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

 General Details

Title:
NIH Toolbox Sensation Domain Visual Acuity Test
Short Name:
NIHTBVisualAcuityTest
Description:
The NIH Toolbox Visual Acuity Test directly measures participantsÂ’ visual acuity, or distance vision. For participants ages 3-7, only the letters H, O, T, and V are used, and children may point to a laminated card showing the letters if they cannot verbalize or cannot recall the letter names. For participants ages 8 and above, the entire set of optotypes is used, following a common protocol used in professional vision testing. This test takes approximately three minutes to administer and is recommended for ages 3-85. 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:
2016-06-03
Owner:
Number of Data Elements:
37
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 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 Visual Acuity Test: Practice Test (Appears Up To 3 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 Visual Acuity Test - Trial result type  Trial result type (correct or incorrect), as part of NIH Toolbox Sensation Domain Visual Acuity Test NIHTBVATrialResultType Recommended CDE
3 NIH Toolbox Sensation Domain Visual Acuity Test - Practice test completed successfully indicator  Indicator of whether participant has successfully completed the practice test, as a part of the NIH Toolbox Sensation Domain Vestibular Measure Visual Acuity Test NIHTBVAPracticeCmpltSuccssInd Recommended CDE

NIH Toolbox Visual Acuity Test (Appears Up To 1 Time)

# 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 Visual Acuity Test - Trial result type  Trial result type (correct or incorrect), as part of NIH Toolbox Sensation Domain Visual Acuity Test NIHTBVATrialResultType Recommended CDE

NIH Toolbox Visual Acuity Test Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test - Log minimum angle of resolution (MAR) score  Score for log of minimum angle of resolution (MAR), as part of the NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test NIHTBVALogMARScore Recommended CDE
2 NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test - Static visual acuity Snellen score  Snellen score for static visual acuity, as part of the NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test NIHTBVAStaticSnellenScore Recommended CDE
3 NIH Toolbox Performance Measures - Age-adjusted scale score  Age-adjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMAgeAdjSclScore Recommended CDE
4 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
5 NIH Toolbox Performance Measures - Fully-adjusted scale score  Fully-adjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMFullyAdjSclScore Recommended CDE
6 NIH Toolbox Performance Measures - Unadjusted scale score  Unadjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMUnadjSclScore Recommended CDE
7 NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test - Minimum angle of resolution (MAR) number  Number for the minimum angle of resolution (MAR), as part of the NIH Toolbox Sensation Domain Vision Measure Visual Acuity Test NIHTBVAMinAngleResolutionNum Recommended CDE
8 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