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Form Structure: Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P)

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P)
Short Name:
QOLIE10P
Description:
Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) is a brief survey of health-related quality of life for adults with epilepsy.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard
Labels:
Form Type:
Clinical Assessment
Publication Date:
2024-06-25
Version:
1.0
Date Created:
2024-02-12
Owner:
Number of Data Elements:
30
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
7 Assessment completion status  Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. AssessmentCompletionStat Recommended CDE
8 Assessment completion status text  A free text related to Assessment completion status specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion AssessmentCompletionStatTxt Recommended CDE

QOLIE-10-P (Appears Up To 7 Times)

# Title Short Description Variable Name Required? Type
1 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - A lot of energy scale  Scale representing that the subject had a lot of energy during the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PAlotOfEnergyScl Recommended UDE
2 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Felt downhearted and low scale  Scale representing that the subject had felt downhearted and low during the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PFeltDwnhrtdAndLowScl Recommended UDE
3 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Trouble with driving scale  Scale representing how much time during the past 4 weeks the subject's epilepsy or antiepileptic drugs caused them to have trouble with driving (or other transportation), as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PTroubleWithDrivingScl Recommended UDE
4 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Bothered by work limitations scale  Scale representing how much the subject's work limitations bothered them during the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PBtherdByWrkLimtatnsScl Recommended UDE
5 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Bothered by social limitations scale  Scale representing how much the subject's social limitations bothered them during the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PBtherdBySoclLimtnsScl Recommended UDE
6 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Bothered by memory difficulties scale  Scale representing how much the subject's memory difficulties that bothered them during the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PBothrByMemDiffcltesScl Recommended UDE
7 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Physical effects of antiepileptic drugs scale  Scale representing how much the subject's physical difficulties of antiepileptic drugs bothered them during the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PPhyEffctsAntiepiDrgScl Recommended UDE
8 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Psychological effects of antiepileptic drugs scale  Scale representing how much the subject's psychological difficulties of antiepileptic drugs bothered them during the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PPsyEffctsAntiepiDrgScl Recommended UDE
9 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Afraid of having a seizure scale  Scale representing how much the subject is afraid of having a seizure during the next 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PAfraidHvngASeizreScl Recommended UDE
10 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Quality of life scale  Scale representing how much the subject's quality of life been during the next 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PQualityOfLifeScl Recommended UDE
11 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Epilepsy-related quality of life distress scale  Scale representing how much the subject's epilepsy-related quality of life distresses them in the past 4 weeks, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PEpilRltdQulLifDstrsScl Recommended UDE
12 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Epilepsy areas category  Category for areas related to subject's epilepsy, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PEpilepsyAreasCat Recommended UDE
13 Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P) - Epilepsy areas number  Number representing the importance of areas related to subject's epilepsy, as part of the Patient Weighted Quality Of Life In Epilepsy (QOLIE-10-P). QOLIE10PEpilepsyAreasNum Recommended UDE
Keywords