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

 General Details

Title:
Neuro-QoL Sleep Disturbance Short Form
Short Name:
NeuroQolSleepDisturbaSF
Description:
NeuroQoL Sleep Disturbance Short 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:
2016-12-28
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

Sleep Disturbance SF (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Force awake morning past week scale  The scale representing how often the participant had to force himself/herself to get up in the morning in the past 7 days, as part of Neuro-QOL Sleep Disturbance. QoLForceAwakeMorningScl Recommended CDE
2 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble stop thoughts at bedtime past week scale  The scale which represents how often the participant had trouble stopping his/her thoughts at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTrblStpThghtBedtimeScale Recommended CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble stay awake during day past week scale  The scale which represents how often the participant had trouble staying awake during the day in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTrblStayAwakeInDayScale Recommended CDE
4 Quality of Life - Bad dream sleep trouble past week scale  The scale representing how often the participant had trouble sleeping because of dreams in the past 7 days, as part of Neuro-QOL Sleep Disturbance. QoLBadDreamSleepTroubleScl Recommended CDE
5 Patient-Reported Outcome Measurement Information System (PROMIS) - difficult to fall asleep past week scale  The scale which represents how often the participant had difficulty falling asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISDifficultFallAsleepScale Recommended CDE
6 Quality of Life - Awake pain past week scale  The scale representing how often pain woke the participant up in the last 7 days, as part of Neuro-QOL Sleep Disturbance. QoLAwakePainScl Recommended CDE
7 Quality of Life - Cancel friend activity bad sleep past week scale  The scale representing how often the participant avoided or cancelled activities with their friends because they were tired from having a bad night's sleep in the past 7 days, as part of Neuro-QOL Sleep Disturbance. QoLCancelFriendActvtBadSlpScl Recommended CDE
8 Quality of Life - Middle night physical tension past week scale  The scale representing how often the participant felt physically tense during the middle of the night or early morning hours in the past 7 days, as part of Neuro-QOL Sleep Disturbance. QoLMddleNightPhysiclTensionScl 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