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Form Structure: TBI-QOL Item Bank v1.0 - Ability to Participate in Social Roles and Activities-Short Form 10a

This form structure is an organized set of data definitions for a copyrighted form
Title:
TBI-QOL Item Bank v1.0 - Ability to Participate in Social Roles and Activities-Short Form 10a
Short Name:
TBIQOLAbilityPartinSRA
Description:
TBI-QOL Item Bank v1.0-Ability to Participate in Social Roles and Activities-Short Form 10a. 10 items are included. Tulsky, D. S., Kisala, P. A., Victorson, D., Carlozzi, N., Bushnik, T., Sherer, M., & Englander, J. (2016). TBI-QOL: development and calibration of item banks to measure patient reported outcomes following traumatic brain injury.The Journal of head trauma rehabilitation, 31(1), 40. TBI-QOL Items Copyright 2015 David Tulsky and Kessler Foundation. All rights reserved. http://www.assessmentcenter.net/ Recommended by CDISC for TBI
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-30
Version:
1.1
Date Created:
2016-06-02
Owner:
Number of Data Elements:
26
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 (Repeat Infinitely)

# 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

TBI-QOL Ability to Participate in SRA (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Regular family activity ability past week scale  The scale representing how often the participant was able to do all of their regular family activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLRegulrFamilyActvityAbltyScl Recommended CDE
2 Quality of Life - Family activity want complete past week scale  The scale representing how often the participant was able to do all of the family activities that they wanted to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLFamilyActivtyWantComplScl Recommended CDE
3 Quality of Life - Regular friend activity ability complete past week scale  The scale representing how often the participant was able to do all of their regular activities with friends in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLRegFrndActvtyAbltyCmplteScl Recommended CDE
4 Quality of Life - Friend activity satisfactory past week scale  The scale representing how often the participant was able to do all of the activities with friends that they wanted to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLFriendActivitySatisfactScl Recommended CDE
5 Quality of Life - Regular leisure activity ability complete past week scale  The scale representing how often the participant was able to do all of their regular leisure activities in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLRegLesurActvtyAbltyCmpltScl Recommended CDE
6 Quality of Life - Community activity want complete past week scale  The scale representing how often the participant was able to do all of the community activities that they wanted to do in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLCommActivityWantCompletScl Recommended CDE
7 Quality of Life - Outside home entertainment want satisfication past week scale  The scale representing how often the participant was able to go out for entertainment as much as they want in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLOutsdeEntrtnmntWntStfctnScl Recommended CDE
8 Quality of Life - Daily routine perform past week scale  The scale representing how often the participant was able to perform their daily routines in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLDailyRoutnPerformScl Recommended CDE
9 Quality of Life - Work usual abililty complete past week scale  The scale representing how often the participant was able to do all of their usual work (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLWorkUsualAbilityCompleteScl Recommended CDE
10 Quality of Life - Work everything ability past week scale  The scale representing how often the participant could do everything for work that they wanted do (include work at home) in the past 7 days, as part of Neuro-QOL Ability to Participate in SRA. QoLWorkEverythingAbilityScl Recommended CDE

TBI-QOL Ability to Participate in SRA Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Ability participate in social roles activity raw score  The raw score for the summation of responses for TBI-QOL Ability to Participate in Social Roles and Activities. TBIQOLAbilPartRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Ability participate social role activity T-score  The T-Score related to degree of involvement in ones usual social roles, activities, and responsibilities, including work, family, friends, and leisure. TBIQOLAbilPartTScore Recommended CDE
3 TBI Quality of Life (TBI - QOL) - Standard error  Standard error (a statistical measure of variance that represents the margin of error for the T-score), as part of TBI-Quality of Life (TBI-QOL) measures TBIQOLStandardError Recommended CDE
Keywords

Change History