This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L)
Short Name:
EQ5D5L
Description:
The EQ-5D-5L consists of 6 items that measure aspects of quality of life.
Disease:
Traumatic Brain Injury
Organization:
University of Washington
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-04-01
Version:
1.0
Date Created:
2015-03-26
Owner:
Number of Data Elements:
18
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 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Repeat Infinitely)

# 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

EQ-5D-5L (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Mobility category  Category determining the extent to which the participant has problems with mobility, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). EQ5D5LMobilityCat Recommended CDE
2 European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Self-care category  Category determining the extent to which the participant has problems with self-care, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). EQ5D5LSelfCareCat Recommended CDE
3 European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Usual activities category  Category determining the extent to which the participants has problems with usual activities (e.g. work, study, housework, family or leisure activities), as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). EQ5D5LUsualActivitiesCat Recommended CDE
4 European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Pain discomfort category  Category determining the extent to which the participant has problems with pain or discomfort category, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). EQ5D5LPainDiscomfortCat Recommended CDE
5 European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Anxiety depression category  Category determining the extent to which the participant has problems with anxiety or depression category, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). EQ5D5LAnxietyDepressionCat Recommended CDE
6 European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) - Health today scale  Scale of how good or bad the participant's health is today, as part of the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). EQ5D5LHealthTodayScl Recommended CDE

 Change History

 Administrative Change History