Form Structure: JFK Coma Recovery Scale- Revised (CRS-R)
This form structure is an organized set of data definitions for a copyrighted form
Title:
JFK Coma Recovery Scale- Revised (CRS-R)
Short Name:
JKFCRSR
Description:
The CRS-R consists of twenty-three items comprising six hierarchically-arranged subscales addressing auditory, visual, motor, oromotor/verbal, communication and arousal functions. The lowest item on each subscale represents reflexive activity while the highest items represent cognitively-mediated behaviors. CDISC (TAUG TBI)
References: Arch Phys Med Rehabil. 2004 Dec;85(12):2020-9. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Giacino JT1, Kalmar K, Whyte J. https://www.ncbi.nlm.nih.gov/pubmed/15605342
Copyright 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Recommended by CDISC for TBI.
Disease:
General (For all diseases)
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-28
Version:
1.2
Date Created:
2016-04-07
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.
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 |
JFK CRS-Revised Visit Detail (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | JFK Coma Recovery Scale - Revised (JFK CRS-R) - Consciousness Diagnosis Criteria Category | Category for Consciousness Diagnosis criteria, as a part of JFK Coma Recovery Scale - Revised (JFK CRS-R) | ConscDiganosisCriteriaCat | Recommended | UDE |
| 2 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Etiology text | Text for Etiology related to specific condition, as a part of JFK Coma Recovery Scale - Revised (JFK CRS-R) | EtiologyTxt | Recommended | CDE |
| 3 | Symptom onset date and time | Date (and time, if applicable and known) reported for onset of participant's/subject's symptoms | SymptmOnsetDateTime | Recommended | CDE |
| 4 | Hospital admission date and time | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | HospitlAdmissDateTime | Recommended | CDE |
| 5 | Data collected date and time | Data collected date and time | DataCollDateTime | Recommended | CDE |
JFK Coma Recovery Scale-Revised (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Auditory function scale score | Score on the auditory function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). | JFKCRSRAdtyFuncScaleScore | Recommended | CDE |
| 2 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Visual function scale score | Score on the visual function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). | JFKCRSRVislFuncScaleScore | Recommended | CDE |
| 3 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Motor function scale score | Score on the motor function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). | JFKCRSRMotrFuncScaleScore | Recommended | CDE |
| 4 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Oromotor verbal function scale score | Score on the oromotor verbal function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). | JFKCRSROrmtrVerbFuncScaleScore | Recommended | CDE |
| 5 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Communication scale score | Score on the communication scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). | JFKCRSRCommScaleScore | Recommended | CDE |
| 6 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Arousal scale score | Score on the arousal scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). | JFKCRSRArousalScaleScore | Recommended | CDE |
| 7 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Total score | Total Score - Sum of 6 scales (0-23), as part of JFK Coma Recovery Scale Revised (JFK CRS-R). | JFKCRSRTotalScore | Recommended | CDE |
Assessment of Contingent Behavior (Supplementary item) (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Target behavior text | Text for target behavior noted in the assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) | JFKCRSRAsmtConTargtBehaviorTxt | Recommended | CDE |
| 2 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Spontaneous occurences of target behavior number | Number of spontanoeus occurences of target behavior in the assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) | JFKCRSRAsmtConSpontanOccrncNum | Recommended | CDE |
| 3 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Contingent eliciting stimulus text | Text for eliciting stimulus in the assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) | JFKCRSRAsmtConBehElictStimlTxt | Recommended | CDE |
| 4 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Occurences of target behavior within 10 sec of eliciting stimulus | Number of occurences of target behavior within 10 sec of eliciting stimulus in assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) | JFKCRSRAsmtConOccrWthn10SecNum | Recommended | CDE |
| 5 | JFK Coma Recovery Scale Revised (JFK CRS-R) - Spontaneous occurences of target behavior time duration | Time duration for the spontaneous occurences of target behavior noted in assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) | JFKCRSRAsmtConSpontanOccTimDur | Recommended | CDE |
Keywords
