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

 General Details

Title:
FIM Instrument
Short Name:
FIM_Instrument
Description:
The FIM instrument, version 5.2, provides an established means of collecting rehabilitation data in a consistent manner. It allows to follow changes in the functional status of subjects from the start of rehabilitative care through discharge and follow-up. Copyright UDSMR, 1999 - 2016 Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. (https://www.udsmr.org/Default.aspx) Recommended by CDISC for TBI (TAUG TBI)
Disease:
General (For all diseases)
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-22
Version:
1.2
Date Created:
2015-10-15
Owner:
Number of Data Elements:
44
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 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 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 Optional CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Optional CDE
5 Data source  Source of the data provided on the case report form DataSource Optional 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 Optional CDE

Motor subscale (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Visit type  The type of visit from the visit types available for this particular study VisitTyp Recommended CDE
2 FIM instrument Motor subscale, self-care - Eating scale  Scaled ability of a subject to eat independently, as part of the Motor subscale - self-care of the FIM instrument FIMMotorSelfCareEatingScl Recommended CDE
3 FIM instrument Motor subscale, self-care - Grooming scale  Scaled ability of a subject to groom independently, as part of the Motor subscale - self-care of the FIM instrument FIMMotorSelfCareGroomingScl Recommended CDE
4 FIM instrument Motor subscale, self-care - Bathing scale  Scaled ability of a subject to bath independently, as part of the Motor subscale - self-care of the FIM instrument FIMMotorSelfCareBathingScl Recommended CDE
5 FIM instrument Motor subscale, self-care - Dressing lower body scale  Scaled ability of a subject to dress lower body independently, as part of the Motor subscale - self-care of the FIM instrument FIMMotorSelfCareDresLowBodyScl Recommended CDE
6 FIM instrument Motor subscale, self-care - Dressing upper body scale  Scaled ability of a subject to dress upper body independently, as part of the Motor subscale - self-care of the FIM instrument FIMMotorSelfCareDresUppBodyScl Recommended CDE
7 FIM instrument Motor subscale, self-care - Toileting scale  Scaled ability of a subject to toilet independently, as part of the Motor subscale - self-care of the FIM instrument FIMMotorSelfCareToiletingScl Recommended CDE
8 FIM instrument Motor subscale, sphincter control - Bladder management scale  Scaled ability of a subject control/manage their bladder, as part of the Motor subscale - sphincter control of the FIM instrument FIMMotorSphContrBladderMgmtScl Recommended CDE
9 FIM instrument Motor subscale, sphincter control - Bowel management scale  Scaled ability of a subject control/manage their bowel, as part of the Motor subscale - sphincter control of the FIM instrument FIMMotorSphContrBowelMgmtScl Recommended CDE
10 FIM instrument Motor subscale, transfers - Bed, chair, wheelchair scale  Scaled ability of a subject to transfer themselves to/from a bed, chair, wheelchair, as part of Motor subscale - transfers of the FIM instrument FIMMotorTransfBedChairWChScl Recommended CDE
11 FIM instrument Motor subscale, transfers - Toilet scale  Scaled ability of a subject to transfer themselves to/from a toilet, as part of Motor subscale - transfers of the FIM instrument FIMMotorTransfToiletScl Recommended CDE
12 FIM instrument Motor subscale, transfers - Tub or shower scale  Scaled ability of a subject to transfer themselves to/from tub or shower, as part of Motor subscale - transfers of the FIM instrument FIMMotorTransfTubShowerScl Recommended CDE
13 FIM instrument Motor subscale, locomotion - Walk/wheelchair  Scaled ability of a subject to walk or use a wheelchair, as part of Motor subscale - locomotion of the FIM instrument FIMMotorLocomotionWalkWCScl Recommended CDE
14 FIM instrument Motor subscale - Locomotion mode type  Type of locomotion used by the subject (walk/wheelchair/both), as part of Motor subscale the FIM instrument FIMMotorLocomotionModeTyp Recommended CDE
15 FIM instrument Motor subscale, locomotion - Stairs scale  Scaled ability of a subject to walk stairs, as part of Motor subscale - locomotion of the FIM instrument FIMMotorLocomotionStairsScl Recommended CDE

Comprehension (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Visit type  The type of visit from the visit types available for this particular study VisitTyp Recommended CDE
2 FIM instrument Cognitive subscale, communication - Comprehension scale  Scaled ability of a subject to comprehend (auditory/visual/both), as part of Cognitive subscale of the FIM instrument FIMCognCompehensScl Recommended CDE
3 FIM instrument Cognitive subscale, communication - Usual mode of comprehension/expression type  Type of usual mode of comprehension (auditory/visual/both), as part of Cognitive subscale of the FIM instrument FIMCognCompehensExpressModeTyp Recommended CDE

Expression (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Visit type  The type of visit from the visit types available for this particular study VisitTyp Recommended CDE
2 FIM instrument Cognitive subscale, communication - Expression scale  Scaled ability of a subject to express themselves, as part of Cognitive subscale of the FIM instrument FIMCognExpressionScl Recommended CDE
3 FIM instrument Cognitive subscale, communication - Usual mode of comprehension/expression type  Type of usual mode of comprehension (auditory/visual/both), as part of Cognitive subscale of the FIM instrument FIMCognCompehensExpressModeTyp Recommended CDE

Social Cognition (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Visit type  The type of visit from the visit types available for this particular study VisitTyp Recommended CDE
2 FIM instrument Cognitive subscale - Social interaction scale  Scaled ability of a subject to handle social interactions, as part of Cognitive subscale of the FIM instrument FIMCognSoclInteractScl Recommended CDE
3 FIM instrument Cognitive subscale - Problem solving scale  Scaled ability of a subject to handle problem solving, as part of Cognitive subscale of the FIM instrument FIMCognProbSolvScl Recommended CDE
4 FIM instrument Cognitive subscale - Memory scale  Scaled ability of a subject to memorize, as part of Cognitive subscale of the FIM instrument FIMCognMemoryScl Recommended CDE

Scores (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Visit type  The type of visit from the visit types available for this particular study VisitTyp Recommended CDE
2 FIM instrument - Motor subscore  Motor functions subscore, as part of the Motor subscale of the FIM instrument FIMInstrMotorSubscore Recommended CDE
3 FIM instrument - Cognitive functions subscore  Cognitive functions subscore, as part of the Cognitive subscale of the FIM instrument FIMInstrCognFunctSubscore Recommended CDE
4 FIM instrument - Total score  Total score for the FIM instrument FIMInstrTotalScore Recommended CDE

 Change History

 Administrative Change History