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

 General Details

Title:
Grooved Pegboard Test (GPT)
Short Name:
GPT
Description:
The Grooved Pegboard Test is a manipulative dexterity test involving a pegboard containing twenty-five holes with randomly positioned slots and pegs which have a key along one side. Pegs must be rotated to match the hole before they can be inserted. This procedure measures performance speed in a fine motor task by examining both sides of the body. This version of GPT with 25 pegs was developed for adults and adolescents, age range 15+-89. For children age 5-15 they should use GPT for Kiddies with only 10 pegs. Copyright 2002 by Lafayette Instrument Company, Inc. All Rights Reserved, www.lafayetteinstrument.com
Disease:
Traumatic Brain Injury
Organization:
Virginia Commonwealth University
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-08-13
Version:
1.2
Date Created:
2015-03-31
Owner:
Number of Data Elements:
22
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

Hand Preference Type (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Hand preference type  Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. HandPrefTyp Recommended CDE

Dominant Hand (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Hand preference type  Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. HandPrefTyp Recommended CDE
2 Grooved Pegboard Test (GPT) - Hand time duration  Duration of time for hand to place pegs as part of Grooved Pegboard Test (GPT) GPTHandTimDur Recommended CDE
3 Grooved Pegboard Test (GPT) - Hand time T-score  Hand time T-score to determine statistical significance for the hand time and pegs placed/dropped, as part of Grooved Pegboard Test (GPT) GPTTimeTScore Recommended CDE
4 Grooved Pegboard Test (GPT) - Hand pegs dropped number  Number of pegs dropped during hand test, as part of Grooved Pegboard Test (GPT) GPTHandPegDropNum Recommended CDE
5 Grooved Pegboard Test (GPT) - Hand pegs placed correctly number  Number of pegs placed correctly during hand test, as part of Grooved Pegboard Test (GPT) GPTHandPegCorrectNum Recommended CDE

Non-Dominant Hand (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Grooved Pegboard Test (GPT) - Hand time duration  Duration of time for hand to place pegs as part of Grooved Pegboard Test (GPT) GPTHandTimDur Recommended CDE
2 Grooved Pegboard Test (GPT) - Hand time T-score  Hand time T-score to determine statistical significance for the hand time and pegs placed/dropped, as part of Grooved Pegboard Test (GPT) GPTTimeTScore Recommended CDE
3 Grooved Pegboard Test (GPT) - Hand pegs dropped number  Number of pegs dropped during hand test, as part of Grooved Pegboard Test (GPT) GPTHandPegDropNum Recommended CDE
4 Grooved Pegboard Test (GPT) - Hand pegs placed correctly number  Number of pegs placed correctly during hand test, as part of Grooved Pegboard Test (GPT) GPTHandPegCorrectNum Recommended CDE

 Change History

 Administrative Change History