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Form Structure: TBI-QOL Item Bank v1.0 - Stigma -7a

This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
TBI-QOL Item Bank v1.0 - Stigma -7a
Short Name:
TBIQOLStigma
Description:
TBI-QOL Item Bank v1.0 - Stigma - 7a. 7 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
Version:
1.0
Date Created:
2016-05-26
Owner:
Number of Data Elements:
25
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 Stigma (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Uncomfortable around me scale  The scale representing how often the participant felt like other people were uncomfortable around him/her because of his/her injury lately, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLUncomfrtblAroundMeScl Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Uncomfortable with me scale  The scale representing how often the participant felt some people seemed uncomfortable with him/her because of his/her injury lately, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLUncomfrtblWithMeScl Recommended CDE
3 TBI Quality of Life (TBI-QOL) - Avoid me scale  The scale which represents how often the participant felt some people avoided him/her because of his/her injury lately, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLAvdMeScl Recommended CDE
4 TBI Quality of Life (TBI-QOL) - Avoid looking at me scale  The scale which represents how often the participant avoided looking at him/her lately, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLAvdLookingAtMeScl Recommended CDE
5 TBI Quality of Life (TBI-QOL) - Left out of things due to injury scale  The scale which represents how often the participant felt left out of things lately, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLLeftOutOfTngsDueToInjScl Recommended CDE
6 TBI Quality of Life (TBI-QOL) - Low expectations due to injury scale  The scale which represents how often the participant felt that other people had low expectations of him/her because of injury lately, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLLowExpDueToInjScl Recommended CDE
7 TBI Quality of Life (TBI-QOL) - Make fun due to injury scale  The scale which represents how often the participant felt people made fun of him/her because of his/her injury lately, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLMakeFunDueToInjScl Recommended CDE

TBI-QOL Stigma- scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Stigma raw score  The raw score related to others' perceptions of oneself and publically enacted negativity, prejudice, and discrimination as a result of injury-related manifestations, as part of the TBI Quality of Life (TBI-QOL). TBIQOLStigRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Stigma T-score  The T-Score related to stigma , as part of the TBI Quality of Life (TBI-QOL). TBIQOLStigTScore 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