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Form Structure: Pediatric Quality of Life Inventory (PedsQL) General Well Being Scale

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Pediatric Quality of Life Inventory (PedsQL) General Well Being Scale
Short Name:
PedsQLGenWellBeingScale
Description:
The PedsQL General Well-Being Scale is composed of 6 items for ages 8-25 years of age, and 1 overall General Health item. Copyright 1998 JW Varni, PhD. All rights reserved. Varni JW, Seid M, Kurtin PD. PedsQL 4.0: Reliability and validity of the pediatric quality of life inventory Version 4.0 generic core scales in healthy and patient populations. Medical Care. 2001; 38(8): 800-12.
Disease:
General (For all diseases) Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-27
Owner:
Number of Data Elements:
24
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.

Collapse All   Expand All

Form Administration (Appears 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

Context Age Group (Appears 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - AgeRange  Age Range as a part of Pediatric Quality of Life Inventory (PedsQL). AgeRange Recommended CDE

PedsQL GWBS: About Me (Appears 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale - About me feel happy scale  Scale of how often the child feels happy, as part of the Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale. PedsQLGenWBSclFeelHappyScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale - About me feel good self scale  Scale of how often the child feels good about himself or herself, as part of the Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale. PedsQLGenWBSclFeelGoodScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale - About me eel good health scale  Scale of how often the child feels good about his or her health, as part of the Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale. PedsQLGenWBScaFeelGooHlthScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale - About me gets support scale  Scale of how often the child feels that he or she has the support of his or her friends and family, as part of the Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale. PedsQLGenWBSclGetSupprtScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale - About me good thing happen scale  Scale of how often the child thinks that good things will happen to him or her, as part of the Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale. PedsQLGenWBSclGoodThingHapScl Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale - About me good health will happen future scale  Scale of how often the child thinks that his or her health will be good in the future, as part of the Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale. PedsQLGenWBScaGoodHlthFutScl Recommended CDE

PedsQL GWBS: General (Appears 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale - Well health scale  Scale of how the child would rate his health in general, as part of the Pediatric Quality of Life Inventory (PedsQL) General Well-Being Scale. PedsQLGenWBSclWellHlthScl Recommended CDE

PedsQL GWBS Scoring (Appears 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory(PedsQL) - Total Score  Total Score as a part of Pediatric Quality of Life Inventory (PedsQL). PedsQLTtlScore Recommended CDE
Keywords