Form Structure: Participation Assessment with Recombined Tools-Objective (PART-O-17) and supplemental questions
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Participation Assessment with Recombined Tools-Objective (PART-O-17) and supplemental questions
Short Name:
PARTO
Description:
The Participation Assessment with Recombined Tools-Objective (PART-O-17) and 7 supplemental questions (PART-OS) is an objective measure of participation, representing functioning at the societal level.
References: Whiteneck GG, Dijkers MP, Heinemann AW, Bogner JA, Bushnik T, Cicerone KD, Corrigan JD, Hart T, Malec JF, Millis SR. Development of the Participation Assessment With Recombined Tools-Objective for use after traumatic brain injury. Arch Phys Med Rehabil 2011;92:542-51.
Scoring: Bogner JA, Whiteneck GG, Corrigan JD, Lai J-S, Dijkers MP, Heinemann AW. Comparison of scoring methods for the Participation Assessment with Recombined Tools-Objective. Arch Phys Med Rehabil 2011;92:552-63.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-22
Version:
1.0
Date Created:
2016-04-29
Owner:
Number of Data Elements:
45
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 |
PART-O-17 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Participation Assessment with Recombined Tools-Objective (PART-O) - Job money time scale | Scale for the number of hours in a typical week the participant/subject spends working for money, whether in a job or self-employed as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOJobMoneyTimeScore | Recommended | CDE |
| 2 | Participation Assessment with Recombined Tools-Objective (PART-O) - School study degree time scale | Scale for the number of hours the participant/subject spends in a typical week in school working toward a degree or in an accredited technical training program, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOSchoolStdyDegreeTimeScore | Recommended | CDE |
| 3 | Participation Assessment with Recombined Tools-Objective (PART-O) - Active homemaker time scale | Scale for the number of hours in a typical week the participant/subject will spend in active homemaking, including cleaning, cooking, and raising children as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOActiveHomemakeTimeScore | Recommended | CDE |
| 4 | Participation Assessment with Recombined Tools-Objective (PART-O) - Socialize friend number scale | Scale for the number of times the participant/subject will socialize with friends in person or by phone, in a typical week as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOSocializeFriendNumScore | Recommended | CDE |
| 5 | Participation Assessment with Recombined Tools-Objective (PART-O) - Socialize family number scale | Scale for the number of times the participant/subject will socialize with family and relatives in person or by phone in a typical week as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOSocializeFamilyNumScore | Recommended | CDE |
| 6 | Participation Assessment with Recombined Tools-Objective (PART-O) - Emotional support number scale | Scale for the number of times the participant/subject will give emotional support to other people by listening or helping them with their problems as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOEmotionalSuprtNumScore | Recommended | CDE |
| 7 | Participation Assessment with Recombined Tools-Objective (PART-O) - Internet communication number scale | Scale for the number of times the participant/subject uses the Internet for communication, such as for e-mail, visiting chat rooms or instant messaging in a typical week as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOInternetComunictnNumScore | Recommended | CDE |
| 8 | Participation Assessment with Recombined Tools-Objective (PART-O) - Go out house day scale | Scale for the number of days the participant/subject goes out of the house to go somewhere in a typical week. It could be anywhere, it doesn't have to be anyplace special as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOGoOutHouseDayScore | Recommended | CDE |
| 9 | Participation Assessment with Recombined Tools-Objective (PART-O) - Eat restaurant number scale | Scale for the number of times the participant/subject eats out in a restaurant in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOEatRestaurantNumScore | Recommended | CDE |
| 10 | Participation Assessment with Recombined Tools-Objective (PART-O) - Shop number scale | Scale for the number of times the participant/subject goes shopping in a typical month, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOShopNumScore | Recommended | CDE |
| 11 | Participation Assessment with Recombined Tools-Objective (PART-O) - Engage sport exercise outside scale | Scale for the number of times the participant/subject engages in sports or exercise outside the house in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOEngageSprtExrcsOutsdScore | Recommended | CDE |
| 12 | Participation Assessment with Recombined Tools-Objective (PART-O) - Movie trip number scale | Scale for the number of times the participant/subject goes to see a movie in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOMovieTripNumScore | Recommended | CDE |
| 13 | Participation Assessment with Recombined Tools-Objective (PART-O) - Sport spectator number scale | Scale for the number of times the participant/subject has attended a sports event in person as a spectator in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOSportSpectatorNumScore | Recommended | CDE |
| 14 | Participation Assessment with Recombined Tools-Objective (PART-O) - Religious spiritual service number scale | Scale for the number of times the participant/subject attends religious or spiritual services in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTORlgsSpiritlSrvcNumScore | Recommended | CDE |
| 15 | Participation Assessment with Recombined Tools-Objective (PART-O) - Live significant other indicator scale | Scale for indicating whether the participant/subject lives with a spouse or a significant other as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOLiveSignifcntOthrIndScore | Recommended | CDE |
| 16 | Participation Assessment with Recombined Tools-Objective (PART-O) - Ongoing intimate relationship indicator scale | Scale for indicating whether the participant/subject is currently in an ongoing intimate, romantic or sexual, relationship as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOOngngIntimtRelateIndScore | Recommended | CDE |
| 17 | Participation Assessment with Recombined Tools-Objective (PART-O) - Confidant indicator scale | Scale for indicating whether the participant/subject has a close friend to confide in, not including your spouse or significant other as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOConfidantIndScore | Recommended | CDE |
Supplemental (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Participation Assessment with Recombined Tools (PART-O) supplemental - Spend day category/scale | Supplemental scale that best describes how does the subject spends their days in a typical month, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | SpendDayCat | Recommended | CDE |
| 2 | Participation Assessment with Recombined Tools (PART-O) supplemental - Public transit hours week frequency | Scale representing in a typical week, how many hours does he subject drives in trains, buses, taxis, and other public transportation, as part of Participation Assessment with Recombined Tools - Objective (PART-O) | PublicTransitHrsWkFrq | Recommended | CDE |
| 3 | Participation Assessment with Recombined Tools (PART-O) supplemental - Classes last 3 months indicator | Supplemental indicator representing if the subject was taking in the last 3 month adult education classes, GED classes, continuing education, special courses, or used other opportunities for learning, for example, seminars or conferences? | ClassLast3MonthsInd | Recommended | UDE |
| 4 | Participation Assessment with Recombined Tools (PART-O) supplemental - Club month count scale | Scale that represents in a typical month, how many times does the subject participate in a club or organization, such as the PTA, a choir, sorority, hobby group, neighborhood organization, or brain injury or other support group? | ClubMonthCt | Recommended | CDE |
| 5 | Participation Assessment with Recombined Tools (PART-O) supplemental - Car use hours week frequency | Scale representing in a typical week, how many hours does the subject drives or rides in a car, as part of Participation Assessment with Recombined Tools - Objective (PART-O) | CarUseHrsWkFrq | Recommended | UDE |
| 6 | Participation Assessment with Recombined Tools (PART-O) supplemental- Volunteer work month count scale | Scale representing in a typical month, how many times does the subject do volunteer work, as part of Participation Assessment with Recombined Tools - Objective (PART-O) | VolWorkMonthCt | Recommended | CDE |
| 7 | Participation Assessment with Recombined Tools (PART-O) supplemental- Home maintenance hours week count | Scale representing in a typical week, how many hours do you spend in home maintenance activities, such as home repairs, home improvements, and gardening, as part of Participation Assessment with Recombined Tools - Objective (PART-O) | HomeMaintHrsWkCt | Recommended | CDE |
Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Participation Assessment with Recombined Tools-Objective (PART-O) - Average total score | Average total score calculated as an average of scores for 3 domains - Productivity, Social Relations and Out and About, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOAverageTotalScore | Recommended | CDE |
| 2 | Participation Assessment with Recombined Tools-Objective (PART-O) - Balanced total score | Balanced total score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOBalancedTotalScore | Recommended | CDE |
| 3 | Participation Assessment with Recombined Tools-Objective (PART-O) - Productivity domain sub-score | Productivity domain sub-score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOProductivitySubScore | Recommended | CDE |
| 4 | Participation Assessment with Recombined Tools-Objective (PART-O) - Social Relations | Productivity domain sub-score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOSocialRelSubScore | Recommended | CDE |
| 5 | Participation Assessment with Recombined Tools-Objective (PART-O) - Out and About domain sub-score | Out and About domain sub-score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOOutAboutSubScore | Recommended | CDE |
| 6 | Participation Assessment with Recombined Tools-Objective (PART-O) - Standard deviation of domain scores value | Value of standard deviation (STD) of domain scores, as part of Participation Assessment with Recombined Tools - Objective (PART-O). | PARTOSTDVal | Recommended | CDE |
Keywords
