Form Structure: Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design
Short Name:
WAISIV_Block_Design
Description:
The Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Perceptual Reasoning Index (PRI) Block Design subtest measures ability to analyze and synthesize abstract visual stimuli. Copyright Pearson Inc. (2008), (http://www.pearsonclinical.com/content/ani/clinicalassessments/us/en.html). References: Wechsler D. Wechsler Adult Intelligence Scale?Fourth Edition. Pearson; San Antonio, TX: 2008.
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2024-11-13
Version:
1.0
Date Created:
2016-08-12
Owner:
Number of Data Elements:
32
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 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 |
WAIS-IV-Block Design Sample (Appears 2 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
2 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Completion time duration | Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDTimeDur | Recommended | CDE |
WAIS-IV-Block Designs 1-4 (Appears 8 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
2 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
3 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Completion time duration | Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDTimeDur | Recommended | CDE |
4 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 1-4 score | Score for Items 1-4, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDItem1to4Score | Recommended | CDE |
WAIS-IV-Block Designs 5-8 (Appears 4 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
2 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Completion time duration | Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDTimeDur | Recommended | CDE |
3 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 5-8 score | Score for Items 5-8, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDItem5to8Score | Recommended | CDE |
WAIS-IV-Block Designs 9-10 (Appears 2 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
2 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Completion time duration | Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDTimeDur | Recommended | CDE |
3 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 9-10 score | Score for Items 9-10, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDItem9to10Score | Recommended | CDE |
WAIS-IV-Block Designs 11-14 (Appears 4 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Test item number (numeric) | The test (or assessment) item number representing the sequence for the items/questions of each test/assessmet/questionnaire being asked | TestItemNum | Recommended | CDE |
2 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Completion time duration | Time interval required to complete Block Design, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDTimeDur | Recommended | CDE |
3 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Items 11-14 score | Score for Items 11-14, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDItem11to14Score | Recommended | CDE |
WAIS-IV Block Design-Scoring (Appears 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - No time bonus total raw score | Total raw score with no time bonus, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDNRawScore | Recommended | CDE |
2 | Wechsler Adult Intelligence Scale IV (WAIS-IV) Block Design - Total raw score | Total raw score, as part of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Block Design subtest | WAISIVBDRawScore | Recommended | CDE |
Keywords