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Form Structure: Sensory Assessment

This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
Sensory Assessment
Short Name:
Sense
Description:
The sensory assessment is intended to detect and quantify positive and negative sensory signs indicative of somatosensory (dys)function.
Disease:
Traumatic Brain Injury
Organization:
University of Miami Health System
Required Program Form:
No
Standardization:
Unique
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-04-13
Version:
1.0
Date Created:
2016-12-16
Owner:
Number of Data Elements:
21
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

Sensory Forms (Appears Up To 5 Times)

# Title Short Description Variable Name Required? Type
1 Vibration Threshold Measurement  The vibratory perception threshold in response to a vibratory stimulus (micrometers). VibrationThresholdMeas Recommended UDE
2 Thermal Cool Threshold Measurement  The cool perception threshold in response to a cool stimulus (degrees - celcius). ThermalCoolThresholdMeas Recommended UDE
3 Thermal Warm Threshold Measurement  The warm perception threshold in response to a warm stimulus (degrees - celcius). ThermalWarmThresholdMeas Recommended UDE
4 Thermal Cold Pain Threshold Measurement  The pain perception threshold in response to a cold stimulus (degrees - celcius). ThermalColdPainThresholdMeas Recommended UDE
5 Thermal Hot Pain Threshold Measurement  The pain perception threshold in response to a warm stimulus (degrees - celcius). ThermalHotPainThresholdMeas Recommended UDE
6 Pressure Pain Threshold Measurement  The pressure pain perception threshold in response to pressure stimulus (kg). PressurePainThresholdMeas Recommended UDE
Keywords