Form Structure: Neuro-QoL Pediatric Depression Long Form
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Neuro-QoL Pediatric Depression Long Form
Short Name:
NeuroQoLPedDeprssnLF
Description:
NeuroQoL Pediatric Depression. 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
Version:
1.0
Date Created:
2016-12-28
Owner:
Number of Data Elements:
37
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 Depression LF (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Quality of Life - Sadness interefere with friend assessment past week scale | The scale which represents how often the participant felt too sad to do things with friends in the past 7 days, as part of Neuro-QOL Depression. | QoLSdnssIntfrFrndAssmtPstWkScl | Recommended | CDE |
2 | Quality of Life - Sadness assessment past week scale | The scale which represents how often the participant felt sad in the past 7 days, as part of Neuro-QOL Depression. | QoLSdnssAssmtPstWkScl | Recommended | CDE |
3 | Quality of Life - Loneliness assessment past week scale | The scale which represents how often the participant felt lonely in the past 7 days, as part of Neuro-QOL Depression. | QoLLonelinessAssmtPastWkScl | Recommended | CDE |
4 | Quality of Life - Less interested enjoyable activity assessment past week scale | The scale which represents how often the participant was less interested in doing things he or she usually enjoys in the past 7 days, as part of Neuro-QOL Depression. | QoLLssIntrstdActvAssmtPstWkScl | Recommended | CDE |
5 | Quality of Life - Hard to care assessment past week scale | The scale which represents how often the participant found it hard for him or herself to care about anything in the past 7 days, as part of Neuro-QOL Depression. | QoLHardToCareAssmtPstWkScl | Recommended | CDE |
6 | Quality of Life - Not have fun assessment past week scale | The scale which represents how often the participant found it hard to have fun in the past 7 days, as part of Neuro-QOL Depression. | QoLNotFunAssmtPstWkScl | Recommended | CDE |
7 | Quality of Life - Nothing right assessment past week scale | The scale which represents how often the participant felt like he or she couldn't do anything right in the past 7 days, as part of Neuro-QOL Depression. | QoLNothingRightAssmtPstWkScl | Recommended | CDE |
8 | Quality of Life - Everthing wrong assessment past week scale | The scale which represents how often the participant felt as if everything in his or her life went wrong in the past 7 days, as part of Neuro-QOL Depression. | QoLEvrythingWrongAssmtPstWkScl | Recommended | CDE |
9 | Quality of Life - Bored assessment past week scale | The scale which represents how often the participant was bored in the past 7 days, as part of Neuro-QOL Depression. | QoLBoredAssmtPstWkScl | Recommended | CDE |
10 | Quality of Life - Frustrated assessment past week scale | The scale which represents how often the participant was frustrated in the past 7 days, as part of Neuro-QOL Depression. | QoLFrustratedAssmtPstWkScl | Recommended | CDE |
11 | Quality of Life - Trouble sleeping assessment past week scale | The scale which represents how often the participant had trouble sleeping in the past 7 days, as part of Neuro-QOL Depression. | QoLTrblSlpingAssmtPstWkScl | Recommended | CDE |
12 | Quality of Life - Felt no love assessment past week scale | The scale which represents how often the participant felt that no one loved him or her in the past 7 days, as part of Neuro-QOL Depression. | QoLFeltNoLoveAssmtPstWkScl | Recommended | CDE |
13 | Quality of Life - Cry extra assessment past week scale | The scale which represents how often the participant cried more often than usual in the past 7 days, as part of Neuro-QOL Depression. | QoLCryExtraAssmtPstWkScl | Recommended | CDE |
14 | Quality of Life - Alone assessment past week scale | The scale which represents how often the participant felt alone in the past 7 days, as part of Neuro-QOL Depression. | QoLAloneAssmtPstWkScl | Recommended | CDE |
15 | Quality of Life - Sadness schoolwork assessment past week scale | The scale which represents how often the participant felt too sad to do his or her schoolwork in the past 7 days, as part of Neuro-QOL Depression. | QoLSdnssSchlwrkAssmtPstWkScl | Recommended | CDE |
16 | Quality of Life - Mood swings assessment past week scale | The scale which represents how often the participant felt his or her mood swing from good feelings to bad feelings in the past 7 days, as part of Neuro-QOL Depression. | QoLMoodSwingsAssmtPstWkScl | 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) - 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 |
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