Form Structure: Neuro-QoL Satisfaction with Social Roles and Activities Short Form
This form structure is an organized set of data definitions for a copyrighted form
Title:
Neuro-QoL Satisfaction with Social Roles and Activities Short Form
Short Name:
NeuroQoLSatfcnSRASF
Description:
NeuroQoL Satisfaction Social Roles and Activities Short Form. 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
Publication Date:
2021-07-08
Version:
1.0
Date Created:
2016-12-29
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.
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 |
Satisfaction SRA SF (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life - Family regular activity limitation bother past week scale | The scale which represents the extent to which the participant was bothered by their limitations in regular family activities in the past 7 days, as part of Neuro-QOL Satisfaction with SRA. | QoLFamRegActvtyLimtnBotherScl | Recommended | CDE |
| 2 | Quality of Life - Family socialize ability disappointment past week scale | The scale which represents the extent to which the participant was disappointed in their ability to socialize with their family in the past 7 days, as part of Neuro-QOL Satisfaction with SRA. | QoLFamSoclizAbltyDisppntmntScl | Recommended | CDE |
| 3 | Quality of Life - Friend regular activity limitation bother past week scale | The scale which represents the extent to which the participant was bothered by limitations in their regular activities with friends in the past 7 days, as part of Neuro-QOL Satisfaction with SRA. | QoLFriendRegActivtyLimBothrScl | Recommended | CDE |
| 4 | Quality of Life - Friend need ability disappointment past week scale | The scale which represents the extent to which the participant was disappointed in their ability to meet the needs of their friends in the past 7 days, as part of Neuro-QOL Satisfaction with SRA. | QoLFriendNeedAbilityDisappScl | Recommended | CDE |
| 5 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for fun outside of home past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do things for fun outside of the home in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyDoFunOutHomeScale | Recommended | CDE |
| 6 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with amount of time spent doing leisure activities past week scale | The scale which represents the extent of the participant's satisfaction with the amount of time he spent doing leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyLeisureTimeScale | Recommended | CDE |
| 7 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with how much work could do past week scale | The scale which represents how often the participant's satisfaction with how much work he/she could do in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyHowMuchWorkScale | Recommended | CDE |
| 8 | Quality of Life - Household chore satisfaction ability past week scale | The scale which represents the extent to which the participant was satisfied with their ability to do household chores and tasks in the past 7 days, as part of Neuro-QOL Satisfaction with SRA. | QoLHoushldChoreStsfctnAbltyScl | 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) - 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
