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

 General Details

Title:
NIH Toolbox Emotion Domain Emotional Support Survey 8-17
Short Name:
NIHTBEmotionSupport8to17
Description:
The NIH Toolbox Emotional Support Survey is a self-report measure that assesses emotional support through two fixed-length forms: an 8-item form for ages 18-85 and a 7-item form for ages 8-17. There are no Parent-Report versions. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
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:
2016-07-15
Owner:
Number of Data Elements:
40
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 Emotional Support Survey Ages 8-17 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotional Support - Understands scale  Scale of participant report of statement: I have someone who understands my problems, during the past month, for participants ages 18+ as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSFUnderstandsScl Recommended CDE
2 NIH Toolbox Emotional Support - Listens scale  Scale of participant report of statement: I have someone who will listen to me when I need to talk, during the past month, for participants ages 18+ as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSFListensScl Recommended CDE
3 NIH Toolbox Emotional Support - Bad day scale  Scale of participant report of statement: I have someone to talk with when I have a bad day, during the past month, for participants ages 18+ as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSFBadDayScl Recommended CDE
4 NIH Toolbox Emotional Support Short Form 8-17 - Help scale  Scale of participant report of statement: There is someone around to help me if I need it, during the past month, for participants ages 8-17 as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSF8to17HelpScl Recommended CDE
5 NIH Toolbox Emotional Support - Advice scale  Scale of participant report of statement: I can get helpful advice from others when dealing with a problem, during the past month, for participants ages 18+ as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSFAdviceScl Recommended CDE
6 NIH Toolbox Emotional Support Short Form 8-17 - Useful scale  Scale of participant report of statement: I can get useful advice about important things in my life, during the past month, for participants ages 8-17 as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSF8to17UsefulScl Recommended CDE
7 NIH Toolbox Emotional Support Short Form 8-17 - Problems scale  Scale of participant report of statement: I have someone to talk with about school problems, during the past month, for participants ages 8-17 as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSF8to17ProblemsScl Recommended CDE

NIH Toolbox Emotional Support 8-17 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotional Support 18+ - Raw score  Raw score, during the past month, for participants ages 18+ as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSF18RawScore Recommended CDE
2 NIH Toolbox Emotional Support 18+ - Theta score  Theta score, during the past month, for participants ages 18+ as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSF18ThetaScore Recommended CDE
3 NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted scale score  Age-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROAgeAdjSclScore Recommended CDE
4 NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted national percentile value  Value of age-adjusted national percentile, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROAgeAdjNationalPctVal Recommended CDE
5 NIH Toolbox Patient Reported Outcome (PRO) Measures - Fully-adjusted scale score  Fully-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROFullyAdjSclScore Recommended CDE
6 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
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
8 NIH Toolbox Emotional Support Short Form 8-17 - Raw score  Raw score, during the past month, for participants ages 8-17 as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSF8to17RawScore Recommended CDE
9 NIH Toolbox Emotional Support Short Form 8-17 - Theta score  Theta score, during the past month, for participants ages 8-17 as part of the NIH Toolbox Emotional Support Survey Short Form NIHTBESSF8to17ThetaScore Recommended CDE

 Change History

 Administrative Change History