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

 General Details

Title:
NIH Toolbox Emotion Domain Instrumental Support Survey SF Ages 18-85
Short Name:
NIHTBInstrmtlSuprtSF18to85
Description:
The NIH Toolbox Instrumental Support Survey is a self - report measure that assesses Instrumental Support for ages 18-85,using an 8-item fixed-length form. No versions for other ages are available. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-07-07
Owner:
Number of Data Elements:
39
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 Instrumental Support SF Ages 18-85 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Meals scale  Scale of patient report of statement: Someone is around to make my meals if I am unable to do it myself, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18MealsScl Recommended CDE
2 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Shopping scale  Scale of patient report of statement: I have someone to take me shopping if I need it, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18ShoppingScl Recommended CDE
3 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Sick scale  Scale of patient report of statement: I have someone to help me if I'm sick in bed, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18SickScl Recommended CDE
4 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Medicine scale  Scale of patient report of statement: I have someone to pick up medicine for me if I need it, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18MedicineScl Recommended CDE
5 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Doctor scale  Scale of patient report of statement: I have someone to take me to the doctor if I need it, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form NIHTBISSF18DoctorScl Recommended CDE
6 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Help scale  Scale of patient report of statement: There is a someone around to help me if I need it, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18HelpScl Recommended CDE
7 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Drive scale  Scale of patient report of statement: I can find someone to drive me places if I need it, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18DriveScl Recommended CDE
8 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Cleaning scale  Scale of patient report of statement: I can get help cleaning up around my home if I need it, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18CleaningScl Recommended CDE

NIH Toolbox Instrumental Support SF Ages 18-85 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Raw Score  Raw score, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18RawScore Recommended CDE
2 NIH Toolbox Emotion Instrumental Support Short Form 18+ - Theta Score  Theta score, in the past month, for ages 18+, as part of the NIH Toolbox Emotion Battery Instrumental Support Survey Short Form. NIHTBISSF18ThetaScore 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

 Change History

 Administrative Change History