Form Structure: Craig Handicap and Assessment Reporting Technique (CHART-SF)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Craig Handicap and Assessment Reporting Technique (CHART-SF)
Short Name:
CHARTSF
Description:
Craig Handicap and Assessment Reporting Technique paper and Interview forms (CHART-SF) provide a simple, objective measure of the degree to which impairments and disabilities result in handicaps in the years after initial rehabilitation. Six subscales: physical independence; cognitive independence; mobility; occupation; social integration; economic self-sufficiency.This form structure was built based on CDISC terminology. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2014-08-25
Owner:
Number of Data Elements:
42
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.
Form Administration (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
2 | 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 |
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 |
Form Completion (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Paid physical assistance hour value | Number of paid physical assistance hours the subject receives in a typical day, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFPaidPhysAssstncHrVal | Recommended | CDE |
2 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Unpaid physical assistance hour value | Number of unpaid physical assistance hours the subjects needs in a typical day, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFUnpdPhysAssstncHrVal | Recommended | CDE |
3 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Home activities assistance indicator | Indicator of assistance the subject receives in the subject's home with activities, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFHmActAssstncInd | Recommended | CDE |
4 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Outside activities assistance indicator | Indicator of assistance the subject receives outside of the subject's home with activities, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFOutsdActAssstncInd | Recommended | CDE |
5 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Off bed day hour value | Number of hours the subject spends out of bed on a typical day, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFOffBdDyHrVal | Recommended | CDE |
6 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Outside week day value | Number of days the subject spends out of the house and go somewhere, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFOutsdWkDyVal | Recommended | CDE |
7 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Outside year night indicator | Indicator of how many days the subject spent away from home, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFOutsdYrNgtInd | Recommended | CDE |
8 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Paid job week hour value | Number of hours the subject spends working in a paid job per week, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFPaidJbWkHrVal | Recommended | CDE |
9 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Paid job occupation text | Text of paid occupation the subject has, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFPaidJbOccptnTxt | Recommended | CDE |
10 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Academic program week hour value | Number of hours the subject spends in school for a degree or other technical training program per week, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFAcadmcProgrmWkHrVal | Recommended | CDE |
11 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Home making week hour value | Number of hours the subject spends for home making activities per week, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFHmMkngHrVal | Recommended | CDE |
12 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Home improvement week hour value | Number of hours the subject spends for home maintenance activities per week, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFHmImprvmntWkHrVal | Recommended | CDE |
13 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Recreational activities week hour value | Number of hours the subject spends for recreational activities per week, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFRecrtnlActWkHrVal | Recommended | CDE |
14 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - People living with subject value | Number of people the subject lives with, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFPplLvngSubVal | Recommended | CDE |
15 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Spouse significant other indicator | Indicator of if the subject lives with spouse or significant other, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFSpseSignfcntOthrInd | Recommended | CDE |
16 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Living with relatives value | Number of relatives the subject lives with, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFLvngWthReltvVal | Recommended | CDE |
17 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Business associate visit month value | Number of business or organizational associates the subject visits per month, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFBusnssAssctVstMoVal | Recommended | CDE |
18 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Friends visit month value | Number of friends the subject visits per month, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFFrndVstMoVal | Recommended | CDE |
19 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Strangers conversation month indicator | Indicator of how often the subject spoke to strangers in the last month, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFStrngrConvstnMoInd | Recommended | CDE |
20 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Combined family income indicator | Indicator of subject and the subject's family combined income in the last year, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFCombndFmlyIncInd | Recommended | CDE |
21 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Unreimbursed medical care expenses indicator | Indicator of how much money the subject spent for medical care expenses last year and did not get reimbursed for, as part of the Craig Handicap and Assessment Reporting Technique (CHART-SF) | CHARTSFReimbrsdMedCrExpnsInd | Recommended | CDE |
Scores (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Mobility Score | Total mobility score (0-100) | CHARTSFMobilityScore | Recommended | CDE |
2 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Physical Independence Score | Total physical independence score (0-100) | CHARTSFPhysIndependScore | Recommended | CDE |
3 | Craig Handicap and Assessment Reporting Technique (CHART-SF) - Cognitive Independence Score | Total cognitive independence score (0-100) | CHARTSFCogIndependScore | Recommended | CDE |
4 | Craig Handicap and Assessment Reporting Technique (CHART-SF) -Occupation Score | Total occupation score (0-100) | CHARTSFOccupScore | Recommended | CDE |
5 | Craig Handicap and Assessment Reporting Technique (CHART-SF) -Economic Self Sufficiency Score | Total economic self-sufficiency score (0-100) | CHARTSFEconSelfSufficScore | Recommended | CDE |
6 | Craig Handicap and Assessment Reporting Technique (CHART-SF) -Social Integration Score | Total social integration score (0-100) | CHARTSFSocialIntgratnScore | Recommended | CDE |
Keywords