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

 General Details

Title:
NIH Toolbox Emotion Domain Apathy Survey 18-85
Short Name:
NIHTBApathySurvey18to85
Description:
The NIH Toolbox Apathy Survey is a supplemental measure that is a 7-item fixed-length self-report form for ages 18-85. There are no other versions. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx available.
Disease:
Traumatic Brain Injury , General (For all diseases)
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-07-14
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 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 Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended 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 Recommended CDE

NIH Toolbox Administration (Appears Up To 1 Time)

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

NIH Toolbox Apathy Survey Ages 18-85 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Interested in things scale  Scale for level of interest in things, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18InterestInThingsScl Recommended CDE
2 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Get things done scale  Scale for getting things done during the day, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18GetThingsDoneScl Recommended CDE
3 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Importance of starting things independently scale  Scale for importance of getting things started on their own, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18ImportStrtThngIndpScl Recommended CDE
4 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Importance of completing jobs scale  Scale for importance of seeing a job through to the end, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18ImportCompleteJobScl Recommended CDE
5 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Spending time on interesting things scale  Scale for spending time doing things that interest them, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18SpendTimIntrstThngScl Recommended CDE
6 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Importance of getting things done scale  Scale for importance of getting things done during the day, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18ImportGetThngDoneScl Recommended CDE
7 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Have motivation scale  Scale for having motivation, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18HaveMotivatnScl Recommended CDE

NIH Toolbox Apathy Survey Ages 18-85 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Raw score  Raw score, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18RawScore Recommended CDE
2 NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey 18-85 - Rasch/Item Response Theory (IRT) theta score  Rasch/Item Response Theory (IRT) theta score, for the ages of 18-85, as part of the NIH Toolbox Emotion Domain Negative Affect Subdomain Sadness Measure Apathy Survey NIHTBAS18ThetaScore Recommended CDE
3 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
4 NIH Toolbox Patient Reported Outcome (PRO) Measures - Unadjusted scale score  Unadjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROUnadjSclScore Recommended CDE

 Change History

 Administrative Change History