Form Structure: 12-item Short Form Health Survey Version 2 (SF-12v2)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
12-item Short Form Health Survey Version 2 (SF-12v2)
Short Name:
SF12
Description:
12-item Short Form Health Survey Version 2 (SF-12v2) . Uses SF-36 CDEs. Can be found in public domain. The FS does not contain scoring information, because scoring is vary.
References: Eduardo Lacson, Jr.,corresponding author Jianglin Xu, Shu-Fang Lin, Sandie Guerra Dean, J. Michael Lazarus, and Raymond M. Hakim, A Comparison of SF-36 and SF-12 Composite Scores and Subsequent Hospitalization and Mortality Risks in Long-Term Dialysis Patients. Clin J Am Soc Nephrol. 2010 Feb; 5(2): 252?260. doi: 10.2215/CJN.07231009 PMCID: PMC2827595
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-03-31
Version:
1.3
Date Created:
2016-03-29
Owner:
Number of Data Elements:
25
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 | 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 |
SF-12 (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | 36-item Short Form Health Survey (SF-36, VR-36) - General health scaled score | Scaled score that reflects surveyee-reported general health. Q1. SF-36 v1: General Health (GH) scale. SF-36 v2: General Health (GH) scale. VR36 General health scale score | SF36GenHlthScore | Recommended | CDE |
| 2 | 36-item Short Form Health Survey (SF-36, VR-36) - Health limited moderate activities scaled score | Scaled score that reflects surveyee-reported general health. Q3b. SF-36 v1: LIMITATIONS OF ACTIVITIES scale. SF-36 v2: Physical Functioning (PF) scale. VR36 Q2b: Physical Functioning scale | SF36HlthLmtModActScore | Recommended | CDE |
| 3 | 36-item Short Form Health Survey (SF-36, VR-36) - Health limited climbing several stairs scaled score | Scaled score that reflects surveyee-reported general health. Q3d. SF-36 v1: LIMITATIONS OF ACTIVITIES scale. SF-36 v2: Physical Functioning (PF) scale. VR36 Q2d: Physical Functioning scale | SF36HlthLmtClmbSvrlStairScore | Recommended | CDE |
| 4 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Less accomplished physical health scale | Score of surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) | SF12LesAccompPhyHlthScale | Recommended | CDE |
| 5 | 12-item Short Form Health Survey Version 2 (SF-12v2)- Limited work activities physical health scale | Scale for surveyee-reported limited work or activities as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | SF12LmtWrkActPhyHlthScale | Recommended | CDE |
| 6 | 12-item Short Form Health Survey Version 2 (SF-12v2)- Less accomplished emotional problems scale | Scale for surveyee-reported less accomplishment as a result of emotional problems, as part of version2.0 of 12-item Short Form Health Survey (SF-12) | SF12LesAccompEmotProbScale | Recommended | CDE |
| 7 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Work not carefully emotional problems indicator | Scale for surveyee-reported doing work or other activities not as carefully as usual as a result of emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | SF12WkNotCarefulEmotProbScale | Recommended | CDE |
| 8 | 36-item Short Form Health Survey (SF-36, VR-36) - Pain interfere work scaled score | Scaled score that reflects surveyee-reported general health. Q8. SF-36 v1: Pain scale. SF-36 v2: Bodily Pain (BP) scale. VR36 Q7: Pain scale | SF36PainInterfWrkScore | Recommended | CDE |
| 9 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Times calm peaceful scale | Scale of times feeling calm and peaceful during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | SF12TimesCalmPcfulScale | Recommended | CDE |
| 10 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Times energy scale | Scale of times having a lot of energy during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | SF12TimesEnrgyScale | Recommended | CDE |
| 11 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Times downhearted depressed scale | Scale of times feeling downhearted and depressed during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | SF12TimesDownDepressedScale | Recommended | CDE |
| 12 | 12-item Short Form Health Survey Version 2 (SF-12v2) - Interferingsocial activties physical emotional scale | Scale of interfered normal social activities due to physical and emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) | SF12InterfSocPhyEmotScale | Recommended | CDE |
Keywords
