This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
NIH Toolbox Motor Domain 4-Meter Walk Gait Speed Test
Short Name:
NIHTB4MtrWlkGtSpeedTest
Description:
Motor Domain: The NIH Toolbox 4-Meter Walk Gait Speed Test is adapted from the 4-meter walk test in the Short Physical Performance Battery. Participants are asked to walk a short distance (four meters) at their usual pace. Participants complete one practice and then two timed trials. Raw scores are recorded as the time in seconds required to walk four meters on each of the two trials, with the better trial used for scoring. The test takes approximately three minutes to administer (including instructions and practice). This test is recommended for ages 7-85. This test is part of the NIH Toolbox Motor Domain Locomotion Measure.
Disease:
Traumatic Brain Injury
Organization:
BRICS/CIT/NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-07-01
Version:
1.0
Date Created:
2016-04-07
Owner:
Number of Data Elements:
29
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 (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

NIH Toolbox Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox - Test name type  Type of NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestNameTyp Recommended CDE
2 NIH Toolbox - Test name type other  The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox NIHTBAdminTestNameTypOTH Recommended CDE
3 NIH Toolbox - Test administration language type  Type of language for test being administrated, as part of the NIH Toolbox NIHTBTestAdminLanguageTyp Recommended CDE
4 NIH Toolbox - Test administration language type other  Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox NIHTBTestAdminLanguageTypOTH Recommended CDE
5 NIH Toolbox - Test domain battery type  Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox NIHTBTestDomainBatteryTyp Recommended CDE
6 NIH Toolbox - Test domain battery type other  The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox NIHTBTestDomainBatteryTypOTH Recommended CDE
7 NIH Toolbox - Form administered type  Type of NIH Toolbox form being administered, as part of the NIH Toolbox NIHTBFormAdminTyp Recommended CDE
8 NIH Toolbox - Test administration flag type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE
9 NIH Toolbox - Test administration flag indicator  Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagInd Recommended CDE

NIH Toolbox 4-Meter Walk Gait Speed Test (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Trial number (numeric)  The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. TrialNumber Recommended CDE
2 NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Trial 1 completion time duration  Duration of time to complete Trial 1, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test NIHTB4MWGSTrial1CompletnDur Recommended CDE
3 NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Trial 2 completion time duration  Duration of time to complete Trial 2, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test NIHTB4MWGSTrial2CompletnDur Recommended CDE
4 NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Unable to complete test indicator  Indicator that subject was unable to complete the test, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test NIHTB4MWGSUnableCompleteInd Recommended CDE
5 NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Best trial raw completion duration  Duration of trial with best raw completion time, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test NIHTB4MWGSBtTrialRawCompletDur Recommended CDE
6 NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test - Best trial computed score  Computed score (in meters per second) for trial with best completion time, as part of the NIH Toolbox Motor Domain Locomotion Measure 4-Meter Walk Gait Speed Test NIHTB4MWGSBtTrialCompScore Recommended CDE
7 NIH Toolbox - Standard error  Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox NIHTBStandardError Optional CDE

 Change History

 Administrative Change History