Form Structure: NIH Toolbox Sensation Domain Odor Identification Test
This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH Toolbox Sensation Domain Odor Identification Test
Short Name:
NIHTBOdorIdentifnTest
Description:
The NIH Toolbox Odor Identification Test assesses a persons ability to identify various odors. Participants use scratch-and-sniff cards and, after scratching them one at a time, are asked to identify which of four pictures on the computer screen matches the odor they have just smelled. Participants ages 10-85 are administered nine odor cards, while those ages 3-9 are administered five odor cards. Child participants (ages 3-9 years) are first asked to identify the eight pictures that are used as answer choices, to ensure they can complete the task. Having identified the pictures, they are asked if they have tasted or smelled the objects or foods depicted. This test takes approximately four to five minutes to administer and is recommended for ages 3-85. This test is part of the NIH Toolbox Sensation Domain Olfaction 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
General (For all diseases)
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-08
Owner:
Number of Data Elements:
38
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 |
NIH Toolbox Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox - Test administration language type | Type of language for test being administrated, as part of the NIH Toolbox | NIHTBTestAdminLanguageTyp | Recommended | CDE |
| 2 | NIH Toolbox - Test administration language type other | Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox | NIHTBTestAdminLanguageTypOTH | 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 flag type | Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestFlagTyp | Recommended | CDE |
| 6 | 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 |
| 7 | NIH Toolbox - Form administered type | Type of NIH Toolbox form being administered, as part of the NIH Toolbox | NIHTBFormAdminTyp | Recommended | CDE |
NIH Toolbox Odor Identification Test: Part 1: Ages 3-9 (Appears Up To 16 Times)
| # | 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 Sensation Domain Olfaction Measure Odor Identification Test - Familiar odor picture type | Type of response to the picture of a familiar used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOIFamiliarOdorPictureTyp | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Familiar odor picture response type | Type of response to the picture of a familiar odor used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOIFamiliarOdorPictRespTyp | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Familiar picture taste and smell response type | Type of response to the taste and smell corresponding to the picture of a familiar odor used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOIPictureTastSmelRespTyp | Recommended | CDE |
NIH Toolbox Odor Identification Test: Part 2: Ages 3-9 (Appears Up To 5 Times)
| # | 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 Sensation Domain Olfaction Measure Odor Identification Test - Odor card type | Type of odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOIOdorCardTyp | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Odor card response type | Type of response to the odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOIOdorCardResponseTyp | Recommended | CDE |
NIH Toolbox Odor Identification Test: Ages 10-85 (Appears Up To 9 Times)
| # | 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 Sensation Domain Olfaction Measure Odor Identification Test - Odor card type | Type of odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOIOdorCardTyp | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Odor card response type | Type of response to the odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOIOdorCardResponseTyp | Recommended | CDE |
NIH Toolbox Odor Identification Test: Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Number of odors correctly identified | Number of odors correctly identified, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test | NIHTBOICorrectNum | 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
