Form Structure: PROMIS Bank v1.0 - Sleep Related Impairment
This form structure is an organized set of data definitions for a copyrighted form
Title:
PROMIS Bank v1.0 - Sleep Related Impairment
Short Name:
PROMISSleepImpairment
Description:
PROMIS - Sleep Related Impairment. 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-Related Impairment v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 8a.
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:
30
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) - hard time get things done because sleepy past week scale | The scale which represents how often the participant had a hard time getting things done because he/she was sleepy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISHardDoThingsSleepyScale | Optional | CDE |
2 | Patient-Reported Outcome Measurement Information System (PROMIS) - hard time concentrate because sleepy past week scale | The scale which represents how often the participant had a hard time concentrating because he/she was sleepy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISHardConcntratSleepyScale | Optional | CDE |
3 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel alert wake up past week scale | The scale which represents how often the participant felt alert when he/she woke up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISAlertWhenWakeUpScale | Optional | CDE |
4 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel ready start day when wake past week scale | The scale which represents the extent to which the participant felt ready to start the day upon waking up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. | PROMISReadyToStartDayScale | Optional | CDE |
5 | Patient-Reported Outcome Measurement Information System (PROMIS) - difficult wake up past week scale | The scale which represents how often the participant had difficulty waking up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISDifficultyWakingUpScale | Optional | CDE |
6 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel sleepy still when wake up past week scale | The scale which represents how often the participant still felt sleepy when he/she woke up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISStillSleepyWhenWakeScale | Optional | CDE |
7 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel tired past week scale | The scale which represents how often the participant felt tired in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltTiredScale | Optional | CDE |
8 | Patient-Reported Outcome Measurement Information System (PROMIS) - try sleep whenever can past week scale | The scale which represents how often the participant tried to sleep whenever he/she could in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepWheneverCouldscale | Optional | CDE |
9 | Patient-Reported Outcome Measurement Information System (PROMIS) - day problem because poor sleep past week scale | The scale which represents how often the participant had problems during the day because of poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. | PROMISDayProblemPoorSleepScale | Optional | CDE |
10 | Patient-Reported Outcome Measurement Information System (PROMIS) - hard concentrate because poor sleep past week scale | The scale which represents how often the participant had a hard time concentrating because of poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. | PROMISTrblCncntratPoorSlpScale | Optional | CDE |
11 | Patient-Reported Outcome Measurement Information System (PROMIS) - daytime activity disturb by poor sleep past week scale | The scale which represents how often the participant's daytime activities were disturbed by poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. | PROMISDayActDstrbPoorSlpScale | Optional | CDE |
12 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel irritable because poor sleep past week scale | The scale which represents how often the participant felt irritable because of poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltIrritablPoorSlpScale | Optional | CDE |
13 | Patient-Reported Outcome Measurement Information System (PROMIS) - hard control emotions because poor sleep past week scale | The scale which represents how often the participant had a hard time controlling emotions because of poor sleep in the past 7 days, as part of Patient-Reported Outcome Measurement Information System. | PROMISHrdCntrlEmoPoorSlpScale | Optional | CDE |
14 | Patient-Reported Outcome Measurement Information System (PROMIS) - have enough energy past week scale | The scale which represents how often the participant had enough energy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISHadEnoughEnergyScale | Optional | CDE |
15 | Patient-Reported Outcome Measurement Information System (PROMIS) - sleepy during daytime past week scale | The scale which represents how often the participant was sleepy during the daytime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISSleepyDuringDaytimeScale | Optional | CDE |
16 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble stay awake during day past week scale | The scale which represents how often the participant had trouble staying awake during the day in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTrblStayAwakeInDayScale | 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