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

 General Details

Title:
NIH Toolbox Sensation Domain Hearing Handicap Inventory (Supplementary Measure)
Short Name:
NIHTBHearingHandicpInvntry
Description:
This supplemental instrument is a brief, reliable self-report measure of hearing-related disability. There is a 10-item survey for adults ages 18-64, and another 10-item form for ages 65-85. This survey has validity in studies that examine correlations with audiometric testing (e.g., pure tone audiometry, such as the NIH Toolbox Hearing Threshold Test). This test can be administered to participants ages 18 and older and requires three minutes to administer. 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:
2016-06-20
Owner:
Number of Data Elements:
48
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 HHIE-Screening (HHIE-S) (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Hearing Handicap Inventory (HHI) - Embarrassed to meet new people scale  Scale of when a hearing problem causes the subject to feel embarrassed when meeting new people, as part of the Hearing Handicap Inventory (HHI) HHIEmbarrasMeetNewPplScl Recommended CDE
2 Hearing Handicap Inventory (HHI) - Frustrated talking to family scale  Scale of when a hearing problem causes the subject to feel frustrated when talking to members of the family, as part of the Hearing Handicap Inventory (HHI) HHIFrustratTalkFamilyScl Recommended CDE
3 Hearing Handicap Inventory(HHI) - Difficulty hearing when someone whispers scale  Scale of when the subject has difficulty hearing when someone speaks in a whisper, as part of the Hearing Handicap Inventory(HHI) HHIDiffHearWhisperScl Recommended CDE
4 Hearing Handicap Inventory (HHI) - Felt handicapped by hearing problem scale  Scale of when the subject feels handicapped by a hearing problem, as part of the Hearing Handicap Inventory (HHI) HHIFeltHandcapHearProbScl Recommended CDE
5 Hearing Handicap Inventory (HHI) - Difficulty hearing when visiting friends scale  Scale of when a hearing problem causes the subject difficulty when visiting friends, relatives, or neighbors, as part of the Hearing Handicap Inventory (HHI) HHIDiffHearVisitFriendScl Recommended CDE
6 Hearing Handicap Inventory (HHI) - Limits religious attendance scale  Scale of when a hearing problem causes the subject to attend religious services less often than they would like, as part of the Hearing Handicap Inventory (HHI) HHILimitReligiousAttndScl Recommended CDE
7 Hearing Handicap Inventory (HHI) - Causes arguments with family scale  Scale of when a hearing problem causes the subject to have arguments with family members, as part of the Hearing Handicap Inventory (HHI) HHICauseArgumntFamilyScl Recommended CDE
8 Hearing Handicap Inventory (HHI) - Difficulty listening to TV scale  Scale of when a hearing problem causes the subject difficulty when listening to TV or radio, as part of the Hearing Handicap Inventory (HHI) HHIDiffListenTVScl Recommended CDE
9 Hearing Handicap Inventory (HHI) - Limits social life scale  Scale of when the subject feels that any difficulty with their hearing limits or hampers their personal or social life, as a part of the Hearing Handicap Inventory (HHI) HHILimitSocialLifeScl Recommended CDE
10 Hearing Handicap Inventory (HHI) - Difficulty hearing in restaurants scale  Scale of when a hearing problem causes the subject difficulty when in a restaurant with relatives or friends, as part of the Hearing Handicap Inventory (HHI) HHIDiffHearRestaurantScl Recommended CDE
11 Hearing Handicap Inventory (HHI) - 10 Item sum score  Sum score, as part of the 10-item Hearing Handicap Inventory (HHI) screening test HHIScreening10ItemSumScore Recommended CDE
12 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

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 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 HHIA-Screening (HHIA-S) (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Hearing Handicap Inventory (HHI) - Embarrassed to meet new people scale  Scale of when a hearing problem causes the subject to feel embarrassed when meeting new people, as part of the Hearing Handicap Inventory (HHI) HHIEmbarrasMeetNewPplScl Recommended CDE
2 Hearing Handicap Inventory (HHI) - Frustrated talking to family scale  Scale of when a hearing problem causes the subject to feel frustrated when talking to members of the family, as part of the Hearing Handicap Inventory (HHI) HHIFrustratTalkFamilyScl Recommended CDE
3 Hearing Handicap Inventory for Adults (HHIA) - Difficulty hearing at work scale  Scale of when a hearing problem causes the subject difficulty hearing/understanding coworkers, clients, or customers, as part of the Hearing Handicap Inventory (HHI) HHIADiffHearWorkScl Recommended CDE
4 Hearing Handicap Inventory (HHI) - Felt handicapped by hearing problem scale  Scale of when the subject feels handicapped by a hearing problem, as part of the Hearing Handicap Inventory (HHI) HHIFeltHandcapHearProbScl Recommended CDE
5 Hearing Handicap Inventory (HHI) - Difficulty hearing when visiting friends scale  Scale of when a hearing problem causes the subject difficulty when visiting friends, relatives, or neighbors, as part of the Hearing Handicap Inventory (HHI) HHIDiffHearVisitFriendScl Recommended CDE
6 Hearing Handicap Inventory for Adults (HHIA) - Difficulty hearing in movie theater scale  Scale of when a hearing problem causes the subject difficulty in movies or theater, as part of the Hearing Handicap Inventory for Adults (HHIA) HHIADiffHearMovieTheatrScl Recommended CDE
7 Hearing Handicap Inventory (HHI) - Causes arguments with family scale  Scale of when a hearing problem causes the subject to have arguments with family members, as part of the Hearing Handicap Inventory (HHI) HHICauseArgumntFamilyScl Recommended CDE
8 Hearing Handicap Inventory (HHI) - Difficulty listening to TV scale  Scale of when a hearing problem causes the subject difficulty when listening to TV or radio, as part of the Hearing Handicap Inventory (HHI) HHIDiffListenTVScl Recommended CDE
9 Hearing Handicap Inventory (HHI) - Limits social life scale  Scale of when the subject feels that any difficulty with their hearing limits or hampers their personal or social life, as a part of the Hearing Handicap Inventory (HHI) HHILimitSocialLifeScl Recommended CDE
10 Hearing Handicap Inventory (HHI) - Difficulty hearing in restaurants scale  Scale of when a hearing problem causes the subject difficulty when in a restaurant with relatives or friends, as part of the Hearing Handicap Inventory (HHI) HHIDiffHearRestaurantScl Recommended CDE
11 Hearing Handicap Inventory (HHI) - 10 Item sum score  Sum score, as part of the 10-item Hearing Handicap Inventory (HHI) screening test HHIScreening10ItemSumScore Recommended CDE
12 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