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

 General Details

Title:
NIH Toolbox Sensation Domain Words In Noise Test
Short Name:
NIHTBWordsInNoiseTest
Description:
Sensation Domain: The NIH Toolbox Words-in-Noise Test (WIN) measures a person’s ability to recognize single words presented amid varying levels of background noise. It measures how much difficulty a person might have hearing in a noisy environment. A recorded voice instructs the participant to listen to and then repeat words. The task becomes increasingly difficult as the background noise gets louder, thus reducing the signal-to-noise ratio. The test is recommended for participants ages 6-85 and takes approximately six minutes to administer. This test is part of the NIH Toolbox Sensation Domain Audition Measure. 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:
2016-06-01
Owner:
Number of Data Elements:
41
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 Words In Noise Test: List 1 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Ear type 

(Draft)

Type of ear EarTyp Recommended UDE
2 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Word type  Type of word being used, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINWordTyp Recommended CDE
3 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Decibel level number  Number for decibel level being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINdBLvlNum Recommended CDE
4 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Correct response indicator  Indicator of correct response, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINCorrectRespInd Recommended CDE

NIH Toolbox Words In Noise Test: List 2 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Ear type 

(Draft)

Type of ear EarTyp Recommended UDE
2 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Word type  Type of word being used, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINWordTyp Recommended CDE
3 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Decibel level number  Number for decibel level being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINdBLvlNum Recommended CDE
4 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Correct response indicator  Indicator of correct response, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINCorrectRespInd Recommended CDE

NIH Toolbox Word In Noise Test Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Total correct words count  Count of total correct words, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINTtlCorrectWrdCt Recommended CDE
2 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Hearing loss type  Type of hearing loss, as part of the NIH Toolbox Sensation Domain Audition Measure Words in Noise Test NIHTBWINHearingLossTyp Recommended CDE
3 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Dominant Ear Raw Score  Raw score for the dominant ear, as a part of the NIH Toolbox Sensation Domain Audition Measure Words In Noise Test NIHTBWINDomintEarRawScore Recommended CDE
4 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Non dominant ear raw score  Raw score for the non dominant ear, as a part of the NIH Toolbox Sensation Domain Audition Measure Words In Noise Test NIHTBWINNonDomintEarRawScore Recommended CDE
5 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Non dominant ear percent correct score  Percent correct score for the non dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test NIHTBWINNDmintEarPrcntCrtScore Recommended CDE
6 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Dominant ear percent correct score  Percent correct score for the dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test NIHTBWINDomtEarPercntCortScore Recommended CDE
7 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Dominant ear computed score  Computed score for the dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test NIHTBWINDomintEarComputedScore Recommended CDE
8 NIH Toolbox Sensation Domain Audition Measure Words in Noise Test - Non dominant ear computed score  Computed score for the non dominant ear, as a part of the NIH Toolbox Sensation Domain Audtion Measure Words in Noise Test NIHTBWINNonDomintEarCompScore Recommended CDE
9 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