Form Structure: NIH Toolbox Sensation Domain Words In Noise Test
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
NIH Toolbox Sensation Domain Words In Noise Test
Short Name:
NIHTBWordsInNoiseTest
Description:
Sensation Domain: The NIH Toolbox Words-in-Noise Test (WIN) measures a personÂs ability to recognize single words presented amid varying levels of background noise. It measures how much difficulty a person might have hearing in a noisy environment. A recorded voice instructs the participant to listen to and then repeat words. The task becomes increasingly difficult as the background noise gets louder, thus reducing the signal-to-noise ratio. The test is recommended for participants ages 6-85 and takes approximately six minutes to administer. This test is part of the NIH Toolbox Sensation Domain Audition Measure. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
General (For all diseases)
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:
2016-06-01
Owner:
Number of Data Elements:
41
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 Words In Noise Test: List 1 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 |
Ear type
(Draft) |
Type of ear | EarTyp | Recommended | UDE |
| 2 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Word type | Type of word being used, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINWordTyp | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Decibel level number | Number for decibel level being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINdBLvlNum | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Correct response indicator | Indicator of correct response, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINCorrectRespInd | Recommended | CDE |
NIH Toolbox Words In Noise Test: List 2 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 |
Ear type
(Draft) |
Type of ear | EarTyp | Recommended | UDE |
| 2 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Word type | Type of word being used, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINWordTyp | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Decibel level number | Number for decibel level being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINdBLvlNum | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Correct response indicator | Indicator of correct response, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINCorrectRespInd | Recommended | CDE |
NIH Toolbox Word In Noise Test Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Total correct words count | Count of total correct words, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINTtlCorrectWrdCt | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Hearing loss type | Type of hearing loss, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test | NIHTBWINHearingLossTyp | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Dominant Ear Raw Score | Raw score for the dominant ear, as a part of the NIH Toolbox Sensation Domain Audition Measure Words In Noise Test | NIHTBWINDomintEarRawScore | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Non dominant ear raw score | Raw score for the non dominant ear, as a part of the NIH Toolbox Sensation Domain Audition Measure Words In Noise Test | NIHTBWINNonDomintEarRawScore | Recommended | CDE |
| 5 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Non dominant ear percent correct score | Percent correct score for the non dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test | NIHTBWINNDmintEarPrcntCrtScore | Recommended | CDE |
| 6 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Dominant ear percent correct score | Percent correct score for the dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test | NIHTBWINDomtEarPercntCortScore | Recommended | CDE |
| 7 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Dominant ear computed score | Computed score for the dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test | NIHTBWINDomintEarComputedScore | Recommended | CDE |
| 8 | NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Non dominant ear computed score | Computed score for the non dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test | NIHTBWINNonDomintEarCompScore | Recommended | CDE |
| 9 | 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
