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Form Structure: Neuro-Qol Item Bank v1.0 - Fatigue

This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
Neuro-Qol Item Bank v1.0 - Fatigue
Short Name:
NeuroQolFatigue
Description:
The Neuro-Qol Item Bank v1.0 - Fatigue can be used in its entirely, or as part of the short form Fatigue questionnaire.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-11-03
Version:
1.0
Date Created:
2015-09-03
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 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study. CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

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Form Administration (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

In the past 7 days (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Exhaustion fatigue assessment past week scale  The scale representing how often the participant felt exhausted in the past 7 days, as part of Neuro-QOL Fatigue. QoLExhaustedScale Recommended CDE
2 Quality of Life - No energy fatigue asssessment past week scale  The scale representing how often the participant felt no energy in the past 7 days, as part of Neuro-QOL Fatigue. QoLNoEnergyScale Recommended CDE
3 Quality of Life - Fatigue assessment past week scale  The scale representing how often the participant felt fatigued in the past 7 days, as part of Neuro-QOL Fatigue. QoLFatigueScale Recommended CDE
4 Quality of Life - No household chore fatigue assessment past week scale  The scale representing how often the participant felt too tired to do household chores in the past 7 days, as part of Neuro-QOL Fatigue. QoLTiredChoresScale Recommended CDE
5 Quality of Life - Not leave house fatigue assessment past week scale  The scale representing how often the participant felt too tired to leave the house in the past 7 days, as part of Neuro-QOL Fatigue. QoLTiredLeaveHouseScale Recommended CDE
6 Quality of Life - Frustration tired for action fatigue assessment past week scale  The scale representing how often the participant felt frustrated by being too tired to do the things they wanted to do in the past 7 days, as part of Neuro-QOL Fatigue. QoLFrustTiredThingsScale Recommended CDE
7 Quality of Life - Tiredness fatigue asssessment past week scale  The scale representing how often the participant felt tired in the past 7 days, as part of Neuro-QOL Fatigue. QoLTiredScale Recommended CDE
8 Quality of Life - Limit social activity fatigue assessment past week scale  The scale representing how often the participant had to limit social activity because of being tired in the past 7 days, as part of Neuro-QOL Fatigue. QoLLimitSocialTiredScale Recommended CDE
9 Quality of Life - Usual activity assistance need fatigue assessment past week scale  The scale representing how often the participant needed help doing usual activities because of fatigue in the past 7 days, as part of Neuro-QOL Fatigue. QoLUsualActFatigueScale Recommended CDE
10 Quality of Life - Sleep need during day past week scale  The scale representing how often the participant needed to sleep during the day in the past 7 days, as part of Neuro-QOL Fatigue. QoLNeedSleepDayScale Recommended CDE
11 Quality of Life - Difficulty begin task fatigue assessment past week scale  The scale representing how often the participant had trouble starting things because they were too tired in the past 7 days, as part of Neuro-QOL Fatigue. QoLTroubleStartScale Recommended CDE
12 Quality of Life - Difficulty finish task fatigue assessment past week scale  The scale representing how often the participant had trouble finishing things because they were too tired in the past 7 days, as part of Neuro-QOL Fatigue. QoLTroubleFinishScale Recommended CDE
13 Quality of Life - No short walk fatigue assessment past week scale  The scale representing how often the participant was too tired to take a short walk in the past 7 days, as part of Neuro-QOL Fatigue. QoLTiredShortWalkScale Recommended CDE
14 Quality of Life - Poor appetite fatigue assessment past week scale  The scale representing how often the participant was too tired to eat in the past 7 days, as part of Neuro-QOL Fatigue. QoLTiredEatScale Recommended CDE
15 Quality of Life - Rest during day fatigue assessment past week scale  The scale representing how often the participant was so tired that they needed rest during the day in the past 7 days, as part of Neuro-QOL Fatigue. QoLNeedRestDayScale Recommended CDE
16 Quality of Life - Overall weakness fatigue assessement past week scale  The scale representing how often the participant felt weak all over in the past 7 days, as part of Neuro-QOL Fatigue. QoLWeakAllOverScale Recommended CDE
17 Quality of Life - Usual activity help requirement fatigue assessment past week scale  The scale representing how often the participant needed help during usual activities because of weakness in the past 7 days, as part of Neuro-QOL Fatigue. QoLUsualActWeakScale Recommended CDE
18 Quality of Life - Limit social activity physical weakness fatigue asssessment past week scale  The scale representing how often the participant had to limit social activity because of being physically weak in the past 7 days, as part of Neuro-QOL Fatigue. QoLLimitSocialWeakScale Recommended CDE
19 Quality of Life - Force self action physical weakness fatigue assessment past week scale  The scale representing how often the participant had to force self to get up and do things because they were physically too weak in the past 7 days, as part of Neuro-QOL Fatigue. QoLForceWakeUpWeakScale Recommended CDE

Scoring (Repeat Infinitely)

# 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
2 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
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) - 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
5 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
6 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
Keywords