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Form Structure: TBI-QOL Item Bank v1.0 - Self-Esteem - Short Form 10a

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
TBI-QOL Item Bank v1.0 - Self-Esteem - Short Form 10a
Short Name:
TBIQOLSelfEst
Description:
TBI-QOL Item Bank v1.0 - Self-Esteem - 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:
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:
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.

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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 Self-esteem (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Inferior to friends family scale  The scale representing how often the participant felt inferior to my friends or family in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLInfrToFrindsFmlyScl Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Bad about myself scale  The scale representing how often the participant bad about himself/herself in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLBadAbtMyselfScl Recommended CDE
3 TBI Quality of Life (TBI-QOL) - Poor self esteem scale  The scale which represents to what extent the participant had poor self-esteem in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLPoorSelfEsteemScl Recommended CDE
4 TBI Quality of Life (TBI-QOL) - Insecure scale  The scale which represents to what extent the participant felt insecure in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLInsecureScl Recommended CDE
5 TBI Quality of Life (TBI-QOL) - Ashamed injury scale  The scale which represents how often the participant was ashamed of his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLAshamedInjuryScl Recommended CDE
6 TBI Quality of Life (TBI-QOL) - No longer whole person scale  The scale which represents how often the participant felt he/she was no longer a "whole person" in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLNoLngrWholePrsnScl Recommended CDE
7 TBI Quality of Life (TBI-QOL) - Invisible to others scale  The scale which represents how often the participant felt invisible to other people in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLInvisblToOthrsScl Recommended CDE
8 TBI Quality of Life (TBI-QOL) - Unhappy because of injury scale  The scale which represents how often the participant felt unhappy with who he/she is because of his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLUnhapyBecozOfInjScl Recommended CDE
9 TBI Quality of Life (TBI-QOL) - Difficult to achieve goals scale  The scale which represents how often the participant felt it was difficult to achieve goals set for himself/herself in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLDiffcltToAchievGoalsScl Recommended CDE
10 TBI Quality of Life (TBI-QOL) - Performing tasks in fronr of people scale  The scale which represents how often the participant worried about performing tasks in front of other people because of his/her injury in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLPrfrmTsksInFrntOfPplScl Recommended CDE

TBI-QOL Self-esteem- scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Self esteem raw score  The raw score related to assessment of one's emotional, evaluative, and cognitive perceptions of competence and worth, as part of the TBI Quality of Life (TBI-QOL). TBIQOLSelfEstRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Self esteem T-score  The T-Score related to assessment of one's self esteem, including emotional, evaluative, and cognitive perceptions of competence and worth, as part of the TBI Quality of Life (TBI-QOL). TBIQOLSelfEstTScore 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
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