Form Structure: PROMIS Bank v1.0 - Satisfaction with Participation in Discretionary Social Activities
This form structure is an organized set of data definitions for a copyrighted form
Title:
PROMIS Bank v1.0 - Satisfaction with Participation in Discretionary Social Activities
Short Name:
PROMISSatSocActivity
Description:
PROMIS - Satisfaction with Participation in Discretionary Social Activities. 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 Satisfaction with Participation in Discretionary Social Activities v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 7a.
Disease:
Traumatic Brain Injury
General (For all diseases)
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:
26
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) - satisfaction with amount of time spent doing leisure activities past week scale | The scale which represents the extent of the participant's satisfaction with the amount of time he spent doing leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyLeisureTimeScale | Optional | CDE |
| 2 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with current level of social activity past week scale | The scale which represents the extent of the participant's satisfaction with his/her current level of social activity in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyLvlSocActvtyScale | Optional | CDE |
| 3 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do all of important community activities past week scale | The scale which represents the extent of the participant's satisfaction with ability to do all of the important community activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyCommunityActScale | Optional | CDE |
| 4 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for friends past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do things for his friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyDoForFriendsScale | Optional | CDE |
| 5 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do leisure activities past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiDoLeisrActScale | Optional | CDE |
| 6 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with current level of activities with friends past week scale | The scale which represents the extent of the participant's satisfaction with his/her current level of activities with friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyLvlActWthFrndScale | Optional | CDE |
| 7 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for fun outside of home past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do things for fun outside of the home in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyDoFunOutHomeScale | Optional | CDE |
| 8 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel good ability do for friend past week scale | The scale which represents the extent to which the participant felt good about his/her ability to do things for his friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFltGoodAbiDoForFrndScale | Optional | CDE |
| 9 | Patient-Reported Outcome Measurement Information System (PROMIS) - happy how much do for friend past week scale | The scale which represents how often the participant was happy with how much he/she did for his friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISHpyHowMuchDidFrndsScale | Optional | CDE |
| 10 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with amount of time spent visiting friends past week scale | The scale which represents the extent of the participant's satisfaction with the amount of time spent visiting his/her friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyTimeVisitFrndScale | Optional | CDE |
| 11 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for fun at home past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do things for fun at home in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiFunAtHomeScale | Optional | CDE |
| 12 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability do all leisure activity really important past week scale | The scale which represents the extent of the participant's satisfaction with ability to do all of the important leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiLeisureActScale | 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
