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

 General Details

Title:
Neuro-Qol Item Bank v1.0 - Anxiety
Short Name:
NeuroQolAnxiety
Description:
This form contains the entire contents of the Neuro-QOL Item Bank v1.0 questions for Anxiety. This form can be used in it's entirety, or partly for the short form.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-11-03
Version:
1.0
Date Created:
2015-09-11
Owner:
Number of Data Elements:
39
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 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

In the past 7 days (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Patient-Reported Outcome Measurement Information System (PROMIS) - feel uneasy past week scale  The scale which represents how often the participant felt uneasy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltUneasyScale Recommended CDE
2 Patient-Reported Outcome Measurement Information System (PROMIS) - feel nervous past week scale  The scale which represents how often the participant felt nervous in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltNervousScale Recommended CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - many situations made worry past week scale  The scale which represents how often many situations made the participant worry in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISManySitsMadeWorryScale Recommended CDE
4 Patient-Reported Outcome Measurement Information System (PROMIS) - worries overwhelmed past week scale  The scale which represents how often the participant's worries overwhelmed him in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISWorriesOverwhelmedScale Recommended CDE
5 Patient-Reported Outcome Measurement Information System (PROMIS) - feel tense past week scale  The scale which represents how often the participant felt tense in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltTenseScale Recommended CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - difficult calm down past week scale  The scale which represents how often the participant had difficulty calming down in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISDifficultyCalmDownScale Recommended CDE
7 Patient-Reported Outcome Measurement Information System (PROMIS) - sudden feelings panic past week scale  The scale which represents how often the participant had sudden feelings of panic in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSuddenFeelingsOfPncScale Recommended CDE
8 Quality of Life - Normal routine disturbance nervousness past week scale  The scale representing how often the participant felt nervous when their normal routine was disturbed in the past 7 days, as part of Neuro-QOL Anxiety. QoLNrmRoutnDisturbncNrvsnssScl Recommended CDE
9 Quality of Life - Future fear assessment past week scale  The scale representing how often the participant felt fearful about their future in the past 7 days, as part of Neuro-QOL Anxiety. QoLFutureFearAssessmentScl Recommended CDE
10 Patient-Reported Outcome Measurement Information System (PROMIS) - feel anxious past week scale  The scale which represents how often the participant felt anxious in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltAnxiousScale Recommended CDE
11 Quality of Life - Physical health worry past week scale  The scale which represents how often the participant worried about their physical health, as part of Neuro-QOL Anxiety. QoLPhysicalHealthWorryScl Recommended CDE
12 Patient-Reported Outcome Measurement Information System (PROMIS) - feel need help with anxiety past week scale  The scale which represents how often the participant felt like help was needed for his anxiety in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFltHlpNeedFrAnxietyScale Recommended CDE
13 Patient-Reported Outcome Measurement Information System (PROMIS) - easily startled past week scale  The scale which represents how often the participant was easily startled in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISEasilyStartledScale Recommended CDE
14 Patient-Reported Outcome Measurement Information System (PROMIS) - feel fidgety past week scale  The scale which represents how often the participant felt fidgety in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltFidgetyScale Recommended CDE
15 Patient-Reported Outcome Measurement Information System (PROMIS) - feel something awful would happen past week scale  The scale which represents how often the participant felt something awful would happen in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSomethingAwflHappenScale Recommended CDE
16 Patient-Reported Outcome Measurement Information System (PROMIS) - feel worried past week scale  The scale which represents how often the participant felt worried in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltWorriedScale Recommended CDE
17 Quality of Life - No reason fear assessment past week scale  The scale which represents how often the participant suddenly felt scared for no reason in the past 7 days, as part of Neuro-QOL Anxiety. QoLNoReasonFearAssessmentScl Recommended CDE
18 Quality of Life - Death worry past week scale  The scale representing how often the participant worried about dying in the past 7 days, as part of Neuro-QOL Anxiety. QoLDeathWorryScl Recommended CDE
19 Quality of Life - Shyness assessment past week scale  The scale which represents how often the patient felt shy in the past 7 days, as part of Neuro-QOL Anxiety. QoLShynessAssessmentScl Recommended CDE
20 Patient-Reported Outcome Measurement Information System (PROMIS) - difficult sleep past week scale  The scale which represents how often the participant had difficulty sleeping in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISDifficultySleepingScale Recommended CDE
21 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble relax past week scale  The scale which represents how often the participant had trouble relaxing in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTroubleRelaxingScore Recommended CDE

Scoring (Repeat Infinitely)

# 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
2 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
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) - 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
5 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
6 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

 Change History

 Administrative Change History