Form Structure: PROMIS Bank v1.0 - Emotional Distress - Anxiety
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
PROMIS Bank v1.0 - Emotional Distress - Anxiety
Short Name:
PROMISAnxiety
Description:
PROMIS - Emotional Distress - Anxiety. This form should be used for any version of the PROMIS forms that are derived from this bank of questions, including (but not limited to) the Emotional Distress - Anxiety v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 8a.
Disease:
General (For all diseases)
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-02-11
Version:
1.1
Date Created:
2015-01-12
Owner:
Number of Data Elements:
43
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.
In the past 7 days (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel fearful past week scale | The scale which represents how often the participant felt fearful in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltFearfulScale | Optional | CDE |
| 2 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel frightened past week scale | The scale which represents how often the participant felt frightened in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltFrightenedScale | Optional | CDE |
| 3 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel scared when nervous past week scale | The scale which represents how often the participant was scared when he/she felt nervous in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISScaredWhenNervousScale | Optional | CDE |
| 4 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel anxious past week scale | The scale which represents how often the participant felt anxious in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltAnxiousScale | Optional | CDE |
| 5 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel need help with anxiety past week scale | The scale which represents how often the participant felt like help was needed for his anxiety in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFltHlpNeedFrAnxietyScale | Optional | CDE |
| 6 | Patient-Reported Outcome Measurement Information System (PROMIS) - concerned about mental health past week scale | The scale which represents how often the participant was concerned about his mental health in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISCncrndAbtMentalHlthScale | Optional | CDE |
| 7 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel upset past week scale | The scale which represents how often the participant felt upset in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltUpsetScale | Optional | CDE |
| 8 | Patient-Reported Outcome Measurement Information System (PROMIS) - racing pounding heart past week scale | The scale which represents how often the participant had a racing or pounding heart in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISRacePoundHeartScale | Optional | CDE |
| 9 | Patient-Reported Outcome Measurement Information System (PROMIS) - anxious if normal routine disturbed past week scale | The scale which represents how often the participant was anxious if his normal routine was disturbed in the past 7 days as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISAnxsIfRoutinDstrbedScale | Optional | CDE |
| 10 | Patient-Reported Outcome Measurement Information System (PROMIS) - sudden feelings panic past week scale | The scale which represents how often the participant had sudden feelings of panic in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSuddenFeelingsOfPncScale | Optional | CDE |
| 11 | Patient-Reported Outcome Measurement Information System (PROMIS) - easily startled past week scale | The scale which represents how often the participant was easily startled in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISEasilyStartledScale | Optional | CDE |
| 12 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble pay attention past week scale | The scale which represents how often the participant had trouble paying attention in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTrblPayingAttentionScale | Optional | CDE |
| 13 | Patient-Reported Outcome Measurement Information System (PROMIS) - avoid public places and activities past week scale | The scale which represents how often the participant avoided public places or activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISAvdPubPlaceActivityScale | Optional | CDE |
| 14 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel fidgety past week scale | The scale which represents how often the participant felt fidgety in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltFidgetyScale | Optional | CDE |
| 15 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel something awful would happen past week scale | The scale which represents how often the participant felt something awful would happen in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSomethingAwflHappenScale | Optional | CDE |
| 16 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel worried past week scale | The scale which represents how often the participant felt worried in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltWorriedScale | Optional | CDE |
| 17 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel terrified past week scale | The scale which represents how often the participant felt terrified in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltTerrifiedScale | Optional | CDE |
| 18 | Patient-Reported Outcome Measurement Information System (PROMIS) - worry reaction other people past week scale | The scale which represents how often participant was worried about other people's reactions to him in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISWorriedAbtOthReactnScale | Optional | CDE |
| 19 | Patient-Reported Outcome Measurement Information System (PROMIS) - hard focus anything anxiety past week scale | The scale which represents how often participant found it hard to focus on anything other than anxiety in the past 7 days, as part of Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISConcntrtOnlyOnAnxtyScale | Optional | CDE |
| 20 | Patient-Reported Outcome Measurement Information System (PROMIS) - worries overwhelmed past week scale | The scale which represents how often the participant's worries overwhelmed him in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISWorriesOverwhelmedScale | Optional | CDE |
| 21 | Patient-Reported Outcome Measurement Information System (PROMIS) - twitch or tremble muscles past week scale | The scale which represents how often the participant had twitching or trembling muscles in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTwitchTrembleMuscleScale | Optional | CDE |
| 22 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel nervous past week scale | The scale which represents how often the participant felt nervous in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltNervousScale | Optional | CDE |
| 23 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel indecisive past week scale | The scale which represents how often the participant felt indecisive in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltIndecisiveScale | Optional | CDE |
| 24 | Patient-Reported Outcome Measurement Information System (PROMIS) - many situations made worry past week scale | The scale which represents how often many situations made the participant worry in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISManySitsMadeWorryScale | Optional | CDE |
| 25 | Patient-Reported Outcome Measurement Information System (PROMIS) - difficult sleep past week scale | The scale which represents how often the participant had difficulty sleeping in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISDifficultySleepingScale | Optional | CDE |
| 26 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble relax past week scale | The scale which represents how often the participant had trouble relaxing in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTroubleRelaxingScore | Optional | CDE |
| 27 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel uneasy past week scale | The scale which represents how often the participant felt uneasy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltUneasyScale | Optional | CDE |
| 28 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel tense past week scale | The scale which represents how often the participant felt tense in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltTenseScale | Optional | CDE |
| 29 | Patient-Reported Outcome Measurement Information System (PROMIS) - difficult calm down past week scale | The scale which represents how often the participant had difficulty calming down in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISDifficultyCalmDownScale | Optional | CDE |
Scoring (Appears Exactly 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Patient-Reported Outcome Measure Information System (PROMIS) - form administered type | The specific PROMIS form type administered, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFormType | Required | CDE |
| 2 | Patient-Reported Outcome Measure Information System (PROMIS) - raw score | The participant's raw score on the PROMIS form, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISRawScore | Optional | CDE |
| 3 | Patient-Reported Outcome Measure Information System (PROMIS) - items completed count | The count of items on the PROMIS form completed by the participant, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISItemCompletedCount | Optional | CDE |
| 4 | Patient-Reported Outcome Measure Information System (PROMIS) - T-score value | The T-score value, a standardized score with a mean of 50 and standard deviation of 10 representing the rescaled raw score, as part of the Patient-Reported Outcome Measurement Information System. | PROMISTScore | Recommended | CDE |
| 5 | Patient-Reported Outcome Measure Information System (PROMIS) - Standard error | Standard error, as part of the Patient-Reported Outcome Measurement Information System (PROMIS) | PROMISStandardError | Recommended | CDE |
| 6 | Patient-Reported Outcome Measure Information System (PROMIS) - theta value | The value of theta reported from the CAT PROMIS results, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTheta | Optional | CDE |
Keywords
