Form Structure: PROMIS Bank v1.0 - Satisfaction with Participation in Social Roles
This form structure is an organized set of data definitions for a copyrighted form
Title:
PROMIS Bank v1.0 - Satisfaction with Participation in Social Roles
Short Name:
PROMISSatSocialRoles
Description:
PROMIS - Satisfaction with Participation in Social Roles. 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 Social Roles v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 7a.
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:
28
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 ability do things for family past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do things for his family in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiDoForFamlyScale | Optional | CDE |
| 2 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with how much work could do past week scale | The scale which represents how often the participant's satisfaction with how much work he/she could do in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyHowMuchWorkScale | Optional | CDE |
| 3 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel good ability do thing for family past week scale | The scale which represents the extent to which the participant felt good about his ability to do things for his/her family in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFltGoodAbiDoForFamScale | Optional | CDE |
| 4 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability do work really important past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do the work that is really important to him in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiImprtntWrkScale | Optional | CDE |
| 5 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with amount time spend work past week scale | The scale which represents the extent of the participant's satisfaction with the amount of time he/she spent doing work in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyTimeDoWorkScale | Optional | CDE |
| 6 | Patient-Reported Outcome Measurement Information System (PROMIS) - happy how much do for family past week scale | The scale which represents how often the participant was happy with how much he/she did for his family in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISHappyHowMuchDoFamScale | Optional | CDE |
| 7 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability work past week scale | The scale which represents how often the participant's satisfaction with his/her ability to work in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiToWorkScale | Optional | CDE |
| 8 | Patient-Reported Outcome Measurement Information System (PROMIS) - work quality good as want past week scale | The scale which represents how often the the quality of the participant's work was as good as he/she wants it to be in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISWorkQualWantedScale | Optional | CDE |
| 9 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with amount time spend perform daily routine past week scale | The scale which represents the extent of the participant's satisfaction with the amount of time he/she spent performing daily routines in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfySpendDayRoutnScale | Optional | CDE |
| 10 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability household chores/tasks past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do household chores/tasks in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiHouseworkScale | Optional | CDE |
| 11 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do regular personal household responsibility past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to do regular personal and household responsibilities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiDoRspnsbltScale | Optional | CDE |
| 12 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability perform daily routine past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to perform daily routines in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiDoDayRoutnScale | Optional | CDE |
| 13 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability meet needs those depend on self past week scale | The scale which represents the extent of the participant's satisfaction with his/her ability to meet the needs of those who depend on him in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiMeetNeedsScale | Optional | CDE |
| 14 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability run errands past week scale | The scale which represents how often the participant's satisfaction with his/her ability to run errands in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatsfyAbiRunErrandsScale | 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
