Canadian Community Health Survey (CCHS) - Rapid Response - Traumatic Brain Injury
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
Traumatic Brain Injury (TBI)
Traumatic Brain Injury (TBI) - Question identifier:TBI_R001
The next set of questions are about concussions. A concussion is a type of traumatic brain injury that is caused by a fall, a blow to the head or body, or another injury that jars or shakes the brain inside the skull.
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q005
In 2019, did you have a concussion?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q010
In 2019, how many concussions did you have that were diagnosed by a medical doctor or nurse practitioner?
Min = 0; Max = 95
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q015
Excluding concussions diagnosed by a medical doctor or nurse practitioner, in 2019 how many other concussions did you have that were identified by a professional such as a physiotherapist, chiropractor, or sports coach?
Min = 0; Max = 95
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q020
For your [most serious] [diagnosed / identified / diagnosed or identified] concussion, were you given any of the following health information?
- 1: Common signs and symptoms of concussions
- 2: Signs and symptoms to help seek urgent follow-up
- 3: Information about anticipated recovery
- 4: Lifestyle advice to assist the recovery
- 5: Other information
- 6: No information
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q025
[Excluding concussions already mentioned], in 2019 how many suspected or self-diagnosed concussions did you have?
Min = 0; Max = 95
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q030
For your [most serious] suspected or self-diagnosed concussion, why did you not go to a medical doctor or nurse practitioner?
- 1: Had a concussion in the past - knew what to do
- 2: Not serious enough
- 3: Did not want to miss school or work
- 4: Did not want to miss sports (present, future)
- 5: No access to regular health care provider
- 6: Other reason
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q035
Thinking about your [most serious] concussion in 2019, where were you when you were injured? For example, someone's house, an office building, or construction site.
- 1: In a home or its surrounding area (including respondent's home or other homes)
- 2: School, college, university (including sports areas)
- 3: Other sports or athletics area (excluding school sports areas)
- 4: Street, highway, sidewalk, including a motor vehicle
- 5: Workplace
- 6: Other
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q040
What were you doing when your [most serious] concussion occurred?
- 01: Riding a bike
- 02: Sports or physical activity, excluding riding a bike
- 03: Household chores, outdoor yard maintenance or unpaid work
- 04: Riding or driving a motor vehicle, including off-road vehicles
- 05: Working at a paid job or business, excluding when driving is your job
- 06: Being assaulted or victimized
- 07: Slip or fall without being struck or pushed
- 08: Other
- 98: RF
- 99: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q045
What sport or physical activity were you doing?
- 1: Hockey
- 2: Football
- 3: Skating
- 4: Rugby
- 5: Soccer
- 6: Skiing or snowboarding
- 7: Other
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q050
Was there a contact between you and ...?
- 1: Another person
- 2: The ground
- 3: Sport-related object (e.g. a ball, stick, board or net)
- 4: Non-activity-related object (e.g. benches, bleachers, or tree)
- 5: Something else
- 6: No contact
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q055
Are you currently experiencing any signs or symptoms of your [most serious] concussion that you had in 2019?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q060
How long have you been experiencing these concussion symptoms? Please provide your answer in months.
Min = 0; Max = 24
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q065
How long did it take for all of your symptoms to completely go away?
Min = 0; Max = 999
Traumatic Brain Injury (TBI) - Question identifier:TBI_N065A
Was this time in days, weeks or months?
- 1: Days
- 2: Weeks
- 3: Months
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q070
Have you fully returned to your regular activities?
- 1: Yes
- 2: No
- 8: RF
- 9: DK
Traumatic Brain Injury (TBI) - Question identifier:TBI_Q075
Have you been cleared by a doctor or nurse practitioner to return to some or all of your regular activities?
- 1: Yes, all
- 2: Yes, some
- 3: No
- 8: RF
- 9: DK
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