Form Structure: NIH Toolbox Motor Domain 4-Meter Walk Gait Speed Test
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
NIH Toolbox Motor Domain 4-Meter Walk Gait Speed Test
Short Name:
NIHTB4MtrWlkGtSpeedTest
Description:
Motor Domain: The NIH Toolbox 4-Meter Walk Gait Speed Test is adapted from the 4-meter walk test in the Short Physical Performance Battery. Participants are asked to walk a short distance (four meters) at their usual pace. Participants complete one practice and then two timed trials. Raw scores are recorded as the time in seconds required to walk four meters on each of the two trials, with the better trial used for scoring. The test takes approximately three minutes to administer (including instructions and practice). This test is recommended for ages 7-85. This test is part of the NIH Toolbox Motor Domain Locomotion Measure.
Disease:
Traumatic Brain Injury
Organization:
BRICS/CIT/NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-07-01
Version:
1.0
Date Created:
2016-04-07
Owner:
Number of Data Elements:
29
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 (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 |
NIH Toolbox Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox - Test name type | Type of NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestNameTyp | Recommended | CDE |
| 2 | NIH Toolbox - Test name type other | The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox | NIHTBAdminTestNameTypOTH | Recommended | CDE |
| 3 | NIH Toolbox - Test administration language type | Type of language for test being administrated, as part of the NIH Toolbox | NIHTBTestAdminLanguageTyp | Recommended | CDE |
| 4 | NIH Toolbox - Test administration language type other | Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox | NIHTBTestAdminLanguageTypOTH | Recommended | CDE |
| 5 |
NIH Toolbox - Test domain battery type
(Retired) |
Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox | NIHTBTestDomainBatteryTyp | Recommended | CDE |
| 6 | 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 |
| 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 4-Meter Walk Gait Speed Test (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 2 | NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Trial 1 completion time duration | Duration of time to complete Trial 1, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test | NIHTB4MWGSTrial1CompletnDur | Recommended | CDE |
| 3 | NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Trial 2 completion time duration | Duration of time to complete Trial 2, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test | NIHTB4MWGSTrial2CompletnDur | Recommended | CDE |
| 4 | NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Unable to complete test indicator | Indicator that subject was unable to complete the test, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test | NIHTB4MWGSUnableCompleteInd | Recommended | CDE |
| 5 | NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Best trial raw completion duration | Duration of trial with best raw completion time, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test | NIHTB4MWGSBtTrialRawCompletDur | Recommended | CDE |
| 6 | NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Best trial computed score | Computed score (in meters per second) for trial with best completion time, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test | NIHTB4MWGSBtTrialCompScore | Recommended | CDE |
| 7 | 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
