Form Structure: Pediatric Quality of Life Inventory(PedsQL) Generic Core Scale
This form structure is an organized set of data definitions for a copyrighted form
Title:
Pediatric Quality of Life Inventory(PedsQL) Generic Core Scale
Short Name:
PedsQLGenericCoreScale
Description:
PedsQL (TM) Pediatric Quality of Life Inventor (TM) PedsQL ver. 4.0 Measurement Model is a modular approach to measuring health related quality of life (HRQOL) in healthy children and adolescents and those with acute and chronic health conditions. The PedsQL Measurement Model covers 4 domains: physical (8 items), emotional (5 items), social (5 items) and school (5 items). It provides a total scales score from 23 items, of which 8 are for physical health summary score and 15 are for psycho-social health summary score. The model includes the Parent-report for Toddlers: 2-4 years; Parent- and self-report for other age groups.
Copyright: 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni 1998.
Disease:
Traumatic Brain Injury
Organization:
BRICS/CIT/NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-03-02
Version:
1.1
Date Created:
2016-02-16
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 | Vital status type | The type of vital status held by the patient on discharge | VitalStatusTyp | Recommended | 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.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 2 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 3 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 4 | 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 Up To 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 | Required | CDE |
Physical Functioning/ABOUT MY HEALTH AND ACTIVITIES (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) - Walking more than one block scale | Scale of problems with walking more than one block, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLWalkScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) - Run scale | Scale of problems with running, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLRunScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) - Participating in sports activity or exercise scale | Scale of problems with participating in sports activity or exercise, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLSportsScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty lifting something heavy scale | Scale of problems with lifting something heavy, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLLiftScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) - Taking a bath or shower by him or herself scale | Scale of problems with taking a bath or shower by themselves, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLBathScl | Recommended | CDE |
| 6 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty doing chores around the house scale | Scale of problems with doing chores around the house, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLChoresScl | Recommended | CDE |
| 7 | Pediatric Quality of Life Inventory (PedsQL) - Hurts or aches scale | Scale of problems with having hurts or aches, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLAchesScl | Recommended | CDE |
| 8 | Pediatric Quality of Life Inventory (PedsQL) - Low energy scale | Scale of problems with low energy, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLEnergyScl | Recommended | CDE |
Emotional Functioning/ABOUT MY FEELINGS (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) - Feeling of being afraid or scared scale | Scale of problems with feeling afraid or scared, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLAfraidScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) - With feeling sad or blue scale | Scale of problems with feeling sad or blue, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLSadScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) - Feeling of being angry scale | Scale of problems with feeling mad, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLAngryScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) - Trouble sleeping scale | Scale of problems with trouble sleeping, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLSleepScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) - Worrying about what will happen to him or her scale | Scale of problems worrying about what will happen to you, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLWorryScl | Recommended | CDE |
Social Functioning/HOW I GET ALONG WITH OTHERS (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) - Getting along with others scale | Scale of problems with getting along with other kids, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLGetAlongScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) - With other kids not wanting to be his or her friend scale | Scale of problems with other kids not wanting to be their friend, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLFriendsScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) - Getting teased by other teens/kids scale | Scale of problems with getting teased by other teen/kids, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTeasedScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) - With not being able to do things that other teens/kids their age can do scale | Scale of problems with not being able to do things that other teens/kids their age can do, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLNotDoThingScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) - With keeping up with other teens/kids when playing scale | Scale of problems with keeping up when playing with other children, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLKeepUpScl | Recommended | CDE |
School Functioning/ABOUT MY WORK/STUDIES (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) - With difficulty paying attention in class scale | Scale of problems paying attention in class, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLAttClssScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) - With problems forgetting things scale | Scale of problems forgetting things, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLForgetScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty keeping up with schoolwork scale | Scale of problems keeping up with schoolwork, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLKeepUpSchoolScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) - Missing school because of not feeling well scale | Scale of problems with missing school because of not feeling well, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLMisSchSickScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) - Missing school to go to the doctor or hospital scale | Scale of problems with missing school to go to the doctor or hospital, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLMisSchDocScl | Recommended | CDE |
| 6 | Pediatric Quality of Life Inventory (PedsQL) - Doing same school activities as peers | Scale of problems with missing school to go to the doctor or hospital, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLSamSchActScl | Recommended | CDE |
PedsQL_Score (Repeat Infinitely)
| # | 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 |
| 2 | Pediatric Quality of Life Inventory(PedsQL) - Psychosocial Health Summary Score | Psychosocial Health Summary Score as a part of Pediatric Quality of Life Inventory (PedsQL). | PedsQLPsyHeaSumScore | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory(PedsQL) - Physical Health Summary Score | Summary Score of the Physical Functioning Scale Score as a part of Pediatric Quality of Life Inventory (PedsQL). | PedsQLPhyHeaSumScore | Recommended | CDE |
Keywords
