Form Structure: Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales
Short Name:
PedsQLPFVSA
Description:
The PedsQL Present Functioning Visual Analogue Scale is composed of 6 items. 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:
Traumatic Brain Injury
General (For all diseases)
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-31
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.
Form Administration (Appears Up To 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 (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 | Recommended | CDE |
PedsQL PF Visual Analogue Scale (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen afraid scale | Scale indicating how afraid or scared the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. | PedsQLPFVASAfraidScl | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen sad scale | Scale indicating how sad or blue the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. | PedsQLPFVASSadScl | Recommended | CDE |
| 3 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen angry scale | Scale indicating how angry the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. | PedsQLPFVASAngryScl | Recommended | CDE |
| 4 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen worry scale | Scale indicating how worried about what will happen to him or her the child or teen patient is at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. | PedsQLPFVASWorryScl | Recommended | CDE |
| 5 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen tired scale | Scale indicating how tired the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. | PedsQLPFVASTiredScl | Recommended | CDE |
| 6 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen pain hurt scale | Scale indicating how much pain or hurt the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. | PedsQLPFVASPainHurtScl | Recommended | CDE |
PedsQL PF Visual Analogue Scale Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Total symptom score | Total symptom score, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. | PedsQLVASTotalSymptomScore | Recommended | CDE |
| 2 | Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Emotional distress summary score | Emotional distress score, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. , | PedsQLVASEmotDistSumScore | Recommended | CDE |
Keywords
