Form Structure: Pediatric Quality of Life Inventory(PedsQL) Multidimensional Fatigue Scale
This form structure is an organized set of data definitions for a copyrighted form
Title:
Pediatric Quality of Life Inventory(PedsQL) Multidimensional Fatigue Scale
Short Name:
PedsQLMultiDimFatiScale
Description:
The PedsQL 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 integrates seamlessly both generic core scales and disease-specific modules into one measurement system. Pediatric Quality of Life Inventory Multidimensional Fatigue Scale includes the Parent-report for Toddlers: 2-4 years; Parent- and self-report for other age groups.
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:
1.0
Date Created:
2016-02-22
Owner:
Number of Data Elements:
35
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 | Recommended | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Recommended | 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 | Recommended | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Recommended | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Recommended | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Repeat Infinitely)
| # | 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 Exactly 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 |
General Fatigue (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) - Feeling tired scale | Scale of problems with feeling tired, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTiredScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) - Feeling physically weak (not strong) Scale | Scale of problems with feeling physically weak (not strong), as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLPhysicalWeakScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) - Feeling too tired to do things he/she likes to do scale | Scale of problems with feeling too tired to do things that he/she likes to do, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTiredDoThingsScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) - Feeling too tired to spend time with friends scale | Scale of problems with feeling too tired to spend time with his/her friends, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLSpendTimeFriendScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) - Trouble finishing things scale | Scale of problems with trouble finishing things, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTroubleFinishScl | Recommended | CDE |
| 6 | Pediatric Quality of Life Inventory (PedsQL) - Trouble starting things scale | Scale of problems with trouble starting things,as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTroubleStartScl | Recommended | CDE |
Sleep/Rest Fatigue (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) - Sleeping a lot scale | Scale of problems with sleeping a lot, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLSleepALotScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty sleeping through night scale | Scale of problems with difficulty sleeping through the night, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLDifficultSleepScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) - Feeling tired when he/she wakes up in the morning scale | Scale of problems with feeling tired when you wake up in the morning, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTiredMorningScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) - Resting a lot scale | Scale of problems with resting a lot, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLRestALotScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) - Taking a lot of naps scale | Scale of problems with taking a lot of naps, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLNapALotScl | Recommended | CDE |
| 6 | Pediatric Quality of Life Inventory (PedsQL) - Spending a lot of time in bed scale | Scale of problems with spending a lot of time in bed, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTimeInBedScl | Recommended | CDE |
Cognitive Fatigue (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty keeping his/her attention on things scale | Scale of problems with difficulty keeping his/her attention on things, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLAttnScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty remembering what people told them scale | Scale of problems with remembering what people told him/her, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLRemToldScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty remembering what he/she had just heard scale | Scale of problems with remembering what he/she just heard, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLRemHearScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) - Difficulty thinking quickly scale | Scale of problems with difficulty thinking quickly, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLThkQukScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) - Trouble remembering what you was just thinking scale | Scale of problems with remembering what you were just thinking, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLTrblThkScl | Recommended | CDE |
| 6 | Pediatric Quality of Life Inventory (PedsQL) - Trouble remembering more than one thing at a time | Scale of problems with remembering more than one thing at a time, as part of the Pediatric Quality of Life Inventory (PedsQL). | PedsQLRemMultScl | Recommended | CDE |
PedsQL_Score (Appears Up To 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 |
| 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
