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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
Resource:
FITBIR
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:
General (For all diseases) Traumatic Brain Injury
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.

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Form Administration (Appears 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 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 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 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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