_PATH_EVAL_OTH

Nested option fields

When FL_ADD_PATH_EVAL_OTH Is selected:
text
Specify other condition (supported by history/clinical evaluation only)
Technical specs
CSV column name:
CD_ADD_PATH_EVAL|TX_ADD_PATH_EVAL_OTH
Required:
true

Validation

Additional conditions (supported by history/clinical evaluation only): the option 'None' cannot be combined with other options (error)

choice

History of complaint

Technical specs

CSV column name:

CD_HISTY_COMPLAIN

Required:

true

Options

Label	Value
First episode	1
Recurrent episode	2

choice

Previous treatment for main condition

Technical specs

CSV column name:

CD_PREV_TREAT_MAIN_PATH

Only when:

Required:

true

Options

Label	Value
None	1
In last 3 months	2
3 - 6 months ago	3
6 - 12 months ago	4
> 12 months ago	5

multichoice

Treatment history of main condition

Technical specs

CSV column name:

CD_TREAT_HISTY_MAIN_PATH

Required:

true

Options

Label	Value
No treatment before	FL_TREAT_HISTY_MAIN_PATH_NO
Pain medication	FL_TREAT_HISTY_MAIN_PATH_MED
Exercise therapy	FL_TREAT_HISTY_MAIN_PATH_EXRCSE
Manual therapy	FL_TREAT_HISTY_MAIN_PATH_MAN
Physical measures	FL_TREAT_HISTY_MAIN_PATH_PHYSI
Psychological intervention	FL_TREAT_HISTY_MAIN_PATH_PHYSOL
Occupational medicine measures	FL_TREAT_HISTY_MAIN_PATH_OMM
Multidisciplinary treatment program	FL_TREAT_HISTY_MAIN_PATH_MT
Invasive pain therapy	FL_TREAT_HISTY_MAIN_PATH_INV_PAIN
Spine surgery	FL_TREAT_HISTY_MAIN_PATH_SPINE
Other	FL_TREAT_HISTY_MAIN_PATH_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureType

Nested option fields

When FL_TREAT_HISTY_MAIN_PATH_OTH Is selected:
text
Specify other treatment history of main condition
Technical specs
CSV column name:
CD_TREAT_HISTY_MAIN_PATH|TX_TREAT_HISTY_MAIN_PATH_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Procedure
Data element:
ProcedureType

Validation

Treatment history of main condition: the option 'No treatment before' cannot be combined with other options (error)

multichoice

Intake medication for main condition - analgesics

Technical specs

CSV column name:

CD_INTK_MEDICT_ANALGS

Required:

true

Options

Label	Value
None	FL_INTK_MEDICT_ANALGS_NONE
Paracetamol	FL_INTK_MEDICT_ANALGS_APAP
NSAIDs	FL_INTK_MEDICT_ANALGS_NSAID
Weak opioids	FL_INTK_MEDICT_ANALGS_WOPI
Strong opioids	FL_INTK_MEDICT_ANALGS_SOPI
SSRIs	FL_INTK_MEDICT_ANALGS_SSRI
SNRIs	FL_INTK_MEDICT_ANALGS_SNRI
Tricyclic antidepressants	FL_INTK_MEDICT_ANALGS_TCAD
Anxiolytics	FL_INTK_MEDICT_ANALGS_ANXLT
Anticonvulsants	FL_INTK_MEDICT_ANALGS_ACV
Neuroleptics	FL_INTK_MEDICT_ANALGS_NEUROLEPC
Other	FL_INTK_MEDICT_ANALGS_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.MedicationAgreement

Data element:

AgreedMedicine::Product

Nested option fields

When FL_INTK_MEDICT_ANALGS_OTH Is selected:
text
Specify other intake medication for main condition - analgesics
Technical specs
CSV column name:
CD_INTK_MEDICT_ANALGS|TX_INTK_MEDICT_ANALGS_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.MedicationAgreement
Data element:
AgreedMedicine::Product

Validation

Intake medication for main condition - analgesics: the option 'None' cannot be combined with other options (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
Analgesic medication ticked at start of therapy has now been ticked as “Not applicable”. Please verify. (error)

multichoice

Intake medication for main condition - non-analgesics

Technical specs

CSV column name:

CD_INTK_MEDICT_NANALGS

Required:

true

Options

Label	Value
None	FL_INTK_MEDICT_NANALGS_NONE
Muscle relaxants	FL_INTK_MEDICT_NANALGS_RLXNT
Corticosteroids	FL_INTK_MEDICT_NANALGS_CORTIC
Bisphosphonate	FL_INTK_MEDICT_NANALGS_BISPH
Calcium/vit. D	FL_INTK_MEDICT_NANALGS_CA_VITD
Selective oestrogen receptor modulator	FL_INTK_MEDICT_NANALGS_SERMOD
Parathyroid hormone	FL_INTK_MEDICT_NANALGS_PTH
TNF inhibitors	FL_INTK_MEDICT_NANALGS_TNF_INHIB
DMARD	FL_INTK_MEDICT_NANALGS_DMARD
Antibiotic therapy	FL_INTK_MEDICT_NANALGS_ANTBIO
Chemotherapy	FL_INTK_MEDICT_NANALGS_CHEMO
Sleep promoting drugs	FL_INTK_MEDICT_NANALGS_SPD
Other	FL_INTK_MEDICT_NANALGS_OTH

Nested option fields

When FL_INTK_MEDICT_NANALGS_OTH Is selected:
text
Specify other intake medication for main condition - non-analgesics
Technical specs
CSV column name:
CD_INTK_MEDICT_NANALGS|TX_INTK_MEDICT_NANALGS_OTH
Required:
true

Validation

Intake medication for main condition - non-analgesics: the option 'None' cannot be combined with other options (error)

questionnaire

Number of previous spinal surgeries

Technical specs

Required:

false

Questions

Label	CSV column name
At same/adjacent levels	CD_PREV_SPINE_SURG_SAME_LVL
At other levels	CD_PREV_SPINE_SURG_OTH_LVL

Answers

Label	Value
0	0
1	1
2	2
3	3
4	4
>4	5

choice

Other musculoskeletal comorbidities

Technical specs

CSV column name:

CD_OTH_MSK_COMORB

Required:

true

Options

Label	Value
Yes	1
No	0

choice

Number of other musculoskeletal comorbidities

Technical specs

CSV column name:

CD_OTH_MSK_COMORB_AMNT

Only when:

Required:

true

Options

Label	Value
1 - 3	1
>3	2

multichoice

Systemic comorbidities

Technical specs

CSV column name:

CD_COMORB

Required:

true

Options

Label	Value
None	FL_COMORB_NONE
Myocardial infarction	FL_COMORB_MI
Congestive heart failure	FL_COMORB_CHFL
Peripheral vascular disease	FL_COMORB_PVD
Cerebrovascular disease	FL_COMORB_CBVD
Dementia	FL_COMORB_DEMENT
Chronic pulmonary disease	FL_COMORB_CPD
Rheumatologic disease	FL_COMORB_RHEUM
Peptic ulcer disease	FL_COMORB_PEPTIC_ULC
Mild liver disease	FL_COMORB_MILD_LIVR
Diabetes without chronic complications	FL_COMORB_DIABT_WO_COMPLIC
Diabetes with chronic complications	FL_COMORB_DIABT_W_COMPLIC
Hemiplegia or paraplegia	FL_COMORB_HEMIPL_PARAPL
Renal disease	FL_COMORB_RENAL
Any malignancy, including leukemia and lymphoma	FL_COMORB_MALIGNCY
Moderate or severe liver disease	FL_COMORB_MODRT_SEV_LIVR
Metastatic solid tumour	FL_COMORB_TUMOR
AIDS/HIV	FL_COMORB_AIDS_HIV
Other	FL_COMORB_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Problem

Data element:

ProblemName

Nested option fields

When FL_COMORB_OTH Is selected:
text
Specify other systemic comorbidity
Technical specs
CSV column name:
CD_COMORB|TX_COMORB_OTH
Required:
true

Validation

Systemic comorbidities: the option 'None' cannot be combined with other options (error)

choice

Typical physical activity or exercise level

Technical specs

CSV column name:

CD_ACTVY_EXRCSE_LEVEL

Required:

true

Options

Label	Value
Sedentary	1
Moderately active	2
Very active	3

choice

Work status

Technical specs

CSV column name:

CD_WRK_STA

Required:

true

Options

Label	Value
Working now, employed	1
Working now, self-employed	2
Looking for work, unemployed	3
Sick leave or maternity leave	4
Not working due to spinal condition	5
Not working for reasons other than spinal condition	6
Keeping house	7
Student	8
Retired	9
Other	10

Nested option fields

When 10 Is selected:
text
Specify other work status
Technical specs
CSV column name:
CD_WRK_STA|TX_WRK_STA_OTH
Required:
true

number

Height (cm)

Technical specs

CSV column name:

MS_PAT_HGHT

Only when:

Required:

true

Mapping of the clinical building blocks (indicative only)

Concept:

Be.en.hd.BodyHeight

Data element:

HeightValue

Validation

The minimum value is 50 (error)
The maximum value is 280 (error)

number

Weight (kg)

Technical specs

CSV column name:

MS_PAT_WGHT

Only when:

Required:

true

Mapping of the clinical building blocks (indicative only)

Concept:

Be.en.hd.BodyWeight

Data element:

WeightValue

Validation

The minimum value is 4 (error)
The maximum value is 399 (error)

choice

Is either of the values estimated?

Technical specs

CSV column name:

CD_VAL_ESTIM

Required:

true

Options

Label	Value
Yes	1
No	0

choice

Current smoker

Technical specs

CSV column name:

CD_SMOK

Only when:

Required:

true

Options

Label	Value
Yes	1
No	0

Mapping of the clinical building blocks (indicative only)

Concept:

Be.en.hd.TobaccoUse

Data element:

TobaccoUseStatus

multichoice

Obstacles to recovery

Technical specs

CSV column name:

CD_OBST_RECOVER

Required:

true

Options

Label	Value
None	FL_OBST_RECOVER_NONE
Red flag	FL_OBST_RECOVER_RED
Yellow flag	FL_OBST_RECOVER_YELLOW
Medicolegal	FL_OBST_RECOVER_MEDLEG
Workers compensation / benefits	FL_OBST_RECOVER_BENEF
Other	FL_OBST_RECOVER_OTH

Nested option fields

When FL_OBST_RECOVER_OTH Is selected:
text
Specify other obstacles to recovery
Technical specs
CSV column name:
CD_OBST_RECOVER|TX_OBST_RECOVER_OTH
Required:
true

Validation

Obstacles to recovery: the option 'None' cannot be combined with other options (error)

multichoice

Therapeutic goals

Technical specs

CSV column name:

CD_THERPC_GOA_ADMI

Required:

true

Options

Label	Value
Axial pain relief	FL_THERPC_GOA_ADMI_APR
Peripheral pain relief	FL_THERPC_GOA_ADMI_PPR
Functional improvement	FL_THERPC_GOA_ADMI_FUNC
Motor improvement	FL_THERPC_GOA_ADMI_MOTOR
Sensory improvement	FL_THERPC_GOA_ADMI_SENSO
Bowel/bladder improvement	FL_THERPC_GOA_ADMI_BB
Cosmetic improvement	FL_THERPC_GOA_ADMI_COSM
Spinal stabilisation	FL_THERPC_GOA_ADMI_STABLZTN
Stop deformity progression	FL_THERPC_GOA_ADMI_STP_DEFRMY
Deformity correction (supported by imaging)	FL_THERPC_GOA_ADMI_DEFRMY_CORRN
Diagnostic measures	FL_THERPC_GOA_ADMI_DIAG_MEASRS
Other	FL_THERPC_GOA_ADMI_OTH

Nested option fields

When FL_THERPC_GOA_ADMI_OTH Is selected:
text
Specify other therapeutic goal
Technical specs
CSV column name:
CD_THERPC_GOA_ADMI|TX_THERPC_GOA_ADMI_OTH
Length:
100
Required:
true

4 Therapy

date

Start of therapy

Technical specs

Format:

DD/MM/YYYY

CSV column name:

DT_THERPY_START

Required:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureStartDate

Validation

The date of birth cannot be after the start of therapy (error)
The start of therapy cannot be after the date of death (error)

multichoice

Therapist credentials

Technical specs

CSV column name:

CD_THERPI_CRED

Required:

true

Options

Label	Value
Physician	FL_THERPI_CRED_PHYS
Physiotherapist	FL_THERPI_CRED_PHYSIO
Chiropractor	FL_THERPI_CRED_CHIRO
Osteopath	FL_THERPI_CRED_OSTEOP
Occupational therapist	FL_THERPI_CRED_OCTH
Massage therapist	FL_THERPI_CRED_MASTH
Acupuncturist	FL_THERPI_CRED_ACU
Manual therapist	FL_THERPI_CRED_MANTH
Psychologist	FL_THERPI_CRED_PSYCHOL
Surgeon	FL_THERPI_CRED_SURGN
Other	FL_THERPI_CRED_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.HealthProfessional

Data element:

Specialty

Nested option fields

When FL_THERPI_CRED_PHYS Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_PHYS
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_PHYSIO Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_PHYSIO
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_CHIRO Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_CHIRO
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_OSTEOP Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_OSTEOP
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_OCTH Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_OCTH
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_MASTH Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_MASTH
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_ACU Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_ACU
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_MANTH Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_MANTH
Required:
true
Options
Label Value
1 - 5 1
6 -10 2
> 10 3
When FL_THERPI_CRED_PSYCHOL Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_PSYCHOL
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_SURGN Is selected:
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_SURGN
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3
When FL_THERPI_CRED_OTH Is selected:
text
Specify
Technical specs
CSV column name:
CD_THERPI_CRED|TX_THERPI_CRED_OTH
Length:
100
Required:
true
choice
Number of sessions
Technical specs
CSV column name:
CD_THERPI_CRED|CD_SESSN_OTH
Required:
true
Options
Label Value
1 - 5 1
6 - 10 2
> 10 3

Label	Value
1 - 5	1
6 - 10	2
> 10	3

Label	Value
1 - 5	1
6 - 10	2
> 10	3

5 Course of therapy / therapeutic measures for current episode

5.1 Medication

choice

Medication

Technical specs

CSV column name:

CD_MEDICT

Required:

true

Options

Label	Value
No	0
Yes	1

Nested option fields

When 1 Is selected:

multichoice

Specify the medication

Technical specs

CSV column name:

CD_MEDICT|CD_MEDICT_SPEC

Only when:

Required:

true

Options

Label	Value
Paracetamol	FL_MEDICT_APAP
NSAIDs	FL_MEDICT_NSAID
Weak opioids	FL_MEDICT_WOPI
Strong opioids	FL_MEDICT_SOPI
SSRIs	FL_MEDICT_SSRI
SNRIs	FL_MEDICT_SNRI
Tricyclic antidepressants	FL_MEDICT_TCAD
Anxiolytics	FL_MEDICT_ANXLT
Anticonvulsants	FL_MEDICT_ACV
Neuroleptics	FL_MEDICT_NEUROLEPC
Other analgesics	FL_MEDICT_OTH_ANALGS
Muscle relaxants	FL_MEDICT_MUSC_RLXNT
Corticosteroids	FL_MEDICT_CORTIC
Bisphosphonate	FL_MEDICT_BISPH
Calcium / vit. D	FL_MEDICT_CA_VITD
Selective oestrogen receptor modulator	FL_MEDICT_SERMOD
Parathyroid hormone	FL_MEDICT_PTH
TNF inhibitors	FL_MEDICT_TNF_INHIB
DMARD	FL_MEDICT_DMARD
Antibiotic therapy	FL_MEDICT_ANTBIO
Chemotherapy	FL_MEDICT_CHEMO
Sleep promoting drugs	FL_MEDICT_SPD
Other	FL_MEDICT_OTH

Nested option fields

When FL_MEDICT_OTH Is selected:
text
Specify other medication
Technical specs
CSV column name:
CD_MEDICT|CD_MEDICT_SPEC|TX_MEDICT_OTH
Required:
true

5.2 Non-invasive therapy

choice

Therapy setting

Technical specs

CSV column name:

CD_THERPY_SETTING

Required:

true

Options

Label	Value
One to one	1
Group	2
One to one and group	3

choice

Type of setting

Technical specs

CSV column name:

CD_SETTING

Required:

true

Options

Label	Value
Outpatient	1
Inpatient	2

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Encounter

Data element:

ContactType

choice

Exercise therapy

Technical specs

CSV column name:

CD_THERPY_EXRCSE

Required:

true

Options

Label	Value
No	0
Yes	1

Nested option fields

When 1 Is selected:

multichoice

Specify

Technical specs

CSV column name:

CD_THERPY_EXRCSE|CD_THERPY_EXRCSE_SPEC

Required:

true

Options

Label	Value
Strength	FL_THERPY_EXRCSE_STRNGTH
Flexibility	FL_THERPY_EXRCSE_FLEXY
Muscular endurance	FL_THERPY_EXRCSE_ME
Cardiovascular endurance	FL_THERPY_EXRCSE_CARDIOVASC
Balance	FL_THERPY_EXRCSE_BALNC
Motor control	FL_THERPY_EXRCSE_MOTOR
Postural control	FL_THERPY_EXRCSE_POSTU
Coordination	FL_THERPY_EXRCSE_COORD
Stability	FL_THERPY_EXRCSE_STAB
Other	FL_THERPY_EXRCSE_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureType

Nested option fields

When FL_THERPY_EXRCSE_OTH Is selected:
text
Specify
Technical specs
CSV column name:
CD_THERPY_EXRCSE|CD_THERPY_EXRCSE_SPEC|TX_THERPY_EXRCSE_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Procedure
Data element:
ProcedureType

multichoice

Exercise setting

Technical specs

CSV column name:

CD_EXRCSE_SETTING

Only when:

Required:

true

Options

Label	Value
Home exercise	FL_EXRCSE_SETTING_HOM
Supervised exercises (one to one)	FL_EXRCSE_SETTING_SUPERV
Group exercises	FL_EXRCSE_SETTING_GR

choice

Manual therapy

Technical specs

CSV column name:

CD_THERPY_MAN

Required:

true

Options

Label	Value
No	0
Yes	1

Nested option fields

When 1 Is selected:

multichoice

Specify

Technical specs

CSV column name:

CD_THERPY_MAN|CD_THERPY_MAN_SPEC

Required:

true

Options

Label	Value
Mobilization	FL_THERPY_MAN_MOBILIZ
Manipulation	FL_THERPY_MAN_MANIP
Techniques for soft tissues	FL_THERPY_MAN_SFT_TISS
Stretches	FL_THERPY_MAN_STRTCH
Neuromeningeal mobilization	FL_THERPY_MAN_NEURMEN
Visceral techniques	FL_THERPY_MAN_VISCERAL
Trigger point treatment	FL_THERPY_MAN_TRIG_PNT
Craniosacral techniques	FL_THERPY_MAN_CRANIO
Massage	FL_THERPY_MAN_MASSAGE
Other	FL_THERPY_MAN_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureType

Nested option fields

When FL_THERPY_MAN_OTH Is selected:
text
Specify
Technical specs
CSV column name:
CD_THERPY_MAN|CD_THERPY_MAN_SPEC|TX_THERPY_MAN_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Procedure
Data element:
ProcedureType

choice

Physical modalities

Technical specs

CSV column name:

CD_MOD_PHYSI

Required:

true

Options

Label	Value
No	0
Yes	1

Nested option fields

When 1 Is selected:

multichoice

Specify

Technical specs

CSV column name:

CD_MOD_PHYSI|CD_MOD_PHYSI_SPEC

Required:

true

Options

Label	Value
Interferential power	FL_MOD_PHYSI_INTERF_POW
Thermo therapy	FL_MOD_PHYSI_THERM
Short-wave diathermy	FL_MOD_PHYSI_SHRTWV
Shockwave therapy	FL_MOD_PHYSI_SHCKWV
Transcutaneous Electrical Nerve Stimulation (TENS)	FL_MOD_PHYSI_TENS
Ultrasound	FL_MOD_PHYSI_ULTRASND
Lumbar orthosis	FL_MOD_PHYSI_LUM
Laser therapy	FL_MOD_PHYSI_LASR
Traction	FL_MOD_PHYSI_TRACT
Acupuncture / dry needling	FL_MOD_PHYSI_ACUPNCTU
Other	FL_MOD_PHYSI_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureType

Nested option fields

When FL_MOD_PHYSI_OTH Is selected:
text
Specify
Technical specs
CSV column name:
CD_MOD_PHYSI|CD_MOD_PHYSI_SPEC|TX_MOD_PHYSI_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Procedure
Data element:
ProcedureType

choice

Psychological intervention

Technical specs

CSV column name:

CD_PSYCH_INTVENT

Required:

false

Options

Label	Value
No	0
Yes	1

Nested option fields

When 1 Is selected:

multichoice

Specify

Technical specs

CSV column name:

CD_PSYCH_INTVENT|CD_PSYCH_INTVENT_SPEC

Required:

true

Options

Label	Value
Counseling	FL_PSYCH_INTVENT_COUNS
Cognitive Behavioural Therapy	FL_PSYCH_INTVENT_CBT
Mindfulness-based therapy	FL_PSYCH_INTVENT_MIND
Acceptance & commitment therapy	FL_PSYCH_INTVENT_ACTH
Compassion focussed therapy	FL_PSYCH_INTVENT_CFT
Other	FL_PSYCH_INTVENT_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureType

Nested option fields

When FL_PSYCH_INTVENT_OTH Is selected:
text
Specify
Technical specs
CSV column name:
CD_PSYCH_INTVENT|CD_PSYCH_INTVENT_SPEC|TX_PSYCH_INTVENT_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Procedure
Data element:
ProcedureType

choice

Occupational medicine measures

Technical specs

CSV column name:

CD_OCCUP_MED_MEASRS

Required:

true

Options

Label	Value
No	0
Yes	1

Nested option fields

When 1 Is selected:

multichoice

Specify

Technical specs

CSV column name:

CD_OCCUP_MED_MEASRS|CD_OCCUP_MED_MEASRS_SPEC

Required:

true

Options

Label	Value
Ergonomic measures	FL_OCCUP_MED_MEASRS_ERGON
Occupational retraining / vocational rehabilitation	FL_OCCUP_MED_MEASRS_RETRAIN
Work reintegration / return to work programs	FL_OCCUP_MED_MEASRS_REINTEGN
Work hardening	FL_OCCUP_MED_MEASRS_WRKHRD
Other	FL_OCCUP_MED_MEASRS_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureType

Nested option fields

When FL_OCCUP_MED_MEASRS_OTH Is selected:
text
Specify
Technical specs
CSV column name:
CD_OCCUP_MED_MEASRS|CD_OCCUP_MED_MEASRS_SPEC|TX_OCCUP_MED_MEASRS_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Procedure
Data element:
ProcedureType

5.3 Invasive therapies

choice

Invasive pain therapy

Technical specs

CSV column name:

CD_INV_PAIN_THERPY

Required:

true

Options

Label	Value
No	0
Yes	1

Nested option fields

When 1 Is selected:

multichoice

Specify

Technical specs

CSV column name:

CD_INV_PAIN_THERPY|CD_INV_PAIN_THERPY_SPEC

Required:

true

Options

Label	Value
Facet block	FL_INV_PAIN_THERPY_FACET
Root block	FL_INV_PAIN_THERPY_ROOT
Epidural infiltration	FL_INV_PAIN_THERPY_INFIL
Epidural catheter	FL_INV_PAIN_THERPY_CATH
Pain pump	FL_INV_PAIN_THERPY_PAIN_PMP
Spinal cord stimulation	FL_INV_PAIN_THERPY_SPINC_STIM
Intradiscal electrothermal therapy	FL_INV_PAIN_THERPY_IDET
Trigger point injection(s)	FL_INV_PAIN_THERPY_TPI
Radiofrequency therapy	FL_INV_PAIN_THERPY_RFREQ
Cryodenervation of facets	FL_INV_PAIN_THERPY_CRYO
Alcohol denervation of facets	FL_INV_PAIN_THERPY_ALC
Neural therapy	FL_INV_PAIN_THERPY_NEURAL
Mesotherapy	FL_INV_PAIN_THERPY_MESO
Ilio-sacral joint infiltration	FL_INV_PAIN_THERPY_ISJ
Other	FL_INV_PAIN_THERPY_OTH

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureType

Nested option fields

When FL_INV_PAIN_THERPY_OTH Is selected:
text
Specify
Technical specs
CSV column name:
CD_INV_PAIN_THERPY|CD_INV_PAIN_THERPY_SPEC|TX_INV_PAIN_THERPY_OTH
Length:
100
Required:
true
Mapping of the clinical building blocks (indicative only)
Concept:
be.en.hd.Procedure
Data element:
ProcedureType

number

Invasive therapy sessions

Technical specs

CSV column name:

MS_INV_THERPY_SESSN

Only when:

Required:

true

6 End of therapy

date

End of therapy

Technical specs

Format:

DD/MM/YYYY

CSV column name:

DT_END_THERPY

Required:

true

Mapping of the clinical building blocks (indicative only)

Concept:

be.en.hd.Procedure

Data element:

ProcedureEndDate

Validation

The end of therapy cannot be in the future (error)
The date of birth cannot be after the end of therapy (error)
The end of therapy cannot be after the date of death (error)

number

Number of sessions received

Technical specs

CSV column name:

MS_SESSN_RECEIVD

Required:

true

choice

Completed conservative treatment

Technical specs

CSV column name:

CD_COMPL_TREAT

Required:

true

Options

Label	Value
Yes	1
No	0

multichoice

Reason for non-completion of treatment

Technical specs

CSV column name:

CD_REAS_NON_TREAT

Only when:

Required:

true

Options

Label	Value
Unknown	FL_REAS_NON_TREAT_UNK
Work	FL_REAS_NON_TREAT_WRK
Medical	FL_REAS_NON_TREAT_MED
Personal	FL_REAS_NON_TREAT_PERS
Insurance	FL_REAS_NON_TREAT_INSUR
Onward referral - spinal surgery	FL_REAS_NON_TREAT_SPIN
Onward referral - other discipline	FL_REAS_NON_TREAT_DISCIP
Other	FL_REAS_NON_TREAT_OTH

Nested option fields

When FL_REAS_NON_TREAT_OTH Is selected:
text
Specify other reason for non-completion of treatment
Technical specs
CSV column name:
CD_REAS_NON_TREAT|TX_REAS_NON_TREAT_OTH
Length:
100
Required:
true

questionnaire

Therapeutic goals

Technical specs

Only when:

Required:

false

Questions

Label	CSV column name
Axial pain relief	CD_THERPC_GOA_END_APR
Peripheral pain relief	CD_THERPC_GOA_END_PPR
Functional improvement	CD_THERPC_GOA_END_FUNC
Motor improvement	CD_THERPC_GOA_END_MOTOR
Sensory improvement	CD_THERPC_GOA_END_SENSO
Bowel/bladder improvement	CD_THERPC_GOA_END_BB
Cosmetic improvement	CD_THERPC_GOA_END_COSM
Spinal stabilisation	CD_THERPC_GOA_END_STABLZTN
Stop deformity progression	CD_THERPC_GOA_END_STP_DEFRMY
Deformity correction (supported by imaging)	CD_THERPC_GOA_END_DEFRMY_CORRN
Diagnostic measures	CD_THERPC_GOA_END_DIAG_MEASRS
Other	CD_THERPC_GOA_END_OTH

Answers

Label	Value
Goal achieved	1
Goal partially achieved	2
Goal not achieved	3

text

Specify other therapeutic goal

Technical specs

CSV column name:

TX_THERPC_GOA_END_OTH

Only when:

Required:

true

choice

Work status

Technical specs

CSV column name:

CD_WRK_STA_END

Required:

true

Options

Label	Value
Unchanged	1
Changed	2

choice

Work status changed to

Technical specs

CSV column name:

CD_WRK_STA_CHNG_END

Only when:

Required:

true

Options

Label	Value
Looking for work	1
Commenced work/returned to work	2
Increased work/studies/household duties	3
Reduced work/studies/household duties	4
Stopped work/studies/household duties	5
Other	6

Nested option fields

When 6 Is selected:
text
Specify other work status
Technical specs
CSV column name:
CD_WRK_STA_CHNG_END|TX_WRK_STA_CHNG_END_OTH
Required:
true

choice

Analgesic medication

Technical specs

CSV column name:

CD_ANALGS_MEDICT

Required:

true

Options

Label	Value
Unchanged	1
Changed	2

questionnaire

Changes in analgesic medication

Technical specs

Only when:

Required:

false

Validation

This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy . (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
This medication was not entered before start of therapy (error)
Analgesic medication ticked at start of therapy has now been ticked as “Not applicable”. Please verify. (error)

Questions

Label	CSV column name
Paracetamol	CD_CHNG_MEDICT_APAP
NSAIDs	CD_CHNG_MEDICT_NSAID
Weak opioids	CD_CHNG_MEDICT_WOPI
Strong opioids	CD_CHNG_MEDICT_SOPI
SSRIs	CD_CHNG_MEDICT_SSRI
SNRIs	CD_CHNG_MEDICT_SNRI
Tricyclic antidepressants	CD_CHNG_MEDICT_TCAD
Anxiolytics	CD_CHNG_MEDICT_ANXLT
Anticonvulsants	CD_CHNG_MEDICT_ACV
Neuroleptics	CD_CHNG_MEDICT_NEUROLEPC
Other	CD_CHNG_MEDICT_OTH

Answers

Label	Value
Increased dosage or introduced medication	1
Continued medication (unchanged)	2
Reduced dosage	3
Stopped medication	4
Not applicable	5

text

Specify other analgesic medication

Technical specs

CSV column name:

TX_CHNG_MEDICT_OTH

Only when:

Required:

true

choice

Adverse events related to therapy

Technical specs

CSV column name:

CD_AE_THERPY

Required:

true

Options

Label	Value
Yes	1
No	0

questionnaire

Adverse events

Technical specs

Only when:

Required:

false

Questions

Label	CSV column name
Increased pain (resolved)	CD_AE_PAIN_RESOLV
Increased pain (continuing)	CD_AE_PAIN_CONTNG
Neurological deficit	CD_AE_ND
Infection	CD_AE_INFCT
Other	CD_AE_OTH

Answers

Label	Value
Attributed to unknown	1
Attributed to medication	2
Attributed to non-invasive therapy	3
Attributed to invasive therapy	4
Not applicable	5

text

Specify other adverse events

Technical specs

CSV column name:

TX_AE_OTH

Only when:

Required:

true

Spine Tango form for conservative treatment (Spine Tango Conservative treatment)

1 Patient identification

National registry ID

Help

Technical specs

Mapping of the clinical building blocks (indicative only)

Validation

Fields

Section help

Internal patient ID

Help

Technical specs

Generated

Help

Technical specs

Options

Name

Help

Technical specs

Mapping of the clinical building blocks (indicative only)

First name

Help

Technical specs

Mapping of the clinical building blocks (indicative only)

Date of birth

Technical specs

Mapping of the clinical building blocks (indicative only)

Validation

Sex

Technical specs

Options

Mapping of the clinical building blocks (indicative only)

Place of residence

Technical specs

Mapping of the clinical building blocks (indicative only)

Deceased?

Technical specs

Mapping of the clinical building blocks (indicative only)

Options

Date of death

Technical specs

Mapping of the clinical building blocks (indicative only)

Validation

2 Caregiver

RIZIV/INAMI-code of the treating physician

Technical specs

Mapping of the clinical building blocks (indicative only)

3 Admission / pathology

Admission date

Technical specs

Mapping of the clinical building blocks (indicative only)

Region of main condition

Technical specs

Options

Nested option fields

Specify other region of main condition

Technical specs

Symptoms

Technical specs

Options

Nested option fields

Specify other symptoms

Technical specs

Duration of symptoms

Technical specs

Options

Diagnosis supported by

Technical specs

Options

Nested option fields

Please specify

Technical specs

Main condition (supported by imaging/labs/other tests)

Technical specs

Options

Mapping of the clinical building blocks (indicative only)

Nested option fields

Specify other main condition (supported by imaging/labs/other tests)

Technical specs

Main condition (supported by history/clinical evaluation only)