Form Structure: Neuro-QoL Pediatric Social Relations Interaction with Peers Long Form
This form structure is an organized set of data definitions for a copyrighted form
Title:
Neuro-QoL Pediatric Social Relations Interaction with Peers Long Form
Short Name:
NeuroQoLPedSocRelPeerLF
Description:
Neuro-QOL Item Bank v1.0 –Pediatric Social Relations- Interaction with Peers.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:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-11-22
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 |
NeuroQoL Ped Social Relations Interactn Peers LF (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life - Felt close friend past week scale | The scale representing how often the participant felt close to his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLFeltCloseFriendPstWkScl | Recommended | CDE |
| 2 | Quality of Life - Able count friend past week scale | The scale representing how often the participant was able to count on his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLAbleCountFriendPstWkScl | Recommended | CDE |
| 3 | Quality of Life - Felt comfortable others past week scale | The scale representing how often the participant felt comfortable with others his or her age in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLFeltComfrtableOthrsPstWkScl | Recommended | CDE |
| 4 | Quality of Life - Happy friend past week scale | The scale representing how often the participant was happy with the friends he or she had in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLHappyFriendPstWkScl | Recommended | CDE |
| 5 | Quality of Life - Comfortable talk with friend past week scale | The scale representing how often the participant felt comfortable talking with his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLComfrtableTlkFrndPstWkScl | Recommended | CDE |
| 6 | Quality of Life - Spent time friend past week scale | The scale representing how often the participant spent time with his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLSpentTimeFriendPstWkScl | Recommended | CDE |
| 7 | Quality of Life - Help friend out past week scale | The scale representing how often the participant and his or her friends helped each other out in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLHelpFriendOutPstWkScl | Recommended | CDE |
| 8 | Quality of Life - Fun with friend past week scale | The scale representing how often the participant had fun with his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLFunWithFriendPstWkScl | Recommended | CDE |
| 9 | Quality of Life - Accept by other kid past week scale | The scale representing how often the participant felt accepted by other kids his or her age in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLAcceptByOtherKidPstWkScl | Recommended | CDE |
| 10 | Quality of Life - Able to talk openly with friend past week scale | The scale representing how often the participant was able to talk openly with his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLAbleTlkOpnlyWthFrndPstWkScl | Recommended | CDE |
| 11 | Quality of Life - Share with other kid past week scale | The scale representing how often the participant shared with other kids (food, games, pens, ect.) in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLShareWthOthrKidPstWkScl | Recommended | CDE |
| 12 | Quality of Life - Able stand up for self past week scale | The scale representing how often the participant was able to stand up for his or herself in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLAbleStandUpForSelfPstWkScl | Recommended | CDE |
| 13 | Quality of Life - Friend ignore me past week scale | The scale representing how often the participant found that his or her friends ignored him or her in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLFriendIgnoreMePstWkScl | Recommended | CDE |
| 14 | Quality of Life - Want spend time with friend past week scale | The scale representing how often the participant wanted to spend time with his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLWantSpndTimeWthFrndPstWkScl | Recommended | CDE |
| 15 | Quality of Life - Did thing with kid my age past week scale | The scale representing how often the participant did things with other kids his or her age in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLDidThngWthKidMyAgePstWkScl | Recommended | CDE |
| 16 | Quality of Life - Think have fewer friend than other people my age scale | The scale representing how often the participant thinks that he or she has fewer friends than other people his or her age, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). | QoLThnkFwrFrndThnOthrMyAgeScl | 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) - 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 |
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