Form Structure: TBI-QOL Item Bank v1.0 - Depression - Short Form 10a
This form structure is an organized set of data definitions for a copyrighted form
Title:
TBI-QOL Item Bank v1.0 - Depression - Short Form 10a
Short Name:
TBIQOLDepress
Description:
TBI-QOL Item Bank v1.0 – Depression– Short Form 10a. Ten 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:
2017-09-25
Version:
1.1
Date Created:
2016-05-27
Owner:
Number of Data Elements:
28
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 Exactly 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 |
TBI-QOL Depression (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | TBI Quality of Life (TBI-QOL) - No reason for living scale | The scale which represents how often the participant felt he/she had no reason for living in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLNoRsnForLivingScl | Recommended | CDE |
| 2 | TBI Quality of Life (TBI-QOL) - Give up on everything scale | The scale which represents how often the participant felt that he/she wanted to give up on everything in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLGiveUpOnEverythingScl | Recommended | CDE |
| 3 | TBI Quality of Life (TBI-QOL) - Worthless scale | The scale which represents how often the participant felt worthless in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLWorthlessScl | Recommended | CDE |
| 4 | TBI Quality of Life (TBI-QOL) - Nothing interesting scale | The scale which represents how often the participant felt nothing was interesting in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLNothingInterestingScl | Recommended | CDE |
| 5 | TBI Quality of Life (TBI-QOL) - Depressed scale | The scale which represents how often the participant felt depressed in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLDepressedScl | Recommended | CDE |
| 6 | TBI Quality of Life (TBI-QOL) - Empty life scale | The scale which represents how often the participant felt his/her life was empty in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLEmptyLifeScl | Recommended | CDE |
| 7 | TBI Quality of Life (TBI-QOL) - Nothing cheer up scale | The scale which represents how often the participant felt nothing could cheer him/her up in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLNothingCheerUpScl | Recommended | CDE |
| 8 | TBI Quality of Life (TBI-QOL) - Hopeless scale | The scale which represents how often the participant felt hopeless in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLHopelessScl | Recommended | CDE |
| 9 | TBI Quality of Life (TBI-QOL) - Unhappy scale | The scale which represents how often the participant felt unhappy in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLUnhappyScl | Recommended | CDE |
| 10 | TBI Quality of Life (TBI-QOL) - Nothing to look forward to scale | The scale which represents how often the participant felt that he/she had nothing to look forward to in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLNothingToLookFrdToScl | Recommended | CDE |
TBI-QOL Depression- scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | TBI Quality of Life (TBI-QOL) - Depression raw score | The raw score related to self-reported negative mood, views of self, and social cognition, as well as decreased positive affect and engagement (loss of interest, meaning, and purpose), as part of the TBI Quality of Life (TBI-QOL). | TBIQOLDepressRawScore | Recommended | CDE |
| 2 | TBI Quality of Life (TBI-QOL) - Depression T-score | The T-Score related to self-reported negative mood, views of self, and social cognition, as well as decreased positive affect and engagement (loss of interest, meaning, and purpose. | TBIQOLDepressTScore | 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
