This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
Modified Balance Error Scoring System (M-BESS)
Short Name:
BESSModified
Description:
Developed by researchers and clinicians at the University of North Carolina's Sports Medicine Research Laboratory, Chapel Hill, NC 27599-8700. The Balance Error Scoring System Modified provides a portable, cost-effective, and objective method of assessing static postural stability. BESS modified can be used to assess the effects of mild head injury on static postural stability. The modified BESS is calculated by adding one error point for each error during the three 20-second tests. The maximum total number of errors for any single condition is 10. For further assessment, the same 3 stances can be performed on a hard surface only. Recommended by CDISC for TBI (TAUG TBI). References: http://www.ncbi.nlm.nih.gov/pubmed/19898074
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-28
Version:
1.2
Date Created:
2016-01-13
Owner:
Number of Data Elements:
29
eForms:
N

 Documentation


 Groups & Attached Data Elements

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 Recommended 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 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

Footwear (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Footwear use type  The type of footwear used. FootwearUseTyp Recommended CDE

Testing Conditions (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Balance Error Scoring System Modified (BESS Modified) - Foot tested anatomic site  Anatomic site of non-dominant foot tested, as part of Balance Error Scoring System Modified (BESS Modified). BESSFootTestAnatSite Recommended CDE
2 Ground surface type  The type of ground surface. GroundSurfTyp Recommended CDE

Balance Examination (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Balance Error Scoring System (BESS) - Double leg stance firm surface error count  Number of errors during double leg stance with feet together on firm surface, as part of Balance Error Scoring System (BESS). BESSDblLegFirmErrorCt Recommended CDE
2 Balance Error Scoring System (BESS) - Single leg stance firm surface error count  Number of errors during single leg stance with non-dominant foot tested on firm surface, as part of Balance Error Scoring System (BESS). BESSSglLegFirmErrorCt Recommended CDE
3 Balance Error Scoring System (BESS) - Tandem stance firm surface error count  Number of errors during tandem stance with non-dominant foot in back on firm surface, as part of Balance Error Scoring System (BESS). BESSTandemFirmErrorCt Recommended CDE
4 Balance Error Scoring System (BESS) - Firm surface total error count  Total number of errors while on firm surface, as part of Balance Error Scoring System (BESS). BESSTotalFirmErrorCt Recommended CDE
5 Balance Error Scoring System (BESS) - Double leg stance foam surface error count  Number of errors during double leg stance with feet together on foam surface, as part of Balance Error Scoring System (BESS). BESSDblLegFoamErrorCt Recommended CDE
6 Balance Error Scoring System (BESS) - Single leg stance foam surface error count  Number of errors during single leg stance with non-dominant foot tested on foam surface, as part of Balance Error Scoring System (BESS). BESSSglLegFoamErrorCt Recommended CDE
7 Balance Error Scoring System (BESS) - Tandem stance foam surface error count  Number of errors during tandem stance with non-dominant foot in back on foam surface, as part of Balance Error Scoring System (BESS). BESSTandemStncFoamSrfcErrorCt Recommended CDE
8 Balance Error Scoring System (BESS) - Foam surface total error count  Total number of errors while on foam surface, as part of Balance Error Scoring System (BESS). BESSTotalFoamErrorCt Recommended CDE
9 Balance Error Scoring System (BESS) - Both firm foam surface total error count  Total number of errors for both firm and foam surface, as part of Balance Error Scoring System (BESS). BESSTotalErrorCt Recommended CDE
10 Balance Error Scoring System Modified (BESS Modified) - Double leg stance total error count  Total number of errors during double leg stance with feet together on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). BESSDblLegTotalErrorCt Recommended CDE
11 Balance Error Scoring System Modified (BESS Modified) - Single leg stance total error count  Total number of errors during single leg stance with non-dominant foot tested on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). BESSSglLegTotalErrorCt Recommended CDE
12 Balance Error Scoring System Modified (BESS Modified) - Tandem stance total error count  Total number of errors tandem stance on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). BESSTandemStncTotalErrorCt Recommended CDE

Tandem gait (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Balance Error Scoring System (BESS) - Full-tandem stand duration  Duration (in sec) of doing the full-tandem (heel to toe) stand, as part of Balance Error Scoring System (BESS) Modified BESSFullTandemStandDur Recommended CDE

 Change History

 Administrative Change History