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

 General Details

Title:
Neuro-QoL Pediatric Anxiety Short Form
Short Name:
NeuroQoLPedAnxietySF
Description:
NeuroQoL Pediatric Anxiety Short Form
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:
2016-12-29
Owner:
Number of Data Elements:
29
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

NeuroQoL Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life in Neurological Disorders (Neuro-Qol) - Form administered status  The specific Neuro-Qol form administered status, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLFormStatus Recommended CDE

Pediatric Anxiety Short Form (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Afraid alone assessment past week scale  The scale representing how often the participant felt afraid to go out alone in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLAfrdAloneAssmtPstWkScl Recommended CDE
2 Quality of Life - Worry create friend difficulty assessment past week scale  The scale representing how often the participant found that being worried made it hard for him or her to be with his or her friends in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLFrdDfcltyAssmtPstWkScl Recommended CDE
3 Quality of Life - Worry schoolwork difficulty assessment past week scale  The scale representing how often the participant found it was hard to do schoolwork because I was nervous or worried in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLWrkDfcltyAssmtPstWkScl Recommended CDE
4 Quality of Life - Afraid assessment past week scale  The scale representing how often the participant felt afraid in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLAfraidAssmtPstWkScl Recommended CDE
5 Quality of Life - Worry home assessment past week scale  The scale representing how often the participant worried when he or she was at home in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLWrryHomeAssmtPstWkScl Recommended CDE
6 Quality of Life - Worry assessment past week scale  The scale representing how often the participant felt worried in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLWorryAssmtPstWkScl Recommended CDE
7 Quality of Life - Worry health assessment past week scale  The scale representing how often the participant worried that his or her health might get worse in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLWorryHlthAssmtPstWkScl Recommended CDE
8 Quality of Life - Worry school assessment past week scale  The scale representing how often the participant worried about doing well in school in the past 7 days, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QOLWrySchoolAssmtPstWkScl Recommended CDE

NeuroQol Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life in Neurological Disorders (Neuro-Qol) - Items completed count  The count of items on the Neuro-Qol form completed by the participant, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLItemCompletedCount Recommended CDE
2 Quality of Life in Neurological Disorders (Neuro-Qol) - Raw score  The participant's raw score on the Neuro-Qol form, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLRawScore Recommended CDE
3 Quality of Life in Neurological Disorders (Neuro-Qol) - Standard error  Standard error, as part of the Quality of Life in Neurological Disorders (Neuro-Qol) QoLStandardError Recommended CDE
4 Quality of Life in Neurological Disorders (Neuro-Qol) - T-score value  The value of the T-score, a standardized score with a mean of 50 and a standard deviation (SD) of 10 representing the rescaled raw score, as part of the Quality of Life in Neurological Disorders (Neuro-Qol).(PROMIS). QoLTScore Recommended CDE
5 Quality of Life in Neurological Disorders (Neuro-Qol) - Theta value  Theta metric value reported from the CAT Neuro-Qol results, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLThetaVal Recommended CDE

 Change History

 Administrative Change History