Form Structure: Tinnitus Functional Index
This form structure is an organized set of data definitions for a copyrighted form
Title:
Tinnitus Functional Index
Short Name:
TFI
Description:
Tinnitus Functional Index (TFI) is a standardized form with 25 questions. Negative tinnitus impact is evaluated based on 8 suscales and one overall score. Meikle, M. B., Henry, J. A., Griest, S. E., Stewart, B. J., Abrams, H. B., McArdle, R., ... & Folmer, R. L. (2012). The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear and hearing, 33(2), 153-176. Copyright 2008, 2012 Oregon Health & Science University's permission required. http://www.ohsu.edu/xd/health/services/ent/research/clinical-research/upload/Corrected-TFI-scoring-instructions-8-2-12.pdf
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2019-03-06
Version:
1.0
Date Created:
2016-03-04
Owner:
Number of Data Elements:
53
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 |
| 7 | Assessment completion status | Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. | AssessmentCompletionStat | Recommended | CDE |
| 8 | Assessment completion status text | A free text related to "Assessment completion status" specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion | AssessmentCompletionStatTxt | Recommended | CDE |
Tinnitus Functional Index (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Tinnitus post-TBI assessment indicator | Patient's response concerning ringing, roaring, buzzing, etc. post-TBI for more than 5 minutes. | TinnitusPostTBIAssmtInd | Recommended | CDE |
| 2 | Tinnitus Functional Index (TFI) - Tinnitus symptom past week indicator | The indicator related tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of Tinnitus Functional Index (TFI). | TFITinnitSympWeekInd | Recommended | CDE |
| 3 | Tinnitus Functional Index (TFI) - Tinnitus symptom awake past week percentage value | The percentage value related tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitSymAwakPastWeekPerVal | Recommended | CDE |
| 4 | Tinnitus Functional Index (TFI) - Tinnitus strong loud scale | The intensity related tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitStrongLoudScl | Recommended | CDE |
| 5 | Tinnitus Functional Index (TFI) - Tinnitus symptom awake annoyance past week scale | The percentage value related to annoyance at tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitSymAwAnPastWeekPerVal | Recommended | CDE |
| 6 | Tinnitus Functional Index (TFI) - Tinnitus in control scale | The controllability over tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitInCtrlScl | Recommended | CDE |
| 7 | Tinnitus Functional Index (TFI) - Tinnitus cope scale | The capability to cope with tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitCopeScl | Recommended | CDE |
| 8 | Tinnitus Functional Index (TFI) - Tinnitus ignore scale | The capability to ignore tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitIgnoreScl | Recommended | CDE |
| 9 | Tinnitus Functional Index (TFI) - Tinnitus concentrate scale | The ability to concentrate in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitConcentrtScl | Recommended | CDE |
| 10 | Tinnitus Functional Index (TFI) - Tinnitus think clearly scale | The ability to think clearly in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitThinkClearScl | Recommended | CDE |
| 11 | Tinnitus Functional Index (TFI) - Tinnitus focus attention scale | The ability to focus attention on other things besides your tinnitus in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitFocusAttenScl | Recommended | CDE |
| 12 | Tinnitus Functional Index (TFI) - Tinnitus fall stay asleep scale | The frequency of having difficulty in falling or staying asleep in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitAsleepScl | Recommended | CDE |
| 13 | Tinnitus Functional Index (TFI) - Tinnitus as much sleep scale | The frequency of having difficulty in getting as much sleep as you needed in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitMuchSleepScl | Recommended | CDE |
| 14 | Tinnitus Functional Index (TFI) - Tinnitus sleep deeply peacefully scale | The frequency of being away from SLEEPING as DEEPLY or as PEACEFULLY as you would have liked in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitDpPcSleepScl | Recommended | CDE |
| 15 | Tinnitus Functional Index (TFI) - Tinnitus hear clearly scale | How much hearing was being interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitHrClrlyScl | Recommended | CDE |
| 16 | Tinnitus Functional Index (TFI) - Tinnitus understand people scale | How much the ability to understand people who are talking has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitUndersdPplScl | Recommended | CDE |
| 17 | Tinnitus Functional Index (TFI) - Tinnitus follow conversations scale | How much the ability to follow conversations in a group or at meetings has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitFollowCvstScl | Recommended | CDE |
| 18 | Tinnitus Functional Index (TFI) - Tinnitus quiet resting activities scale | How much quiet resting activities have been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitQuiRestAcScl | Recommended | CDE |
| 19 | Tinnitus Functional Index (TFI) - Tinnitus relax scale | How much the ability to relax has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitRelaxScl | Recommended | CDE |
| 20 | Tinnitus Functional Index (TFI) - Tinnitus peace and quiet scale | How much the ability to enjoy peace and quiet has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitPeaceQuietScl | Recommended | CDE |
| 21 | Tinnitus Functional Index (TFI) - Tinnitus social activities scale | How much the enjoyment of social activities has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitEnjoySocAcScl | Recommended | CDE |
| 22 | Tinnitus Functional Index (TFI) - Tinnitus enjoyment of life scale | How much enjoyment of life has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitEnjoymtScl | Recommended | CDE |
| 23 | Tinnitus Functional Index (TFI) - Tinnitus relationships scale | How much the relationships with family, friends and other people have been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitRelatScl | Recommended | CDE |
| 24 | Tinnitus Functional Index (TFI) - Tinnitus work tasks scale | The frequency of having difficulty in performing work or other tasks in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitWkTkScl | Recommended | CDE |
| 25 | Tinnitus Functional Index (TFI) - Tinnitus anxious worried scale | The intensity of anxiousness and worry caused by tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitAnxiousWrdScl | Recommended | CDE |
| 26 | Tinnitus Functional Index (TFI) - Tinnitus bothered upset scale | The intensity of being bothered or upset caused by tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitBothrdUpstScl | Recommended | CDE |
| 27 | Tinnitus Functional Index (TFI) - Tinnitus depressed scale | The intensity of being depressed caused by tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). | TFITinnitDepressedScl | Recommended | CDE |
TFI-Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Tinnitus Functional Index (TFI) - Tinnitus total score scale | The overall TFI score, as part of the Tinnitus Functional Index (TFI). | TFITinnitTotalScore | Recommended | CDE |
| 2 | Tinnitus Functional Index (TFI) - Tinnitus intrusive subscale scale | The TFI INTRUSIVE subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitIntrusiveSubscale | Recommended | CDE |
| 3 | Tinnitus Functional Index (TFI) - Tinnitus sense of control subscale scale | The TFI SENSE OF CONTROL subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitSenceControlSubscale | Recommended | CDE |
| 4 | Tinnitus Functional Index (TFI) - Tinnitus cognitive subscale | The TFI COGNITIVE subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitCongnitiveSubscale | Recommended | CDE |
| 5 | Tinnitus Functional Index (TFI) - Tinnitus sleep subscale | The TFI SLEEP subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitSleepSubscale | Recommended | CDE |
| 6 | Tinnitus Functional Index (TFI) - Tinnitus auditory subscale | The TFI AUDITORY subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitAuditorySubscale | Recommended | CDE |
| 7 | Tinnitus Functional Index (TFI) - Tinnitus relaxation subscale | The TFI RELAXATION subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitRelaxationSubscale | Recommended | CDE |
| 8 | Tinnitus Functional Index (TFI) - Tinnitus quality of life subscale | The TFI QUALITY OF LIFE (QOL) subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitQQLSubscale | Recommended | CDE |
| 9 | Tinnitus Functional Index (TFI) - Tinnitus emotional subscale | The TFI EMOTIONAL subscale, as part of the Tinnitus Functional Index (TFI). | TFITinnitEmotionalSubscale | Recommended | CDE |
Keywords
