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Form Structure: Neuro-QoL Stigma Short Form

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Neuro-QoL Stigma Short Form
Short Name:
NeuroQoLStigmaSF
Description:
NeuroQoL Stigma 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:
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:
2016-12-29
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.

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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

Stigma SF (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Stigma illness recent assessment scale  The scale representing how often the participant was avoided by some people because of their illness lately, as part of Neuro-QOL Stigma. QoLStgmaIllnessRcntAssessmtScl Recommended CDE
2 Quality of Life - Stigma illness left out event recent assessment scale  The scale representing how often the participant felt left out of things because of their illness lately, as part of Neuro-QOL Stigma. QoLStgmaIlnssLftOutEvntRcntScl Recommended CDE
3 Quality of Life - Stigma illness avoid visual contact recent assessment scale  The scale representing how often people avoided looking at the participant because of their illness lately, as part of Neuro-QOL Stigma. QoLStgmaIllnssAvodCntctRcntScl Recommended CDE
4 Quality of Life - Stigma illness embarassment recent assessment scale  The scale representing how often the participant felt embarassed about their illness lately, as part of Neuro-QOL Stigma. QoLStgmaIllnssEmbrssmtRcntScl Recommended CDE
5 Quality of Life - Stigma illness uncomfortable other people recent assessment scale  The scale representing how often some people seemed uncomfortable with the participant because of their illness lately, as part of Neuro-QOL Stigma. QoLStgmIlnssUncmftblPplRcntScl Recommended CDE
6 Quality of Life - Stigma illness physical limit embarassment recent assessmen scale  The scale representing how often the participant felt embarassed because of their physical limitations lately, as part of Neuro-QOL Stigma. QoLStgmIllnssPhyclLmtRcntScl Recommended CDE
7 Quality of Life - Stigma illness unkind treatment recent assessment scale  The scale representing how often people were unkind to the participant because of their illness lately, as part of Neuro-QOL Stigma. QoLStigmIllnssUnkndTreatmntScl Recommended CDE
8 Quality of Life - Stigma illness blame recent assessment scale  The scale representing how often some people acted as though it was the participant's own fault they have this illness lately, as part of Neuro-QOL Stigma. QoLStigmaIllnssBlameRecentScl 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