Form Structure: European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L)
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L)
Short Name:
EQ5D5L
Description:
The EQ-5D-5L consists of 6 items that measure aspects of quality of life.
Disease:
Traumatic Brain Injury
Organization:
University of Washington
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-04-01
Version:
1.0
Date Created:
2015-03-26
Owner:
Number of Data Elements:
18
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 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 5 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 6 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 7 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 8 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 2 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 3 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 4 | 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 |
EQ-5D-5L (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Mobility category | Category determining the extent to which the participant has problems with mobility, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). | EQ5D5LMobilityCat | Recommended | CDE |
| 2 | European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Self-care category | Category determining the extent to which the participant has problems with self-care, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). | EQ5D5LSelfCareCat | Recommended | CDE |
| 3 | European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Usual activities category | Category determining the extent to which the participants has problems with usual activities (e.g. work, study, housework, family or leisure activities), as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). | EQ5D5LUsualActivitiesCat | Recommended | CDE |
| 4 | European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Pain discomfort category | Category determining the extent to which the participant has problems with pain or discomfort category, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). | EQ5D5LPainDiscomfortCat | Recommended | CDE |
| 5 | European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Anxiety depression category | Category determining the extent to which the participant has problems with anxiety or depression category, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). | EQ5D5LAnxietyDepressionCat | Recommended | CDE |
| 6 | European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Health today scale | Scale of how good or bad the participant's health is today, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). | EQ5D5LHealthTodayScl | Recommended | CDE |
Keywords
