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Form Structure: Brief Pain Inventory (Short Form)

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Brief Pain Inventory (Short Form)
Short Name:
BPISF
Description:
One of the most widely used measurement tools for assessing clinical pain; shown to be an appropriate measure for pain caused by a wide range of clinical conditions. Cleeland, Charles S., and K. M. Ryan. "The Brief Pain Inventory." Available online: https://www. mdanderson. org/education-andresearch/departments-programs-and-labs/departments-and-divisions/symptom-research/symptomassessment-tools/BPI_UserGuide. pdf (accessed on 1 March 2016) (1994).
Disease:
General (For all diseases) Parkinson's Disease Multiple Sclerosis
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-06-29
Version:
1.0
Date Created:
2017-06-02
Owner:
Number of Data Elements:
32
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study. CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

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Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
2 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

Brief Pain Inventory Short Form (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Brief Pain Inventory (BPI) - other pain indicator  Indicates if the subject had pain other than everyday kinds of pain, as part of the Brief Pain Inventory (BPI) form. BPIOthrPainInd Optional CDE
2 Brief Pain Inventory (BPI) - pain area indicator  On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most, as part of the Brief Pain Inventory (BPI) form. BPIPainAreaInd Optional CDE
3 Brief Pain Inventory (BPI) - worst pain rating scale  Scale indicating the rating of the worst pain, as part of the Brief Pain Inventory (BPI) form. BPIWrstPainRtngScale Optional CDE
4 Brief Pain Inventory (BPI) - least pain rating scale  Scale indicating the rating of the least pain experienced by the subject, as part of the Brief Pain Inventory (BPI) form. BPILstPainRtngScale Optional CDE
5 Brief Pain Inventory (BPI) - average pain rating scale  Scale indicating the rating of the average pain experienced by the subject, as part of the Brief Pain Inventory (BPI) form. BPIAvgPainRtngScale Optional CDE
6 Brief Pain Inventory (BPI) - current pain rating scale  Scale rating the pain the subject is feeling right now, as part of the Brief Pain Inventory (BPI) form. BPICurntPainRtngScale Optional CDE
7 Brief Pain Inventory (BPI) - treatment received text  Text of treatment/medication subject receives for the pain. BPITreatmtRecvdTxt Optional CDE
8 Brief Pain Inventory (BPI) - relief received percentage number  Indicates the relief received from medication use, as part of the Brief Pain Inventory (BPI) form. BPIRelfRecvdPctNum Optional CDE
9 Brief Pain Inventory (BPI) - pain general activity interference scale  Scale assessing how much the pain has interfered with general activity, as part of the Brief Pain Inventory (BPI) form. BPIPainGenrlActIntfrrnScale Optional CDE
10 Brief Pain Inventory (BPI) - pain mood interference scale  Scale assessing how much the pain has interfered with mood, as part of the Brief Pain Inventory (BPI) form. BPIPainMdIntfrrncScale Optional CDE
11 Brief Pain Inventory (BPI) - pain walking ability interference scale  Scale assessing how much the pain has interfered with walking ability, as part of the Brief Pain Inventory (BPI) form. BPIPainWlkngAblIntfrrncScale Optional CDE
12 Brief Pain Inventory (BPI) - pain normal work interference scale  Scale assessing how much the pain has interfered with normal work, as part of the Brief Pain Inventory (BPI) form. BPIPainNormWrkIntfrrncScale Optional CDE
13 Brief Pain Inventory (BPI) - pain relations interference indicator  Scale assessing how much the pain has interfered with relations with other people, as part of the Brief Pain Inventory (BPI) form. BPIPainRelateIntfrrnScale Optional CDE
14 Brief Pain Inventory (BPI) - pain sleep interference scale  Scale assessing how much the pain has interfered with sleep, as part of the Brief Pain Inventory (BPI) form. BPIPainSlpIntfrrnScale Optional CDE
15 Brief Pain Inventory (BPI) - pain enjoyment interference scale  Scale assessing how much the pain has interfered with enjoyment of life, as part of the Brief Pain Inventory (BPI) form. BPIPainEnjmntIntfrrncScale Optional CDE

Brief Pain Inventory SF Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Brief Pain Inventory -Pain severity mean score  Score for mean pain severity, as a part of the Brief Pain Inventory BPIPainSeverityMeanScore Recommended UDE
2 Brief Pain Inventory -Pain average pain interference score  Score for average pain interference, as a part of the Brief Pain Inventory BPIAvPainInterferenceScore Recommended UDE
Keywords