Form Structure: 36-Item Short Form Health Survey (SF-36) version 1
This form structure is an organized set of data definitions for a copyrighted form
Title:
36-Item Short Form Health Survey (SF-36) version 1
Short Name:
SF_36_FITBIR_V1
Description:
Contains data elements for the SF-36 version 1 instrument. SF-36 version 1.0 is reproduced (in its entirety) with permission from the RAND Corporation. Recommended by CDISC for TBI (TAUG TBI)
Copyright by the RAND Corporation. http://www.rand.org/health/surveys_tools/mos/36-item-short-form.html
RAND's permission to reproduce the survey is not an endorsement of the products, services, or other uses in which the survey appears or is applied. Hays, RD (1994). The Medical Outcomes Study (MOS) Measures of Patient Adherence. Retrieved April 19, 2004, from the RAND Corporation web site: http://www.rand.org/health/surveys/MOS.adherence.measures.pdf
Disease:
General (For all diseases)
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-07
Version:
1.3
Date Created:
2014-10-31
Owner:
Number of Data Elements:
58
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 | Recommended | 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 | Recommended | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administation (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-36 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | 36-item Short Form Health Survey (SF-36) - General health scaled score | Scaled score that reflects 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) | SF36GenHlthScore | Recommended | CDE |
| 2 | 36-item Short Form Health Survey (SF-36) - Now heath scaled score | Scaled score that reflects surveyee-reported present general heath compared to a year ago as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36NowHlthScore | Recommended | CDE |
| 3 | 36-item Short Form Health Survey (SF-36) - Health limited vigorous activities scaled score | Scaled score that reflects surveyee-reported limited vigorous activities due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLmtVigorActScore | Recommended | CDE |
| 4 | 36-item Short Form Health Survey (SF-36) - Health limited moderate activities scaled score | Scaled score that reflects 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) | SF36HlthLmtModActScore | Recommended | CDE |
| 5 | 36-item Short Form Health Survey (SF-36) - Health limited carrying groceries scaled score | Scaled score that reflects surveyee-reported limited lifting or carrying groceries due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLmtCrryGrocryScore | Recommended | CDE |
| 6 | 36-item Short Form Health Survey (SF-36) - Health limited climbing several stairs scaled score | Scaled score that reflects 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) | SF36HlthLmtClmbSvrlStairScore | Recommended | CDE |
| 7 | 36-item Short Form Health Survey (SF-36) - Health limited climbing one stair scaled score | Scaled score that reflects surveyee-reported limited climbing one flight of stairs due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLmtClmb1StairScore | Recommended | CDE |
| 8 | 36-item Short Form Health Survey (SF-36) - Health limited bending kneeling stooping scaled score | Scaled score that reflects surveyee-reported limited bending, kneeling, or stooping due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLmtBndKnlStpScore | Recommended | CDE |
| 9 | 36-item Short Form Health Survey (SF-36) - Health limited walking miles scaled score | Scaled score that reflects surveyee-reported limited walking more than one mile due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLmtWlkSvrlMilScore | Recommended | CDE |
| 10 | 36-item Short Form Health Survey (SF-36) - Health limited walking several blocks scaled score | Scaled score that reflects surveyee-reported limited walking several blocks/several hundred yards due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLmtWlkSvrlBlckScore | Recommended | CDE |
| 11 | 36-item Short Form Health Survey (SF-36) - Health limited walking one block scaled score | Scaled score that reflects surveyee-reported limited walking one block/one hundred yards due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLmtWlk1BlckScore | Recommended | CDE |
| 12 | 36-item Short Form Health Survey (SF-36) - Health limited bathing dressing scaled score | Scaled score that reflects surveyee-reported limited bathing or dressing due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthLimtBthDrssScore | Recommended | CDE |
| 13 | 36-item Short Form Health Survey (SF-36) - Cut time on work activities physical health indicator | Indicator for surveyee-reported cut down time on work or other activities as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36CutTimeWrkActPhyHlthInd | Recommended | CDE |
| 14 | 36-item Short Form Health Survey (SF-36) - Less accomplished physical health indicator | Indicator for surveyee-reported less accomplishment as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36LesAccompPhyHlthInd | Recommended | CDE |
| 15 | 36-item Short Form Health Survey (SF-36) - Limited work activities physical health indicator | Indicator for surveyee-reported limited work or activities as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36LmtWrkActPhyHlthInd | Recommended | CDE |
| 16 | 36-item Short Form Health Survey (SF-36) - Difficulty work activities physical health indicator | Indicator for surveyee-reported difficulty performing work or other activities as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36DiffcltWrkActPhyHlthInd | Recommended | CDE |
| 17 | 36-item Short Form Health Survey (SF-36) - Cut time on work activities emotional problems indicator | Indicator for surveyee-reported cut down time on work or other activities as a result of emotional problems during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36CutTmeWrkActEmotProbInd | Recommended | CDE |
| 18 | 36-item Short Form Health Survey (SF-36) - Less accomplished emotional problems indicator | Indicator for surveyee-reported less accomplishment as a result of emotional problems during past 4 weeks as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36LesAccompEmotProbInd | Recommended | CDE |
| 19 | 36-item Short Form Health Survey (SF-36) - Work not carefully emotional problems indicator | Indicator 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 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36WkNotCarefulEmotProbInd | Recommended | CDE |
| 20 | 36-item Short Form Health Survey (SF-36) - Interfered social activities physical emotional problems scaled score | Scaled score that reflects interfered normal social activities with family, friends, neighbors, or groups due to physical health or emotional problems during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36InterfSocPhyEmotScore | Recommended | CDE |
| 21 | 36-item Short Form Health Survey (SF-36) - Bodily pain scaled score | Scaled score that reflects bodily pain during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36BodyPainScore | Recommended | CDE |
| 22 | 36-item Short Form Health Survey (SF-36) - Pain interfere work scaled score | Scaled score that reflects 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) | SF36PainInterfWrkScore | Recommended | CDE |
| 23 | 36-item Short Form Health Survey (SF-36) - Times pep scaled score | Scaled score that reflects times feeling full of pep during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesPepScore | Recommended | CDE |
| 24 | 36-item Short Form Health Survey (SF-36) - Times nervous scaled score | Scaled score that reflects times being a very nervous person during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesNervsScore | Recommended | CDE |
| 25 | 36-item Short Form Health Survey (SF-36) - Times down scaled score | Scaled score that reflects times feeling so down in the dumps that nothing could cheer up during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesDownScore | Recommended | CDE |
| 26 | 36-item Short Form Health Survey (SF-36) - Times calm peaceful scaled score | Scaled score that reflects times feeling calm and peaceful during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesCalmPcfulScore | Recommended | CDE |
| 27 | 36-item Short Form Health Survey (SF-36) - Times energy scaled score | Scaled score that reflects times having a lot of energy during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesEnrgyScore | Recommended | CDE |
| 28 | 36-item Short Form Health Survey (SF-36) - Times downhearted blue scaled score | Scaled score that reflects times feeling downhearted and blue during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesDownBlueScore | Recommended | CDE |
| 29 | 36-item Short Form Health Survey (SF-36) - Times worn out scaled score | Scaled score that reflects times feeling worn out during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesWornOutScore | Recommended | CDE |
| 30 | 36-item Short Form Health Survey (SF-36) - Times happy scaled score | Scaled score that reflects times being a happy person during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesHppyScore | Recommended | CDE |
| 31 | 36-item Short Form Health Survey (SF-36) - Times tired scaled score | Scaled score that reflects times feeling tired during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesTiredScore | Recommended | CDE |
| 32 | 36-item Short Form Health Survey (SF-36) - Times interfered social physical or emotional scaled score | Scaled score that reflects times physical health or emotional problems interfered with social activities (like visiting with friends, relatives, etc.) during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36TimesInterSocPhyEmtScore | Recommended | CDE |
| 33 | 36-item Short Form Health Survey (SF-36) - Sick easier scaled score | Scaled score that reflects how true or false surveyee perceived the statement: I seem to get sick a little easier than other people, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36SckEasierScore | Recommended | CDE |
| 34 | 36-item Short Form Health Survey (SF-36) - Health as anybody scaled score | Scaled score that reflects how true or false surveyee perceived the statement: I am as healthy as anybody I know, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36HlthyAsAnybodyScore | Recommended | CDE |
| 35 | 36-item Short Form Health Survey (SF-36) - Expect worse health scaled score | Scaled score that reflects how true or false surveyee perceived the statement: I expect my health to get worse, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36ExpWorsHlthScore | Recommended | CDE |
| 36 | 36-item Short Form Health Survey (SF-36) - Excellent health scaled score | Scaled score that reflects how true or false surveyee perceived the statement: My health is excellent, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) | SF36ExcelHlthScore | Recommended | CDE |
SF-36 Scores (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | 36-item Short Form Health Survey (SF-36) version 1.0 - Emotional well-being total score | Score of subject's emotional well-being as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1EmotlWellBeingTotalScore | Recommended | CDE |
| 2 | 36-item Short Form Health Survey (SF-36) version 1.0 - Energy/fatigue total score | Score of subject's energy or fatigue as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1EnrgyFatigueTotalScore | Recommended | CDE |
| 3 | 36-item Short Form Health Survey (SF-36) version 1.0 - Role functioning/physical total score | Score of subject's role functioning (physical) as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1RoleFuncPhysicTotalScore | Recommended | CDE |
| 4 | 36-item Short Form Health Survey (SF-36) version 1.0 - Change in health total score | Score of change in subject's health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1HlthChangeTotalScore | Recommended | CDE |
| 5 | 36-item Short Form Health Survey (SF-36) version 1.0 - General health total score | Score of subject's general health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1GenHlthTotalScore | Recommended | CDE |
| 6 | 36-item Short Form Health Survey (SF-36) version 1.0 - Pain total score | Score of pain experienced by the subject as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1PainTotalScore | Recommended | CDE |
| 7 | 36-item Short Form Health Survey (SF-36) version 1.0 - Physical functioning total score | Score of subject's physical functioning as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1PhysFunctTotalScore | Recommended | CDE |
| 8 | 36-item Short Form Health Survey (SF-36) version 1.0 - Role functioning/emotional total score | Score of subject's role functioning (emotional ) as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1RoleFunctEmotlTotalScore | Recommended | CDE |
| 9 | 36-item Short Form Health Survey (SF-36) version 1.0 - Social functioning total score | Score of subject's social functioning as part of version 1.0 of 36-item Short Form Health Survey (SF-36) | SF36V1SocialFunctTotalScore | Recommended | CDE |
Keywords
