Form Structure: NIH Toolbox Sensation Domain Taste Intensity Test
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
NIH Toolbox Sensation Domain Taste Intensity Test
Short Name:
NIHTBTasteIntensityTest
Description:
The NIH Toolbox Taste Intensity Test measures the perceived intensity of quinine and salt administered in liquid solutions. The tastants are each applied to the tip of the tongue as well as swished around in the whole mouth and are rated on a generalized labeled magnitude scale (gLMS). The gLMS is a measure of perceived intensity, with seven anchor labels provided (Strongest imaginable, Very strong, Strong, Moderate, Weak, Barely detectable, No sensation). Participants can rate their intensity by clicking with a computer mouse on any point on the scale from Strongest imaginable to No sensation. The test is recommended for administration to participants ages 12-85 and takes approximately six minutes to administer. This test is part of the NIH Toolbox Sensation Domain Taste 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:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-01
Owner:
Number of Data Elements:
46
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 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 Taste Intensity Test (Appears Up To 1 Time)
| # | 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 Taste Measure Taste Intensity Test - Brightest light intensity scale | Scale for intensity of the brightest light the subject could think of, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTIBrightestLightScl | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Well-lit room intensity scale | Scale for intensity of light in a well-lit room, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTIWellLitRoomScl | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Dimly lit restaurant intensity scale | Scale for intensity of light in a dimly lit restaurant, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTIDimLitRestaurantScl | Recommended | CDE |
| 5 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Tip of the tongue quinine intensity scale | Scale for intensity of quinine on the tip of the tongue, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITTipTongueQuinScl | Recommended | CDE |
| 6 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Tip of the tongue salt intensity scale | Scale for intensity of salt on the tip of the tongue, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITTipTongueSaltScl | Recommended | CDE |
| 7 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Whole mouth quinine intensity scale | Scale for intensity of quinine in the whole mouth, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITWholeMouthQuinScl | Recommended | CDE |
| 8 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Whole mouth salt intensity scale | Scale for intensity of salt in the whole mouth, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITWholeMouthSaltScl | Recommended | CDE |
NIH Toolbox Taste Intensity Test Scoring: Quinine (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Quinine tip of the tongue score | Score for quinine test for the tip of tongue, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITQuinineTipTongueScore | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Quinine whole mouth score | Score for quinine test for the whole mouth, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITQuinineWholeMouthScore | Recommended | CDE |
| 3 | 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 |
| 4 | 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 |
| 5 | NIH Toolbox Performance Measures - Fully-adjusted scale score | Fully-adjusted scale score, as part of the NIH Toolbox Performance Measures | NIHTBPMFullyAdjSclScore | Recommended | CDE |
| 6 | 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 |
| 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 |
NIH Toolbox Taste Intensity Test Scoring: Salt (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Salt tip of the tongue score | Score for salt test for the tip of tongue, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITSaltTipTongueScore | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test - Salt whole mouth score | Score for salt test for the whole mouth, as part of the NIH Toolbox Sensation Domain Taste Measure Taste Intensity Test | NIHTBTITSaltWholeMouthScore | Recommended | CDE |
| 3 | 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 |
| 4 | 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 |
| 5 | NIH Toolbox Performance Measures - Fully-adjusted scale score | Fully-adjusted scale score, as part of the NIH Toolbox Performance Measures | NIHTBPMFullyAdjSclScore | Recommended | CDE |
| 6 | 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 |
| 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
