Form Structure: Quality of Life After Brain Injury -(QOLIBRI)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Quality of Life After Brain Injury -(QOLIBRI)
Short Name:
QOLIBRI
Description:
The QOLIBRI (Quality of Life after Brain Injury) is the first instrument specifically developed to assess health-related quality of life (HRQoL) of individuals after traumatic brain injury. The QOLIBRI is a comprehensive questionnaire with 37 items covering six dimensions of HRQoL after TBI. The QOLIBRI questionnaire is free to use for researchers, clinicians, and non-profit organisations. Please register here on QOLIBRI website and you will be able to download a copy of the questionnaire.
For more information, refer to http://www.qolibrinet.com/;von Steinbuechel N, Wilson L, Gibbons H, et al; QOLIBRI Task Force. Quality of Life after Brain Injury (QOLIBRI): scale validity and correlates of quality of life.
J Neurotrauma 2010;27:1157e65.;von Steinbuechel N, Wilson L, Gibbons H, et al. Quality of Life after Brain Injury
(QOLIBRI): scale development and metric properties. J Neurotrauma 2010;27:1167e85. Recommended by CDISC for TBI.
Disease:
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:
2016-06-16
Owner:
Number of Data Elements:
59
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 |
QOLIBRI Cognition scale (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with concentration scale | Scale for subject's satisfaction with their ability to concentrate, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking | QOLIBRITConcentrationScl | Recommended | CDE |
| 2 | Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with self-expression scale | Scale for subject's satisfaction with their ability to express themselves and understand others in a conversation, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking | QOLIBRITSelfExpressionScl | Recommended | CDE |
| 3 | Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with remembering everyday things scale | Scale for subject's satisfaction with their ability to remember everyday things, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking | QOLIBRITRemembrEvrydyThngsScl | Recommended | CDE |
| 4 | Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with ability to plan scale | Scale for subject's satisfaction with their ability to plan and work out solutions to everyday practical problems, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking | QOLIBRITAbilityToPlanScl | Recommended | CDE |
| 5 | Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with decision-making scale | Scale for subject's satisfaction with their ability to make decisions, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking | QOLIBRITDecisionMakingScl | Recommended | CDE |
| 6 | Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with sense of direction scale | Scale for subject's satisfaction with their ability to find their way around, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking | QOLIBRITSenseDirectionScl | Recommended | CDE |
| 7 | Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with thinking speed scale | Scale for subject's satisfaction with their speed of thinking, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking | QOLIBRITThinkingSpeedScl | Recommended | CDE |
QOLIBRI Self scale (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with energy level scale | Scale for subject's satisfaction with their level of energy, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions | QOLIBRIEEnergyLvlScl | Recommended | CDE |
| 2 | Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with motivation level scale | Scale for subject's satisfaction with their level of motivation to do things, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions | QOLIBRIEMotivationLvlScl | Recommended | CDE |
| 3 | Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with self-esteem scale | Scale for subject's satisfaction with their self-esteem, how valuable they feel, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions | QOLIBRIESelfEsteemScl | Recommended | CDE |
| 4 | Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with looks scale | Scale for subject's satisfaction with the way they look, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions | QOLIBRIESatisfactnLooksScl | Recommended | CDE |
| 5 | Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with achievements scale | Scale for subject's satisfaction with what they have achieved since their brain injury, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions | QOLIBRIEAchievementsScl | Recommended | CDE |
| 6 | Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with self-perception scale | Scale for subject's satisfaction with the way they perceive themselves, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions | QOLIBRIESelfPerceptionScl | Recommended | CDE |
| 7 | Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with perceived future scale | Scale for subject's satisfaction with the way they see their future, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions | QOLIBRIEPerceivedFutureScl | Recommended | CDE |
QOLIBRI Daily Life and Autonomy scale (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with independence scale | Scale for subject's satisfaction with the extent of their independence from other, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence | QOLIBRIIIndependenceScl | Recommended | CDE |
| 2 | Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with ability to go out scale | Scale for subject's satisfaction with their ability to get out and about, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence | QOLIBRIIAbilityGoOutScl | Recommended | CDE |
| 3 | Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with ability to do housework scale | Scale for subject's satisfaction with their ability to carry out domestic activities, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence | QOLIBRIIAbilityDoHouseworkScl | Recommended | CDE |
| 4 | Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with financial responsibility scale | Scale for subject's satisfaction with their ability to run their personal finances, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence | QOLIBRIIFinancialResponsiblScl | Recommended | CDE |
| 5 | Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with work participation scale | Scale for subject's satisfaction with their participation in work or education, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence | QOLIBRIIWorkParticipatnScl | Recommended | CDE |
| 6 | Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with social participation scale | Scale for subject's satisfaction with their participation in social and leisure activities, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence | QOLIBRIISocialParticipatnScl | Recommended | CDE |
| 7 | Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with extent of being in charge scale | Scale for subject's satisfaction with the extent to which they are in charge of their own life, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence | QOLIBRIIExtentInChargeScl | Recommended | CDE |
QOLIBRI Social Relationships scale (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with ability to feel affection scale | Scale for subject's satisfaction with their ability to feel affection towards others, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships | QOLIBRISRFeelAffectnScl | Recommended | CDE |
| 2 | Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with family relationships scale | Scale for subject's satisfaction with their relationships with members of their family, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships | QOLIBRISRFamilyRelationshipScl | Recommended | CDE |
| 3 | Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with friendships scale | Scale for subject's satisfaction with their relationships with their friends, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships | QOLIBRISRFriendshipsScl | Recommended | CDE |
| 4 | Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with partner relationship scale | Scale for subject's satisfaction with their relationship with a partner or with not having a partner, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships | QOLIBRISRPartnerRelationshpScl | Recommended | CDE |
| 5 | Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with sex life scale | Scale for subject's satisfaction with their sex life, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships | QOLIBRISRSexLifeScl | Recommended | CDE |
| 6 | Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with others' opinion of subject scale | Scale for subject's satisfaction with the attitudes of other people towards them, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships | QOLIBRISROthrOpinionScl | Recommended | CDE |
QOLIBRI Emotions scale (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling lonely scale | Scale for how bothered the subject is by feeling lonely, even when they are with other people, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings | QOLIBRIFBotherFeelLonelyScl | Recommended | CDE |
| 2 | Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling bored scale | Scale for how bothered the subject is by feeling bored, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings | QOLIBRIFBotherFeelBoredScl | Recommended | CDE |
| 3 | Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling anxious scale | Scale for how bothered the subject is by feeling anxious, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings | QOLIBRIFBotherFeelAnxiousScl | Recommended | CDE |
| 4 | Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling sad or depressed scale | Scale for how bothered the subject is by feeling sad or depressed, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings | QOLIBRIFBotherFeelSadScl | Recommended | CDE |
| 5 | Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling angry or aggressive scale | Scale for how bothered the subject is by feeling angry or aggressive, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings | QOLIBRIFBotherFeelAngryScl | Recommended | CDE |
QOLIBRI Physical Problems scale (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by slowness scale | Scale for how bothered the subject is by slowness and/or clumsiness of movement, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems | QOLIBRIPPBotherSlownessScl | Recommended | CDE |
| 2 | Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by other injuries scale | Scale for how bothered the subject is by the effects of any other injuries sustained at the same time as the brain injury, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems | QOLIBRIPPBotherOthrInjScl | Recommended | CDE |
| 3 | Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by pain scale | Scale for how bothered the subject is by pain, including headaches, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems | QOLIBRIPPBotherPainScl | Recommended | CDE |
| 4 | Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by vision or hearing scale | Scale for how bothered the subject is by problems with seeing or hearing, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems | QOLIBRIPPBotherVisionHearScl | Recommended | CDE |
| 5 | Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by brain injury scale | Scale for how bothered the subject is by the effects of their brain injury overall, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems | QOLIBRIPPBotherBrainInjScl | Recommended | CDE |
QOLIBRI Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Quality of Life After Brain Injury (QOLIBRI) - Cognition scale score | Cognition scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) | QOLIBRICognitionScaleScore | Recommended | CDE |
| 2 | Quality of Life After Brain Injury (QOLIBRI) - Self Scale score | Self scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) | QOLIBRISelfScaleScore | Recommended | CDE |
| 3 | Quality of Life After Brain Injury (QOLIBRI) - Daily life and autonomy scale score | Daily life and autonomy scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) | QOLIBRIDlyLfAndAutmyScaleScore | Recommended | CDE |
| 4 | Quality of Life After Brain Injury (QOLIBRI) - Social relationships scale score | Social relationships scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) | QOLIBRISocialRltnScaleScore | Recommended | CDE |
| 5 | Quality of Life After Brain Injury (QOLIBRI) - Emotions scale score | Emotions scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) | QOLIBRIEmotionsScaleScore | Recommended | CDE |
| 6 | Quality of Life After Brain Injury (QOLIBRI) - Physical problems scale score | Physical problems scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) | QOLIBRIPhysicalProbsScaleScore | Recommended | CDE |
| 7 | Quality of Life After Brain Injury (QOLIBRI) -Total scale score | Total scale score for Quality of Life After Brain Injury (QOLIBRI) scale, as part of Quality of Life After Brain Injury (QOLIBRI) | QOLIBRITotalScaleScore | Recommended | CDE |
Keywords
