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Form Structure: NIH Toolbox Motor Domain 2-Minute Walk Endurance Test

This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH Toolbox Motor Domain 2-Minute Walk Endurance Test
Short Name:
NIHTB2MinWalkEnduranceTest
Description:
Motor Domain:The NIH Toolbox 2-Minute Walk Endurance Test is adapted from the American Thoracic Society’s 6-Minute Walk Test Protocol. This test measures sub-maximal cardiovascular endurance by recording the distance that the participant is able to walk on a 50-foot (out and back) course in two minutes. The participant’s raw score is the distance in feet and inches walked in two minutes. The test overall takes approximately four minutes to administer (with instructions and practice). This test is recommended for ages 3-85. This test is part of the NIH Toolbox Motor Domain Endurance Measure. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-05-31
Owner:
Number of Data Elements:
37
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 (Repeat Infinitely)

# 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

NIH Toolbox Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox - Test domain battery type  Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox NIHTBTestDomainBattryTyp Recommended CDE
2 NIH Toolbox - Test domain battery type other  The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox NIHTBTestDomainBatteryTypOTH Recommended CDE
3 NIH Toolbox - Test name type  Type of NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestNameTyp Recommended CDE
4 NIH Toolbox - Test name type other  The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox NIHTBAdminTestNameTypOTH Recommended CDE
5 NIH Toolbox - Test administration language type  Type of language for test being administrated, as part of the NIH Toolbox NIHTBTestAdminLanguageTyp Recommended CDE
6 NIH Toolbox - Test administration language type other  Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox NIHTBTestAdminLanguageTypOTH Recommended CDE
7 NIH Toolbox - Form administered type  Type of NIH Toolbox form being administered, as part of the NIH Toolbox NIHTBFormAdminTyp Recommended CDE
8 NIH Toolbox - Test administration flag type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE
9 NIH Toolbox - Test administration flag indicator  Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagInd Recommended CDE

NIH Toolbox 2-Minute Walk Endurance Test (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - Turns count  Count of turns, as part of the NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test NIHTB2MWETurnCt Recommended CDE
2 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - Additional 10ft mark(s) count  Count of additional number of 10ft marks, as part of the NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test NIHTB2MWEAdd10FtMarkCt Recommended CDE
3 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - Additional feet count  Count of additional feet, as part of the NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test NIHTB2MWEAddFtCt Recommended CDE
4 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - Additional inches count  Count of additional inches, as part of the NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test NIHTB2MWEAddInchCt Recommended CDE
5 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - Participant stopped indicator  Indicator that participant stopped, as part of the NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test NIHTB2MWEStopInd Recommended CDE
6 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - First stop time  Time that participant first stopped, as part of the NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test NIHTB2MWEFirstStopTime Recommended CDE
7 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - Unable to complete indicator  Indicator that participant was unable to complete the test, as part of the NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test NIHTB2MWEUnablCompleteInd Recommended CDE

NIH Toolbox 2-Minute Walk Endurance Test Scoring (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Motor Domain Endurance Measure 2-Minute Walk Endurance Test - Raw score  Raw score of the distance that the participant is able to walk on a 50-foot course in two minutes NIHTB2MWERawScore Recommended CDE
2 NIH Toolbox Performance Measures (web and CAT) - Age-adjusted scale score  Age-adjusted scale score, as part of the NIH Toolbox Performance Measures (web and CAT) NIHTBPMAgeAdjSclScore Recommended CDE
3 NIH Toolbox Performance Measures - Age-adjusted national percentile value  Value of age-adjusted national percentile, as part of the NIH Toolbox Performance Measures NIHTBPMAgeAdjNationalPctVal Recommended CDE
4 NIH Toolbox Performance Measures - Fully-adjusted scale score  Fully-adjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMFullyAdjSclScore Recommended CDE
5 NIH Toolbox Performance Measures (web and CAT) - Unadjusted scale score  Unadjusted scale score, as part of the NIH Toolbox Performance Measures (web and CAT) NIHTBPMUnadjSclScore Recommended CDE
6 NIH Toolbox - Standard error  Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox Web, Cat and iPad Cognition measures such as: Picture Vocabulary Test and Oral Reading Recognition Test. NIHTBStandardError Optional CDE
Keywords

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