"Evoked Outcome Assessment (Neurop_SLR)"
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<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">0. Evoked Outcome assessment procedure label? </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">mechanical</option> <option value="2">heat</option> <option value="3">cold</option> <option value="4">movement</option> </select> <span class="help-block">Provide a label to uniquely identify an outcome assessment procedure within the study </span> </select><!-- Text input--> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">1. Outcome measure average type </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Mean</option> <option value="2">Median</option> <option value="">others</option> </select> <span class="help-block">Select the average type for this outcome measure. </span> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">2. Outcome measure error type </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">SD</option> <option value="2">SEM</option> <option value="">95%CI</option> </select> <span class="help-block">Select the error type for this outcome measure. </span> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">3. Outcome measure units </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">gr</option> <option value="2">mN</option> <option value="3">latency time (s)</option> <option value="4">°C</option> <option value="5">Ratio</option> </select> <span class="help-block">Select the units used for this outcome. </span> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">4. Outcome measure error type </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">SD</option> <option value="2">SEM</option> <option value="3">95%CI</option> </select> <span class="help-block">Select the error type for this outcome measure. </span> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">0a. Which method is used for mechanical behavior assessment? (If mechanical was selected) </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">von Frey (manuel)</option> <option value="2">von Frey (electronic)</option> <option value="3">Pin Prick</option> <option value="4">Randall-Selitto</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">0b. Specify the mechanical stimulus</label> <div class="col-md-4"> <input id="textinput" name="textinput" type="text" placeholder=" " class="form-control input-md"> <span class="help-block">Copy and paste description from the text </span> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">5. Where was the stimulus attached to the paw? </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Plantar</option> <option value="2">Medial</option> <option value="3">Lateral</option> <option value="4">Other</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">6. How was the response to the stimuli assessed? </label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">Withdrawal</option> <option value="2">Withdrawal, video based</option> <option value="3">Oberservation animal response (s)</option> <option value="4">Score</option> <option value="5">Response</option> <option value="6">Response Number</option> <option value="7">Nocifensive</option> <option value="8">Not reported</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="textinput">7. What was the habituation time prior the test?</label> <div class="col-md-4"> <input id="textinput" name="textinput" type="text" placeholder=" " class="form-control input-md"> <span class="help-block">give in min</span> </div> </div> <!-- Multiple Radios --> <div class="form-group"> <label class="col-md-4 control-label" for="radios">8. What sex was the experimenter?</label> <div class="col-md-4"> <div class="radio"> <label for="radios-0"> <input type="radio" name="radios" id="radios-0" value="1" checked="checked"> Female </label> </div> <div class="radio"> <label for="radios-1"> <input type="radio" name="radios" id="radios-1" value="2"> Male </label> </div> <div class="radio"> <label for="radios-2"> <input type="radio" name="radios" id="radios-2" value="3"> Not reported </label> </div> </div> </div>

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