Form Structure: PROMIS Global Health Short Form 8a
This form structure is an organized set of data definitions for a copyrighted form
Title:
PROMIS Global Health Short Form 8a
Short Name:
PROMISGlobalHealth
Description:
The PROMIS Global Health form is a carefully standardized psychometric instrument which measures the individuals global health. Copyright 2008-2012 PROMIS Health Organization and PROMIS Cooperative Group
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:
2016-12-14
Owner:
Number of Data Elements:
31
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 |
Global Health (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - General health scale | Scale relating to how good the individual filling out the form believes his or her general health to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHGeneralHealthScl | Recommended | CDE |
| 2 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Quality life scale | Scale relating to how good the individual filling out the form believes his or her quality of life to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHQualityLifeScl | Recommended | CDE |
| 3 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Physical health scale | Scale relating to how good the individual filling out the form believes his or her physical health to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHPhysicalHealthScl | Recommended | CDE |
| 4 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Mental health scale | Scale relating to how good the individual filling out the form believes his or her mental health (including his or her mood and ability to think) to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHMentalHealthScl | Recommended | CDE |
| 5 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Social activity satisfaction scale | Scale relating to how good the individual filling out the form believes his or her satisfaction with his or her social activities to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHSocActvtStsfctnScl | Recommended | CDE |
| 6 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Social activity rating scale | Scale relating to how good the individual filling out the form would rate his or her ability to carry out usual social activities and roles, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHSocActvtRatngScl | Recommended | CDE |
| 7 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Everyday physical activity scale | Scale relating to the extent the individual filling out the form would is able to carry out everyday physical activities (such as walking), as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHEverydayPhysclActvtScl | Recommended | CDE |
| 8 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Bother emotional problem scale | Scale relating to the extent the individual filling out the form has been bothered with emotional problems (such as feeling anxious) in the past 7 days, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHBotherEmtnlPrblmScl | Recommended | CDE |
| 9 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Average fatigue rating scale | Scale relating to the rating the individual filling out the form would give to his or her level of fatigue in the past 7 days, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHAvrgFatigueRtngScl | Recommended | CDE |
| 10 | Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Average pain rating scale | Scale relating to the rating the individual filling out the form would give to his or her level of pain in the past 7 days, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. | PROMISGHAvrgPainRtngScl | Recommended | CDE |
PROMIS Scoring (Appears Up To 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 | Recommended | 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 | Recommended | 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 | Recommended | 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 | Recommended | CDE |
Keywords
