Form Structure: Neuro-Qol Item Bank v1.0 - Participate in Social Roles and Activities
This form structure is an organized set of data definitions for a copyrighted form
Title:
Neuro-Qol Item Bank v1.0 - Participate in Social Roles and Activities
Short Name:
NeuroQolPartSocialRoleAct
Description:
This form contains the entire contents of the Neuro-QOL Item Bank v1.0 questions for Participating in Social Roles and Activities. This form can be used in it's entirety, or partly for the short form.
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:
2015-09-18
Owner:
Number of Data Elements:
63
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 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
8 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
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 - Family responsibility maintain past week scale | The scale representing how often the participant could keep up with their family responsibilities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFamlyResponsbltyMaintainScl | Recommended | CDE |
2 | Quality of Life - Regular family activity ability past week scale | The scale representing how often the participant was able to do all of their regular family activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLRegulrFamilyActvityAbltyScl | Recommended | CDE |
3 | Quality of Life - Social interaction friend ability past week scale | The scale representing how often the participant was able to socialize with their friends in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLSocialInterctnFrndAbltyScl | Recommended | CDE |
4 | Quality of Life - Regular friend activity ability complete past week scale | The scale representing how often the participant was able to do all of their regular activities with friends in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLRegFrndActvtyAbltyCmplteScl | Recommended | CDE |
5 | Quality of Life - Social commitment maintain past week scale | The scale representing how often the participant was able to keep up with their social commitments in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLSocialCommitmentMaintainScl | Recommended | CDE |
6 | Quality of Life - Activity leisure participate past week scale | The scale representing how often the participant was able to participate in leisure activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLActvtyLeisurPartcptScl | Recommended | CDE |
7 | Quality of Life - Daily routine perform past week scale | The scale representing how often the participant was able to perform their daily routines in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLDailyRoutnPerformScl | Recommended | CDE |
8 | Quality of Life - Work responsibility maintain ability past week scale | The scale representing how often the participant could keep up with their work responsibilities (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWrkRspnsbltyMaintnAbltyScl | Recommended | CDE |
9 | Quality of Life - Family activity expectation complete past week scale | The scale representing how often the participant was able to do all of the family activities that people expected them to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFamActvtyExpctatnCompletScl | Recommended | CDE |
10 | Quality of Life - Family activity want complete past week scale | The scale representing how often the participant was able to do all of the family activities that they wanted to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFamilyActivtyWantComplScl | Recommended | CDE |
11 | Quality of Life - Friendship maintain past week scale | The scale representing how often the participant was able to maintain friendships as much as they would like in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFriendshipMaintainScl | Recommended | CDE |
12 | Quality of Life - Friend need satisfactory complete past week scale | The scale representing how often the participant could do everything for their friends that they wanted to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFriendNeedSatsfctryCmpltScl | Recommended | CDE |
13 | Quality of Life - Friend satisfy expectation activity ability past week scale | The scale representing how often the participant was able to do all of the activities with friends that people expected them to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFriendSatisfExpecAbilityScl | Recommended | CDE |
14 | Quality of Life - Friend activity satisfactory past week scale | The scale representing how often the participant was able to do all of the activities with friends that they wanted to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFriendActivitySatisfactScl | Recommended | CDE |
15 | Quality of Life - Regular leisure activity ability complete past week scale | The scale representing how often the participant was able to do all of their regular leisure activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLRegLesurActvtyAbltyCmpltScl | Recommended | CDE |
16 | Quality of Life - Hobby activity complete past week scale | The scale representing how often the participant was able to do their hobbies or leisure activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLHobbyActivityCompleteScl | Recommended | CDE |
17 | Quality of Life - Community activity want complete past week scale | The scale representing how often the participant was able to do all of the community activities that they wanted to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLCommActivityWantCompletScl | Recommended | CDE |
18 | Quality of Life - Leisure activity satisfactory complete past week scale | The scale representing how often the participant was able to do all of the leisure activities that people expect them to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLExpLeisrActvStsfctCmpltScl | Recommended | CDE |
19 | Quality of Life - Participant leisure activity satisfactory complete past week scale | The scale representing how often the participant could do all of the leisure activities that they wanted in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLLeisrActvtyStsfctryCmpltScl | Recommended | CDE |
20 | Quality of Life - Community activity ability complete past week scale | The scale representing how often the participant was able to do all of the community activities that people expect them to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLCommActivityAbilityComplScl | Recommended | CDE |
21 | Quality of Life - Outside home entertainment want satisfication past week scale | The scale representing how often the participant was able to go out for entertainment as much as they want in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLOutsdeEntrtnmntWntStfctnScl | Recommended | CDE |
22 | Quality of Life - No difficulty errand complete past week scale | The scale representing how often the participant was able to run errands without difficulty in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLNoDiffcultyErrndCompleteScl | Recommended | CDE |
23 | Quality of Life - Work usual abililty complete past week scale | The scale representing how often the participant was able to do all of their usual work (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkUsualAbilityCompleteScl | Recommended | CDE |
24 | Quality of Life - Work usual complete past week scale | The scale representing how often the participant was accomplishing as much as usual at work for them (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkUsualCompleteScl | Recommended | CDE |
25 | Quality of Life - Good work ability complete past week scale | The scale representing how often the participant's ability to do their work was as good as it could be (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLGoodWorkAbilityCompleteScl | Recommended | CDE |
26 | Quality of Life - Work everything ability past week scale | The scale representing how often the participant could do everything for work that they wanted do (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkEverythingAbilityScl | Recommended | CDE |
27 | Quality of Life - All work satisfactory complete past week scale | The scale representing how often the participant was able to do all of the work that people expected of them (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLAllWorkSatsfactryCmpletScl | Recommended | CDE |
28 | Quality of Life - Work usual ability past week scale | The scale representing how often the participant was able to do all of their usual work in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkUsualAbilityScl | Recommended | CDE |
29 | Quality of Life - Work satisfactory complete past week scale | The scale representing how often the participant was able to do all of the work that people expected them to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkSatisfactoryCompleteScl | Recommended | CDE |
30 | Quality of Life - Work shorter time period past week scale | The scale representing how often the participant had to do their work for shorter periods of time than usual for them in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkShorterTimePeriodScl | Recommended | CDE |
31 | Quality of Life - Family need satisfaction problem past week scale | The scale representing how often the participant had trouble meeting the needs of their family in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFamNeedSatisfactnProblemScl | Recommended | CDE |
32 | Quality of Life - Regular family activity limit ability past week scale | The scale representing how often the participant had to limit regular family activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLRegFamActivtyLimitAblityScl | Recommended | CDE |
33 | Quality of Life - Friend visit limit ability past week scale | The scale representing how often the participant felt limited in their ability to visit friends in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFriendVisitLimtAbilityScl | Recommended | CDE |
34 | Quality of Life - Friend visit limit time past week scale | The scale representing how often the participant felt limited in the amount of time they had to visit friends in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLFriendVisitLimitTimeScl | Recommended | CDE |
35 | Quality of Life - Home fun limit activity past week scale | The scale representing how often the participant had to limit the things they do for fun at home (like reading, listening to music, etc) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLHomeFunLimitActivityScl | Recommended | CDE |
36 | Quality of Life - Hobby leisure activity limit complete past week scale | The scale representing how often the participant had to limit their hobbies or leisure activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLHobbyLeisrActvtyLmtCmpltScl | Recommended | CDE |
37 | Quality of Life - Hobby leisure activity decrease time period past week scale | The scale representing how often the participant had to do their hobbies or leisure activities for shorter periods of time than usual for them in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLHbbyLeisrActvtyDecrseTmeScl | Recommended | CDE |
38 | Quality of Life - Social activity outside home limit complete past week scale | The scale representing how often the participant had to limit activities outside of their home in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLSocAcvtyOutsdHmeLmtCmpltScl | Recommended | CDE |
39 | Quality of Life - Social communication maintenance trouble past week scale | The scale representing how often the participant had trouble keeping in touch with others in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLSocCommnctnMaintnceTrblScl | Recommended | CDE |
40 | Quality of Life - Outside home entertainment limit ability past week scale | The scale representing how often the participant had to limit the things they do for fun outside their home in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLOutsdeHmEntrtnmtLmtAbltyScl | Recommended | CDE |
41 | Quality of Life - Group social activity decrease complete past week scale | The scale representing how often the participant did fewer social activities with groups of people than usual for them in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLGrpSocActvtyDecrsCompltScl | Recommended | CDE |
42 | Quality of Life - Regular chore trouble complete past week scale | The scale representing how often the participant had trouble doing their regular chores or tasks in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLReglrChoreTrbleCompleteScl | Recommended | CDE |
43 | Quality of Life - Work home limit complete past week scale | The scale representing how often the participant was limited in doing their work (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkHomeLimitCompleteScl | Recommended | CDE |
44 | Quality of Life - Work home decrease time period ability past week scale | The scale representing how often the participant had to do their work for shorter periods of time than usual for them (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWrkHmeDecreasTmeAbltyScl | Recommended | CDE |
45 | Quality of Life - Work limit complete past week scale | The scale representing how often the participant was limited in doing their work in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. | QoLWorkLimitCompleteScl | 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