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Form Structure: Health and Behavior Inventory (HBI) Child Version

This form structure is an organized set of data definitions for a copyrighted form
Title:
Health and Behavior Inventory (HBI) Child Version
Short Name:
HBI_Child_FITBIR
Description:
The HBI consists of 20 items that measure the frequency of post-concussive symptoms. There are three versions of the inventory - Child, Parent Current Version and Parent Retrospective Version. The Parent Retrospective Version is used for rating pre-injury symptoms retrospectively.
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-01-28
Version:
1.0
Date Created:
2015-01-23
Owner:
Number of Data Elements:
34
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.

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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

HBI Child (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Health and Behavior Inventory (HBI) - child trouble paying attention scale  How often participant/subject has trouble paying attention during the last week HBIChldTroubPayAttnScale Optional CDE
2 Health and Behavior Inventory (HBI) - child distract easily scale  How often participant/subject gets distracted easily during the last week HBIChldDistrctEsyScale Optional CDE
3 Health and Behavior Inventory (HBI) - child concentration difficulty scale  How often participant/subject has a hard time concentrating during the last week HBIChldConcenDffcltyScale Optional CDE
4 Health and Behavior Inventory (HBI) - child memory problem scale  How often participant/subject has problems remembering things people tell during the last week HBIChldMemProbScale Optional CDE
5 Health and Behavior Inventory (HBI) - child direction problem scale  How often participant/subject has problems following directions during the last week HBIChldDirProbScale Optional CDE
6 Health and Behavior Inventory (HBI) - child daydream scale  How often participant/subject daydreams too much during the last week HBIChldDaydrmScale Optional CDE
7 Health and Behavior Inventory (HBI) - child confusion scale  How often participant/subject gets confused during the last week HBIChldConfusScale Optional CDE
8 Health and Behavior Inventory (HBI) - child forget scale  How often participant/subject forgets things during the last week HBIChldForgtScale Optional CDE
9 Health and Behavior Inventory (HBI) - child finish problem scale  How often participant/subject has problems finishing things during the last week HBIChldFinshProbScale Optional CDE
10 Health and Behavior Inventory (HBI) - child determine thing trouble scale  How often participant/subject has trouble figuring things out during the last week HBIChldDetermThngTroubScale Optional CDE
11 Health and Behavior Inventory (HBI) - child learn new thing difficulty scale  How often it is hard for participant/subject to learn new things during the last week HBIChldLrnNewThngDffcltyScale Optional CDE
12 Health and Behavior Inventory (HBI) - child headache frequency scale  How often participant/subject has headaches during the last week HBIChldHeadachFreqScale Optional CDE
13 Health and Behavior Inventory (HBI) - child dizziness scale  How often participant/subject feels dizzy during the last week HBIChldDizScale Optional CDE
14 Health and Behavior Inventory (HBI) - child room spinning scale  How often participant/subject feels like the room is spinning during the last week HBIChldRoomSpinScale Optional CDE
15 Health and Behavior Inventory (HBI) - child faint scale  How often participant/subject feels like he/she is going to faint during the last week HBIChldFntScale Optional CDE
16 Health and Behavior Inventory (HBI) - child blurry scale  How often things look blurry to participant/subject during the last week HBIChldBlryScale Optional CDE
17 Health and Behavior Inventory (HBI) - child see double scale  How often participant/subject sees double during the last week HBIChldSeeDblScale Optional CDE
18 Health and Behavior Inventory (HBI) - child stomach sickness scale  How often participant/subject feels sick to the stomach during the last week HBIChldStmchSickScale Optional CDE
19 Health and Behavior Inventory (HBI) - child tired scale  How often participant/subject feels tired a lot during the last week HBIChldTrdScale Optional CDE
20 Health and Behavior Inventory (HBI) - child tired easily scale  How often participant/subject gets tired easily during the last week HBITChldTrdEslyScale Optional CDE
21 Health and Behavior Inventory (HBI) - child version cognitive total score  Sum of cognitive items 1-11 (0-33) HBICVCognitvTotalScore Optional CDE
22 Health and Behavior Inventory (HBI) - child version somatic total score  Sum of somatic items 12-20 (0-27) HBICVSomatTotalScore Optional CDE
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