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

 General Details

Title:
NIH Toolbox Sensation Domain Odor Identification Test
Short Name:
NIHTBOdorIdentifnTest
Description:
The NIH Toolbox Odor Identification Test assesses a person’s ability to identify various odors. Participants use scratch-and-sniff cards and, after scratching them one at a time, are asked to identify which of four pictures on the computer screen matches the odor they have just smelled. Participants ages 10-85 are administered nine odor cards, while those ages 3-9 are administered five odor cards. Child participants (ages 3-9 years) are first asked to identify the eight pictures that are used as answer choices, to ensure they can complete the task. Having identified the pictures, they are asked if they have tasted or smelled the objects or foods depicted. This test takes approximately four to five minutes to administer and is recommended for ages 3-85. This test is part of the NIH Toolbox Sensation Domain Olfaction Measure. 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:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-08
Owner:
Number of Data Elements:
38
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 administration language type  Type of language for test being administrated, as part of the NIH Toolbox NIHTBTestAdminLanguageTyp Recommended CDE
2 NIH Toolbox - Test administration language type other  Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox NIHTBTestAdminLanguageTypOTH 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 flag type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE
6 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
7 NIH Toolbox - Form administered type  Type of NIH Toolbox form being administered, as part of the NIH Toolbox NIHTBFormAdminTyp Recommended CDE

NIH Toolbox Odor Identification Test: Part 1: Ages 3-9 (Appears Up To 16 Times)

# 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 Sensation Domain Olfaction Measure Odor Identification Test - Familiar odor picture type  Type of response to the picture of a familiar used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOIFamiliarOdorPictureTyp Recommended CDE
3 NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Familiar odor picture response type  Type of response to the picture of a familiar odor used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOIFamiliarOdorPictRespTyp Recommended CDE
4 NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Familiar picture taste and smell response type  Type of response to the taste and smell corresponding to the picture of a familiar odor used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOIPictureTastSmelRespTyp Recommended CDE

NIH Toolbox Odor Identification Test: Part 2: Ages 3-9 (Appears Up To 5 Times)

# 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 Sensation Domain Olfaction Measure Odor Identification Test - Odor card type  Type of odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOIOdorCardTyp Recommended CDE
3 NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Odor card response type  Type of response to the odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOIOdorCardResponseTyp Recommended CDE

NIH Toolbox Odor Identification Test: Ages 10-85 (Appears Up To 9 Times)

# 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 Sensation Domain Olfaction Measure Odor Identification Test - Odor card type  Type of odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOIOdorCardTyp Recommended CDE
3 NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Odor card response type  Type of response to the odor identification card used, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOIOdorCardResponseTyp Recommended CDE

NIH Toolbox Odor Identification Test: Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test - Number of odors correctly identified  Number of odors correctly identified, as part of the NIH Toolbox Sensation Domain Olfaction Measure Odor Identification Test NIHTBOICorrectNum Recommended CDE
2 NIH Toolbox Performance Measures - Age-adjusted scale score  Age-adjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMAgeAdjSclScore Recommended CDE
3 NIH Toolbox Performance Measures - Age-adjusted national percentile value  Value of age-adjusted national percentile, as part of the NIH Toolbox Performance Measures NIHTBPMAgeAdjNationalPctVal Recommended CDE
4 NIH Toolbox Performance Measures - Fully-adjusted scale score  Fully-adjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMFullyAdjSclScore Recommended CDE
5 NIH Toolbox Performance Measures - Unadjusted scale score  Unadjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMUnadjSclScore Recommended CDE
6 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