Form Structure: Neuro-QoL Item Bank v2.0-Cognitive Function-Short Form
This form structure is an organized set of data definitions for a copyrighted form
Title:
Neuro-QoL Item Bank v2.0-Cognitive Function-Short Form
Short Name:
NeuroQoLCogSF
Description:
Neuro-QoL Item Bank v2.0-Cognitive Function-Short Form Copyright 2008-2013 David Cella and the PROMIS Health Organization on behalf of the National Institute for Neurological Disorders and Stroke (NINDS)
Disease:
Traumatic Brain Injury
General (For all diseases)
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2021-07-08
Version:
1.0
Date Created:
2016-11-28
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 (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 |
NeuroQoL Form Administration (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Quality of Life in Neurological Disorders (Neuro-Qol) - Form administered status | The specific Neuro-Qol form administered status, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLFormStatus | Recommended | CDE |
Cognitive Function SF (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Quality of Life - Several repeat read past week scale | The scale representing how often the participant had to read something several times to understand it in the past 7 days, as part of Neuro-QOL Cognitive Function. | QoLSeveralRptReadScl | Recommended | CDE |
2 | Quality of Life - Thought process slow past week scale | The scale representing how often the participant's thinking was slow in the past 7 days, as part of Neuro-QOL Cognitive Function. | QoLThoughtProcessSlowScl | Recommended | CDE |
3 | Quality of Life - Attention difficulty past week scale | The scale representing how often the participant had to work really hard to pay attention or they would make a mistake in the past 7 days, as part of Neuro-QOL Cognitive Function. | QoLAttentionDifficultyScl | Recommended | CDE |
4 | Quality of Life - Trouble concentrate scale | The scale representing how often the participant had trouble concentrating, as part of Neuro-QOL Cognitive Function. And as part of Traumatic Brain Injury-Quality of Life (TBI-QOL) Cognition: General Concerns � Short Form 10a | QoLTroubleConcentrateScl | Recommended | CDE |
5 | Quality of Life - Read follow complex instruction difficulty scale | The scale which represents the amount of difficulty the participant currently has in reading and following complex instructions (e.g., directions for a new medication), as part of Neuro-QOL Cognitive Function. | QoLReadComplexInstrDifficltScl | Recommended | CDE |
6 | Quality of Life - Plan keep appointment not weekly routine difficulty scale | The scale which represents the amount of difficulty the participant currently has in planning for and keeping appointments that are not part of their weekly routine, as part of TBI-Quality of Life (TBI-QOL) and Neuro-QOL batteries. | QoLPlanKeepAppmntNtWklyRtneScl | Recommended | CDE |
7 | Quality of Life - Manage time daily activity difficulty scale | The scale which represents the amount of difficulty the participant currently has in managing their time to do most of their daily activities, as part of TBI-Quality of Life (TBI-QOL) and Neuro-QOL batteries. | QoLManagTmeDlyActvityDiffScl | Recommended | CDE |
8 | Quality of Life - Learn new task difficulty scale | The scale which represents the amount of difficulty the participant currently has in learning new tasks or instructions, as part of TBI-Quality of Life (TBI-QOL) and Neuro-QOL batteries. | QoLLearnNewTaskDiffScl | Recommended | CDE |
NeuroQol Scoring (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Quality of Life in Neurological Disorders (Neuro-Qol) - Items completed count | The count of items on the Neuro-Qol form completed by the participant, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLItemCompletedCount | Recommended | CDE |
2 | Quality of Life in Neurological Disorders (Neuro-Qol) - Raw score | The participant's raw score on the Neuro-Qol form, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLRawScore | Recommended | CDE |
3 | Quality of Life in Neurological Disorders (Neuro-Qol) - T-score value | The value of the T-score, a standardized score with a mean of 50 and a standard deviation (SD) of 10 representing the rescaled raw score, as part of the Quality of Life in Neurological Disorders (Neuro-Qol).(PROMIS). | QoLTScore | Recommended | CDE |
4 | Quality of Life in Neurological Disorders (Neuro-Qol) - Standard error | Standard error, as part of the Quality of Life in Neurological Disorders (Neuro-Qol) | QoLStandardError | Recommended | CDE |
5 | Quality of Life in Neurological Disorders (Neuro-Qol) - Theta value | Theta metric value reported from the CAT Neuro-Qol results, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLThetaVal | Recommended | CDE |
Keywords