Form Structure: Neuro-QoL Pediatric Anger Short Form : FITBIR : Federal Interagency Traumatic Brain Injury Research Informatics System

Title:

Neuro-QoL Pediatric Anger Short Form

Short Name:

NeuroQoLPedAngerSF

Description:

Disease:

General (For all diseases) Traumatic Brain Injury

Organization:

FITBIR

Required Program Form:

No

Standardization:

Standard NINDS CDE

Labels:

Form Type:

Clinical Assessment

Version:

1.0

Date Created:

2016-12-22

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.

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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

Pediatric Anger SF (Appears Up To 1 Time)

#	Title	Short Description	Variable Name	Required?	Type
1	Quality of Life - Friend difficulty anger scale	The scale which represents how often the participant found that being angry made it hard for him or her to be with his or her friends, as part of Neuro-QOL Upper Extremity.	QoLFriendDifficultyAngerScl	Recommended	CDE
2	Quality of Life - Schoolwork difficulty anger scale	The scale which represents how often the participant found it hard to do school work because he or she was angry, as part of Neuro-QOL Upper Extremity.	QoLSchoolworkDffcltyAngrScl	Recommended	CDE
3	Quality of Life - Angry anger scale	The scale which represents how often the participant felt angry, as part of Neuro-QOL Upper Extremity.	QoLAngryAngrScl	Recommended	CDE
4	Quality of Life - Throw anger scale	The scale which represents how often the participant was so mad that he or she felt felt like throwing something, as part of Neuro-QOL Upper Extremity.	QoLThrowAngrScl	Recommended	CDE
5	Quality of Life - Hit anger scale	The scale which represents how often the participant was so mad he or she felt like hitting something, as part of Neuro-QOL Upper Extremity.	QoLHitAngrScl	Recommended	CDE
6	Quality of Life - Yell anger scale	The scale which represents how often the participant was so mad he or she felt like yelling at someone, as part of Neuro-QOL Upper Extremity.	QoLYellAngrScl	Recommended	CDE
7	Quality of Life - Break anger scale	The scale which represents how often the participant was so mad he or she felt like breaking things, as part of Neuro-QOL Upper Extremity.	QoLBreakAngrScl	Recommended	CDE
8	Quality of Life - Grouch anger scale	The scale which represents how often the participant was so mad that he or she acted grouchy towards other people, as part of Neuro-QOL Upper Extremity.	QoLGrouchAngrScl	Recommended	CDE

NeuroQol Scores (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) - Standard error	Standard error, as part of the Quality of Life in Neurological Disorders (Neuro-Qol)	QoLStandardError	Recommended	CDE
4	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
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

Change History