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Form Structure: Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS)

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 - Overall Scale (QOLIBRI-OS)
Short Name:
QOLIBRIOS
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. This study examined 6-item QOLIBRI Overall Scale (QOLIBRI-OS), and considered whether it could provide an index of HRQoL after traumatic brain injury(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., Muehlan, H., Schmidt, H., Schmidt, S., & Bullinger, M. (2012). QOLIBRI Overall Scale: a brief index of health-related quality of life after traumatic brain injury. Journal of Neurology, Neurosurgery & Psychiatry, 83(11), 1041-1047. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-10-02
Version:
1.2
Date Created:
2016-06-16
Owner:
Number of Data Elements:
22
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.

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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 Overall Scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) - Satisfaction with physical condition scale  Scale for subject's satisfaction with their physical condition, as part of the Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) QOLIBRIOSSatisfctnPhysCondScl Recommended CDE
2 Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) - Satisfaction with brain function scale  Scale for subject's satisfaction with how their brain is working, in terms of their concentration, memory, and thinking, as part of the Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) QOLIBRIOSSatsfctnBrainFunctScl Recommended CDE
3 Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) - Satisfaction with feelings and emotions scale  Scale for subject's satisfaction with their feelings and emotions, as part of the Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) QOLIBRIOSSatisfctnFeelEmotnScl Recommended CDE
4 Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) - Satisfaction with ability to perform daily activities scale  Scale for subject's satisfaction with their ability to carry out day to day activities, as part of the Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) QOLIBRIOSStsfctnPrfmDailActScl Recommended CDE
5 Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) - Satisfaction with personal and social life scale  Scale for subject's satisfaction with their personal and social life, as part of the Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) QOLIBRIOSStsfctnPrsnlSclLifScl Recommended CDE
6 Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) - Satisfaction with current and future prospects scale  Scale for subject's satisfaction with their current situation and future prospects, as part of the Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) QOLIBRIOSStfctnCurFtrPrspctScl Recommended CDE
7 Quality of Life After Brain Injury - Overall Scale (QOLIBRI-OS) -Total scale score  Total scale score for Quality of Life After Brain Injury (QOLIBRI) overall scale, as part of Quality of Life After Brain Injury (QOLIBRI) QOLIBRIOSTotalScaleScore Recommended CDE
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