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Form Structure: TBI-QOL Item Bank v1.0 - Communication - Short Form 9a

This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
TBI-QOL Item Bank v1.0 - Communication - Short Form 9a
Short Name:
TBIQOLCommunication
Description:
Traumatic Brain Injury - Quality of Life (TBI-QOL) Communication Short Form 9a assesses perceived difficulties related to oral expression, language production, articulation, comprehension, and organization.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
Version:
1.0
Date Created:
2016-06-02
Owner:
Number of Data Elements:
27
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 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

TBI-QOL Communication (Appears Exactly 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI-Quality of Life (TBI-QOL) - Difficulty following what other people are saying scale  The scale representing how much difficulty the participant currently has following what other people are saying TBIQOLDiffcltyPplSayingScl Recommended CDE
2 TBI-Quality of Life (TBI-QOL) - Difficulty carrying on a conversation with more than one person scale  The scale representing how much difficulty the participant currently has carrying on a conversation with more than one person TBIQOLDiffConvPplScl Recommended CDE
3 TBI-Quality of Life (TBI-QOL) - Difficulty understanding what people say to you scale  The scale representing how much difficulty the participant currently has understanding what people say to him/her TBIQOLDiffUndrstndPplSayScl Recommended CDE
4 TBI-Quality of Life (TBI-QOL) - Difficulty speaking scale  The scale representing how much difficulty the participant currently has speaking TBIQOLDiffcltySpeakingScl Recommended CDE
5 Quality of Life - Family friend phone understand difficulty scale  The scale which represents the amount of difficulty the participant currently has in understanding family and friends over the phone, as part of Neuro-QOL Communication. QoLFamFrndPhneUndrstndDiffScl Recommended CDE
6 TBI-Quality of Life (TBI-QOL)- Forgot what I wanted to say when talking to others scale  The scale representing how much in the past 7 days the subject forgot what he/she want to say when talking to others TBIQOLForgotScl Recommended CDE
7 TBI Quality of Life (TBI - QOL) - Difficulty following the topic of conversation scale  The scale representing how often the subject had difficulty following the topic of conversation, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL) Cognition: General Concerns � Short Form 10a TBIQOLDiffcltyTopicConvrstnScl Recommended CDE
8 TBI-Quality of Life (TBI-QOL) - Trouble saying what I mean in conversations with others scale  The scale representing how often in the past 7 days the participant had trouble saying what he/she means in conversations with others TBIQOLTrbleSayingCnverstnsScl Recommended CDE
9 TBI-Quality of Life (TBI-QOL) - Trouble finding the right word(s) to express myself  The scale representing how often in the past 7 days the participant had trouble finding the right word(s) to express him/her self, as part of PROMIS Applied Cog Concerns. TBIQOLTrbleFindRtWrdsXpressScl Recommended CDE

TBI-QOL Communication Scoring (Appears Exactly 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI-Quality of Life (TBI-QOL)- Communication Raw score  Raw score for TBI-QOL Communication TBIQOLCommRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Communication comprehension T-score  The T-Score related to perceived difficulties related to oral expression, language production, articulation, comprehension. TBIQOLCommCompTScore 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

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