Form Structure: PROMIS Bank v1.0 - Sleep Disturbance
This form structure is an organized set of data definitions for a copyrighted form
Title:
PROMIS Bank v1.0 - Sleep Disturbance
Short Name:
PROMISSleepDisturbance
Description:
PROMIS - Sleep Disturbance. 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 Sleep Disturbance v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 8b.
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:
41
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) - sleep restful past week scale | The scale which represents how often the participant's sleep was restful in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepWasRestfulScale | Optional | CDE |
| 2 | Patient-Reported Outcome Measurement Information System (PROMIS) - sleep light past week scale | The scale which represents how often the participant's sleep was light in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepWasLightScale | Optional | CDE |
| 3 | Patient-Reported Outcome Measurement Information System (PROMIS) - sleep deep past week scale | The scale which represents how often the participant's sleep was deep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepWasDeepScale | Optional | CDE |
| 4 | Patient-Reported Outcome Measurement Information System (PROMIS) - sleep restless past week scale | The scale which represents how often the participant's sleep was restless in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepWasRestlessScale | Optional | CDE |
| 5 | Patient-Reported Outcome Measurement Information System (PROMIS) - satisfied sleep past week scale | The scale which represents how often the participant was satisfied with his/her sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSatisfiedWithSleepScale | Optional | CDE |
| 6 | Patient-Reported Outcome Measurement Information System (PROMIS) - sleep refreshing past week scale | The scale which represents how often the participant's sleep was refreshing in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepWasRefreshingScale | Optional | CDE |
| 7 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel lousy wake up past week scale | The scale which represents how often the participant felt lousy when he/she woke up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltLousyWhenWakeScale | Optional | CDE |
| 8 | Patient-Reported Outcome Measurement Information System (PROMIS) - problem sleep past week scale | The scale which represents how often the participant had a problem with sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISProblemWithSleepScale | Optional | CDE |
| 9 | Patient-Reported Outcome Measurement Information System (PROMIS) - difficult to fall asleep past week scale | The scale which represents how often the participant had difficulty falling asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISDifficultFallAsleepScale | Optional | CDE |
| 10 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel physical tense bedtime past week scale | The scale which represents how often the participant felt physically tense at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltTenseAtBedtimeScale | Optional | CDE |
| 11 | Patient-Reported Outcome Measurement Information System (PROMIS) - worry not able fall asleep past week scale | The scale which represents how often the participant worried about not being able to fall asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISWorryNotFallAsleepScale | Optional | CDE |
| 12 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel worry at bedtime past week scale | The scale which represents how often the participant felt worried at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltWorriedBedtimeScale | Optional | CDE |
| 13 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble stop thoughts at bedtime past week scale | The scale which represents how often the participant had trouble stopping his/her thoughts at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTrblStpThghtBedtimeScale | Optional | CDE |
| 14 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel sad at bedtime past week scale | The scale which represents how often the participant felt sad at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltSadAtBedtimeScale | Optional | CDE |
| 15 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble get comfortable position sleep past week scale | The scale which represents how often the participant had trouble getting into a comfortable position to sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System | PROMISTrblCmfrtblPositionScale | Optional | CDE |
| 16 | Patient-Reported Outcome Measurement Information System (PROMIS) - try hard to get to sleep past week scale | The scale which represents how often the participant tried hard to get to sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTryHardGetToSleepScale | Optional | CDE |
| 17 | Patient-Reported Outcome Measurement Information System (PROMIS) - stress disturbed sleep past week scale | The scale which represents how often the Stress disturbed the participant's sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISStressDisturbSleepScale | Optional | CDE |
| 18 | Patient-Reported Outcome Measurement Information System (PROMIS) - toss and turn at night past week scale | The scale which represents how often the participant tossed and turned at night in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTossTurnAtNightScale | Optional | CDE |
| 19 | Patient-Reported Outcome Measurement Information System (PROMIS) - afraid not get back to sleep after wake past week scale | The scale which represents how often the participant was afraid he/she would not get back to sleep after waking up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISAfrdNotGetBackSleepScale | Optional | CDE |
| 20 | Patient-Reported Outcome Measurement Information System (PROMIS) - sleep enough past week scale | The scale which represents how often the participant got enough sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISGotEnoughSleepScale | Optional | CDE |
| 21 | Patient-Reported Outcome Measurement Information System (PROMIS) - easy to fall asleep past week scale | The scale which represents how often the It was easy for the participant to fall asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISEasyToFallAsleepScale | Optional | CDE |
| 22 | Patient-Reported Outcome Measurement Information System (PROMIS) - lay in bed for hours wait fall asleep past week scale | The scale which represents how often the participant laid in bed for hours waiting to fall asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISLaidInBedWaitingScale | Optional | CDE |
| 23 | Patient-Reported Outcome Measurement Information System (PROMIS) - wake early can not fall back asleep past week scale | The scale which represents how often the participant woke too early and could not fall back asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISWokeUpTooEarlyNoSlpScale | Optional | CDE |
| 24 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble stay asleep past week scale | The scale which represents how often the participant had trouble staying asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTrblStayAsleepNightScale | Optional | CDE |
| 25 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble sleep past week scale | The scale which represents how often the participant had trouble sleeping in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTroubleSleepingScale | Optional | CDE |
| 26 | Patient-Reported Outcome Measurement Information System (PROMIS) - wake up have trouble fall back sleep past week scale | The scale which represents how often the participant woke up and had trouble falling back to sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISWokeUpTrblFallBackScale | Optional | CDE |
| 27 | Patient-Reported Outcome Measurement Information System (PROMIS) - sleep quality past week scale | The scale which represents the participant's description of his/her sleep quality in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepQualityScale | Optional | CDE |
Scoring (Appears At Least 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
