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

 General Details

Title:
Neuro-QoL Pediatric Cognitive Function Long Form
Short Name:
NeuroQoLPedCogLF
Description:
NeuroQoL Pediatric Cognitive Function Long Form. Copyright 2008-2013 David Cella and the PROMIS Health Organization on behalf of the National Institute for Neurological Disorders and Stroke (NINDS)
Disease:
Traumatic Brain Injury , General (For all diseases)
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-12-23
Owner:
Number of Data Elements:
35
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 Cognitive Function LF (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Forget schoolwork scale  The scale representing how often the participant forgets schoolwork that he or she needs to do, as part of Neuro-QOL Cognitive Function. QoLForgetSchlwrkScl Recommended CDE
2 Quality of Life - Forget word scale  The scale representing how often the participant sometimes forgets what he or she is going to say, as part of Neuro-QOL Cognitive Function. QoLForgetWordScl Recommended CDE
3 Quality of Life - Slower reaction scale  The scale representing how often the participant reacts slower than most people his or her age when he or she plays games, as part of Neuro-QOL Cognitive Function. QoLSlowerReactionScl Recommended CDE
4 Quality of Life - Forget easy scale  The scale representing how often the participant forgets things easily, as part of Neuro-QOL Cognitive Function. QoLForgetEasyScl Recommended CDE
5 Quality of Life - Trouble remembering scale  The scale representing how often the participant has trouble remembering to do things (e.g., school), as part of Neuro-QOL Cognitive Function. QoLTroubleRememberingScl Recommended CDE
6 Quality of Life - Trouble concentrating scale  The scale representing how often the participant finds it hard to concentrate in school, as part of Neuro-QOL Cognitive Function. QoLTroubleConcentratingScl Recommended CDE
7 Quality of Life - Trouble paying attention scale  The scale representing how often the participant has trouble paying attention to the teacher, as part of Neuro-QOL Cognitive Function. QoLToublePayingAttentionScl Recommended CDE
8 Quality of Life - Concentrate extra to avoid mistake scale  The scale representing how often the participant has to work really hard to pay attention or he or she will make a mistake, as part of Neuro-QOL Cognitive Function. QoLCncntrteExtraAvdMstkeScl Recommended CDE
9 Quality of Life - Trouble keeping track work scale  The scale representing how often the participant has a hard time keeping track of his or her homework, as part of Neuro-QOL Cognitive Function. QoLTroubleKeepingTrackWorkScl Recommended CDE
10 Quality of Life - Forget homework material scale  The scale representing how often the participant forgets to bring books or worksheets home that he or she needs for homework, as part of Neuro-QOL Cognitive Function. QoLForgetHomeworkMaterialScl Recommended CDE
11 Quality of Life - Read several times scale  The scale representing how often the participant has to read something several times to understand it, as part of Neuro-QOL Cognitive Function. QoLReadSeveralTimesScl Recommended CDE
12 Quality of Life - Trouble selecting word scale  The scale representing how often the participant finds it hard to find the right words to say what he or she means, as part of Neuro-QOL Cognitive Function. QoLToubleSelectingWordScl Recommended CDE
13 Quality of Life - Longer time schoolwork scale  The scale representing how often the participant takes longer than other people to get his or her schoolwork done, as part of Neuro-QOL Cognitive Function. QoLLongerTimeSchoolworkScl Recommended CDE
14 Quality of Life - List necessary scale  The scale representing how often the participant has to use written lists more often than other people his or her age so that he or she will not forget things, as part of Neuro-QOL Cognitive Function. QoLListNecessaryScl Recommended CDE

NeuroQol Scores (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