Form Structure: Neuro-QoL Pediatric Anxiety Long Form
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Neuro-QoL Pediatric Anxiety Long Form
Short Name:
NeuroQoLPedAnxietyLF
Description:
NeuroQoL Pediatric Anxiety Long Form. Copyright 2008-2013 David Cella and the PROMIS Health Organization on behalf of the National Institute for Neurological Disorders and Stroke (NINDS)
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:
2016-12-23
Owner:
Number of Data Elements:
40
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 |
Pediatric Anxiety LF (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Quality of Life - Afraid alone assessment past week scale | The scale representing how often the participant felt afraid to go out alone in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLAfrdAloneAssmtPstWkScl | Recommended | CDE |
2 | Quality of Life - Worry create friend difficulty assessment past week scale | The scale representing how often the participant found that being worried made it hard for him or her to be with his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLFrdDfcltyAssmtPstWkScl | Recommended | CDE |
3 | Quality of Life - Worry schoolwork difficulty assessment past week scale | The scale representing how often the participant found it was hard to do schoolwork because I was nervous or worried in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLWrkDfcltyAssmtPstWkScl | Recommended | CDE |
4 | Quality of Life - Afraid assessment past week scale | The scale representing how often the participant felt afraid in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLAfraidAssmtPstWkScl | Recommended | CDE |
5 | Quality of Life - Worry home assessment past week scale | The scale representing how often the participant worried when he or she was at home in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLWrryHomeAssmtPstWkScl | Recommended | CDE |
6 | Quality of Life - Worry assessment past week scale | The scale representing how often the participant felt worried in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLWorryAssmtPstWkScl | Recommended | CDE |
7 | Quality of Life - Family away worry assessment past week scale | The scale representing how often the participant worried when he or she was away from his or her family in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLFamAwyWryAssmtPstWkScl | Recommended | CDE |
8 | Quality of Life - Scare easy assessment past week scale | The scale representing how often the participant got scared easily in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLScareEasyAssmtPstWkScl | Recommended | CDE |
9 | Quality of Life - Death worry assessment past week scale | The scale representing how often the participant was worried that he or she might die in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLDeathWryAssmtPstWkScl | Recommended | CDE |
10 | Quality of Life - Nervous assessment past week scale | The scale representing how often the participant felt nervous in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLNervousAssmtPstWkScl | Recommended | CDE |
11 | Quality of Life - Worry health assessment past week scale | The scale representing how often the participant worried that his or her health might get worse in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLWorryHlthAssmtPstWkScl | Recommended | CDE |
12 | Quality of Life - Worry school assessment past week scale | The scale representing how often the participant worried about doing well in school in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLWrySchoolAssmtPstWkScl | Recommended | CDE |
13 | Quality of Life - Hospital setting anxious past week scale | The scale representing how often the participant became anxious when he or she went back to the hospital or clinic in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLHospSttingAnxsPstWkScl | Recommended | CDE |
14 | Quality of Life - Health affect future assessment past week scale | The scale representing how often the participant worried about how his or her health would affect his or her future in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLHlthFutreAssmtPstWkScl | Recommended | CDE |
15 | Quality of Life - Significant other worry assessment past week scale | The scale representing how often the participant, because of his or her health, worried about having a boyfriend or a girlfriend in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLSigOthWryAssmtPstWkScl | Recommended | CDE |
16 | Quality of Life - Good job worry assessment past week scale | The scale representing how often the participant worried about getting a good job because of his or her medical condition in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLGoodJbWryAssmtPstWkScl | Recommended | CDE |
17 | Quality of Life - Nervous easy assessment past week scale | The scale representing how often the participant got nervous more easily than other people in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLNrvousEsyAssmtPstWkScl | Recommended | CDE |
18 | Quality of Life - College worry assessment past week scale | The scale representing how often the participant, because of his or her health worried about being able to go to college in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLCollegWryAssmtPstWkScl | Recommended | CDE |
19 | Quality of Life - Support self worry assessment past week scale | The scale representing how often the participant, because of his or her health, worried about getting a job to support him or herself in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QOLSptSlfWryAssmtPstWkScl | 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) - Long Form Raw score | The participant's raw score on the Neuro-Qol form, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLLFRawScore | 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