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

 General Details

Title:
Health and Behavior Inventory (HBI) Parent Retrospective Version
Short Name:
HBIParentRetro20
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
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 Retrospective Version (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Health and Behavior Inventory (HBI) - parent retrospective sustain attention trouble scale  Scale for how often the parent thinks the patient/subject had trouble sustaining attention four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetSustAttenTroubScale Optional CDE
2 Health and Behavior Inventory (HBI) - parent retrospective easily distract scale  Scale for how often the parent thinks the patient/subject had been easily distracted four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetEslyDistrctScale Optional CDE
3 Health and Behavior Inventory (HBI) - parent retrospective concentration difficulty scale  Scale for how often the parent thinks the patient/subject had difficulty concentrating four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetConcenDfcltyScale Optional CDE
4 Health and Behavior Inventory (HBI) - parent retrospective memory problem scale  Scale for how often the parent thinks the patient/subject had problems remembering what he/she was told four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetMemProbScale Optional CDE
5 Health and Behavior Inventory (HBI) - parent retrospective direction difficulty scale  Scale for how often the parent thinks the patient/subject had difficulty following directions four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetDirDfcltyScale Optional CDE
6 Health and Behavior Inventory (HBI) - parent retrospective daydream scale  Scale for how often the parent thinks the patient/subject tended to daydream four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetDaydrmScale Optional CDE
7 Health and Behavior Inventory (HBI) - parent retrospective confusion scale  Scale for how often the parent thinks the patient/subject had gotten confused four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetConfusScale Optional CDE
8 Health and Behavior Inventory (HBI) - parent retrospective forgetful scale  Scale for how often the parent thinks the patient/subject was forgetful four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetFrgtflScale Optional CDE
9 Health and Behavior Inventory (HBI) - parent retrospective completion difficulty scale  Scale for how often the parent thinks the patient/subject had difficulty completing tasks four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetCompletDfcltyScale Optional CDE
10 Health and Behavior Inventory (HBI) - parent retrospective poor problem solve skill scale  Scale for how often the parent thinks the patient/subject had poor problem-solving skills four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetPrProbSlveSklScale Optional CDE
11 Health and Behavior Inventory (HBI) - parent retrospective learn problem scale  Scale for how often the parent thinks the patient/subject had problems learning four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetLernProbScale Optional CDE
12 Health and Behavior Inventory (HBI) - parent retrospective headache frequency scale  Scale for how often the parent thinks the patient/subject had headaches four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetHeadachFreqScale Optional CDE
13 Health and Behavior Inventory (HBI) - parent retrospective dizziness scale  Scale for how often the parent thinks the patient/subject had felt dizzy four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetDizScale Optional CDE
14 Health and Behavior Inventory (HBI) - parent retrospective room spin scale  Scale for how often the parent thinks the patient/subject had a feeling that the room is spinning during the past week, as a part of Health Behavior Inventory (HBI). HBIParRetRoomSpinScale Optional CDE
15 Health and Behavior Inventory (HBI) - parent retrospective feel faint scale  Scale for how often the parent thinks the patient/subject had felt faint four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetFeelFantScale Optional CDE
16 Health and Behavior Inventory (HBI) - parent retrospective blur vision scale  Scale for how often the parent thinks the patient/subject had blurred vision four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetBlurVisScale Optional CDE
17 Health and Behavior Inventory (HBI) - parent retrospective double vision scale  Scale for how often the parent thinks the patient/subject had double vision four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetDblVisScale Optional CDE
18 Health and Behavior Inventory (HBI) - parent retrospective nausea scale  Scale for how often the parent thinks the patient/subject experienced nausea four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetNausScale Optional CDE
19 Health and Behavior Inventory (HBI) - parent retrospective tired frequency scale  Scale for how often the parent thinks the patient/subject had gotten tired a lot four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetTiredFreqScale Optional CDE
20 Health and Behavior Inventory (HBI) - parent retrospective tired easily scale  Scale for how often the parent thinks the patient/subject had gotten tired easily four weeks prior to the injury, as a part of Health Behavior Inventory (HBI). HBIParRetTrdEslyScale Optional CDE

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

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

 Change History

 Administrative Change History