Form Structure: TBI-QOL Item Bank v1.0 - Fatigue - Short Form 10a
This form structure is an organized set of data definitions for a copyrighted form
Title:
TBI-QOL Item Bank v1.0 - Fatigue - Short Form 10a
Short Name:
TBIQOLFatigue
Description:
TBI-QOL Item Bank v1.0 - Fatigue - 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:
2016-12-08
Version:
1.1
Date Created:
2016-05-26
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.
Form Administration (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 |
TBI-QOL Fatigue (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | TBI Quality of Life (TBI-QOL) - Trouble starting scale | The scale representing to what degree the participant had trouble starting things because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLTroubleStartScl | Recommended | CDE |
| 2 | TBI Quality of Life (TBI-QOL) - Trouble finishing scale | The scale representing to what degree the participant had trouble finishing things because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLTroubleFinishScl | Recommended | CDE |
| 3 | TBI Quality of Life (TBI-QOL) - Fatigue on average scale | The scale which represents how fatigued was the participant on average in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLFatigueOnAveScl | Recommended | CDE |
| 4 | TBI Quality of Life (TBI-QOL) - Tired even no anything done scale | The scale which represents to what degree the participant felt tired even he/she hadn't done anything in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLTrdEvnNoAnythingDoneScl | Recommended | CDE |
| 5 | TBI Quality of Life (TBI-QOL) - Push to get things done scale | The scale which represents to what degree the participant had to push himself/herself to get things done because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLPushToGtThingsDoneScl | Recommended | CDE |
| 6 | TBI Quality of Life (TBI-QOL) - Carry on conversation scale | The scale which represents how hard it was for the participant to carry on a conversation because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLCarryOnConversatnScl | Recommended | CDE |
| 7 | TBI Quality of Life (TBI-QOL) - Run out of energy scale | The scale which represents how often the participant run out of energy in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLRunOutOfEnergyScl | Recommended | CDE |
| 8 | TBI Quality of Life (TBI-QOL) - Tired socialize with family scale | The scale which represents how often the participant was too tired to socialize with his/her family in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLTrdSocilzeWFmlyScl | Recommended | CDE |
| 9 | TBI Quality of Life (TBI-QOL) - Tired leave the house scale | The scale which represents how often the participant was too tired to leave the house in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLTrdLeaveTheHsScl | Recommended | CDE |
| 10 | TBI Quality of Life (TBI-QOL) - Feel tired scale | The scale which represents how often the participant felt tired in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLFeelTiredScl | Recommended | CDE |
TBI-QOL Fatigue- scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | TBI Quality of Life (TBI-QOL) - Fatigue raw score | The raw score related to sensations ranging from tiredness to an overwhelming, debilitating and sustained sense of exhaustion, as part of the TBI Quality of Life (TBI-QOL). | TBIQOLFatigueRawScore | Recommended | CDE |
| 2 | TBI Quality of Life (TBI-QOL) - Fatigue T-score | The T-Score related to fatigue and sensations ranging from tiredness to an overwhelming, debilitating and sustained sense of exhaustion, as part of the TBI Quality of Life (TBI-QOL). | TBIQOLFatigueTScore | 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
