Form Structure: TBI-QOL Item Bank v1.0 - Grief/Loss - Short Form 9a
This form structure is an organized set of data definitions for a copyrighted form
Title:
TBI-QOL Item Bank v1.0 - Grief/Loss - Short Form 9a
Short Name:
TBIQOLGrief
Description:
TBI-QOL Item Bank v1.0 Grief/Loss Short Form 9a. 9 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:
FITBIR
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.
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 |
TBI-QOL Grief loss (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | TBI Quality of Life (TBI-QOL) - Difficulty accepting injury scale | The scale representing how often the participant had difficulty accepting his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLDiffcultyActInjScl | Recommended | CDE |
| 2 | TBI Quality of Life (TBI-QOL) - Injury taken away Future scale | The scale representing how often the participant felt his/her injury has taken away his/her future in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLInjTakenAwayFutrScl | Recommended | CDE |
| 3 | TBI Quality of Life (TBI-QOL) - Distressed lost abilities due to injury scale | The scale which represents how often the participant was distressed about the abilities that he/she has lost in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLDistrsLostAbDueToInjScl | Recommended | CDE |
| 4 | TBI Quality of Life (TBI-QOL) - Lost opportunities due to injury scale | The scale which represents how often the participant felt like he/she lost many opportunities because of his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLLostOpprtuntsDueToInjScl | Recommended | CDE |
| 5 | TBI Quality of Life (TBI-QOL) - Miss out on life due to injury scale | The scale which represents how often the participant missed out on life because of his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLMissOutOnLifeDueToInjScl | Recommended | CDE |
| 6 | TBI Quality of Life (TBI-QOL) - Miss activities used to do scale | The scale which represents how often the participant missed the activities I used to do in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLMissActUsedToDoScl | Recommended | CDE |
| 7 | TBI Quality of Life (TBI-QOL) - Lost former life scale | The scale which represents how often the participant felt that he/she lost his/her former life in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLLostFormrLfScl | Recommended | CDE |
| 8 | TBI Quality of Life (TBI-QOL) - Felt lost due to injury scale | The scale which represents how often the participant felt lost because of his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLFeltLostDueToInjScl | Recommended | CDE |
| 9 | TBI Quality of Life (TBI-QOL) - Long for life had before injury scale | The scale which represents how often the participant longed for the life he/she had before his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). | TBIQOLLongForLfHdBfInjScl | Recommended | CDE |
TBI-QOL Grief loss- scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | TBI Quality of Life (TBI-QOL) - Grief loss raw score | The raw score related to emotional reactions of grief (the natural process of reacting to a loss) such as anger, guilt, anxiety, sadness, and despair, as part of the TBI Quality of Life (TBI-QOL). | TBIQOLGriefRawScore | Recommended | CDE |
| 2 | TBI Quality of Life (TBI-QOL) - Grief loss T-score | The T-Score related to emotional reactions of grief (the natural process of reacting to a loss) such as anger, guilt, anxiety, sadness, and despair. | TBIQOLGriefTScore | 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
