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

 General Details

Title:
Health and Behavior Inventory (HBI) Parent Current Version
Short Name:
HBIParentCurrent20
Description:
The HBI consists of 20 items that measure the frequency of post-concussive symptoms. There are three versions of the inventory - Child, Parent Current Version and Parent Retrospective Version. The Parent Retrospective Version is used for rating pre-injury symptoms retrospectively. References: Ayr, L., Yeates, K., Taylor, H., and Brown, M. (2009). Dimensions of postconcussive symptoms in children with mild traumatic brain injuries. J Int Neuropsychol Soc 15, 19-30.
Disease:
Traumatic Brain Injury , General (For all diseases)
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-10-12
Version:
1.0
Date Created:
2016-10-12
Owner:
Number of Data Elements:
35
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

HBI Parent Current Version (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Health and Behavior Inventory (HBI) - parent current sustain attention trouble scale  How often the parent thinks the patient/subject has had trouble sustaining attention during the past week HBIParCurntSustAttenTroubScale Optional CDE
2 Health and Behavior Inventory (HBI) - parent current easily distracted scale  How often the parent thinks the patient/subject has been easily distracted during the past week HBIParCurntEslyDistrctScale Optional CDE
3 Health and Behavior Inventory (HBI) - parent current concentration difficulty scale  How often the parent thinks the patient/subject has had difficulty concentrating during the past week HBIParCurntConcenDfcltyScale Optional CDE
4 Health and Behavior Inventory (HBI) - parent current memory problem scale  How often the parent thinks the patient/subject has had problems remembering what he/she was told during the past week HBIParCurntMemProbScale Optional CDE
5 Health and Behavior Inventory (HBI) - parent current direction difficulty scale  How often the parent thinks the patient/subject has had difficulty following directions during the past week HBIParCurntDirectDfcltyScale Optional CDE
6 Health and Behavior Inventory (HBI) - parent current daydream scale  How often the parent thinks the patient/subject has tended to daydream during the past week HBIParCurntDaydrmScale Optional CDE
7 Health and Behavior Inventory (HBI) - parent current confusion scale  How often the parent thinks the patient/subject has gotten confused during the past week HBIParCurntConfusScale Optional CDE
8 Health and Behavior Inventory (HBI) - parent current forgetful scale  How often the parent thinks the patient/subject has been forgetful during the past week HBIParCurntFrgtflScale Optional CDE
9 Health and Behavior Inventory (HBI) - parent current completion difficulty scale  How often the parent thinks the patient/subject has had difficulty completing tasks during the past week HBIParCurntCompletDfcltyScale Optional CDE
10 Health and Behavior Inventory (HBI) - parent current poor problem solve skill scale  How often the parent thinks the patient/subject has had poor problem-solving skills during the past week HBIParCurntPrProbSlveSklScale Optional CDE
11 Health and Behavior Inventory (HBI) - parent current learning problem scale  How often the parent thinks the patient/subject has had problems learning during the past week HBIParCurntLearnProbScale Optional CDE
12 Health and Behavior Inventory (HBI) - parent current headache frequency scale  How often the parent thinks the patient/subject has had problems learning during the past week HBIParCurntHeadachFreqScale Optional CDE
13 Health and Behavior Inventory (HBI) - parent current dizziness scale  How often the parent thinks the patient/subject has felt dizzy during the past week HBIParCurntDizScale Optional CDE
14 Health and Behavior Inventory (HBI) - parent current room spin scale  How often the parent thinks the patient/subject has had a feeling that the room is spinning during the past week HBIParCurntRoomSpinScale Optional CDE
15 Health and Behavior Inventory (HBI) - parent current feel faint scale  How often the parent thinks the patient/subject has felt faint during the past week HBIParCurntFeelFantScale Optional CDE
16 Health and Behavior Inventory (HBI) - parent current blurred vision scale  How often the parent thinks the patient/subject has had blurred vision during the past week HBIParCurntBlurVisScale Optional CDE
17 Health and Behavior Inventory (HBI) - parent current double vision scale  How often the parent thinks the patient/subject has had double vision during the past week HBIParCurntDblVisScale Optional CDE
18 Health and Behavior Inventory (HBI) - parent current nausea scale  How often the parent thinks the patient/subject has experienced nausea during the past week HBIParCurntNausScale Optional CDE
19 Health and Behavior Inventory (HBI) - parent current tired frequency scale  How often the parent thinks the patient/subject has gotten tired a lot during the past week HBIParCurntTiredFreqScale Optional CDE
20 Health and Behavior Inventory (HBI) - parent current tired easily scale  How often the parent thinks the patient/subject has gotten tired easily during the past week HBIParCurntTrdEslyScale Optional CDE

HBI Parent Current Version Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Health and Behavior Inventory (HBI) - Parent Current Version cognitive total score  Sum of cognitive items 1-11 (0-33) HBIPCVCognitvTotlScore Optional CDE
2 Health and Behavior Inventory (HBI) - Parent Current Version somatic total score  Sum of somatic items 12-20 (0-27) HBIPCVSomatTotlScore Optional CDE

 Change History

 Administrative Change History