This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
Participation Assessment with Recombined Tools-Objective (PART-O-17) and supplemental questions
Short Name:
PARTO
Description:
The Participation Assessment with Recombined Tools-Objective (PART-O-17) and 7 supplemental questions (PART-OS) is an objective measure of participation, representing functioning at the societal level. References: Whiteneck GG, Dijkers MP, Heinemann AW, Bogner JA, Bushnik T, Cicerone KD, Corrigan JD, Hart T, Malec JF, Millis SR. Development of the Participation Assessment With Recombined Tools-Objective for use after traumatic brain injury. Arch Phys Med Rehabil 2011;92:542-51. Scoring: Bogner JA, Whiteneck GG, Corrigan JD, Lai J-S, Dijkers MP, Heinemann AW. Comparison of scoring methods for the Participation Assessment with Recombined Tools-Objective. Arch Phys Med Rehabil 2011;92:552-63.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-22
Version:
1.0
Date Created:
2016-04-29
Owner:
Number of Data Elements:
45
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

PART-O-17 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Participation Assessment with Recombined Tools-Objective (PART-O) - Job money time scale  Scale for the number of hours in a typical week the participant/subject spends working for money, whether in a job or self-employed as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOJobMoneyTimeScore Recommended CDE
2 Participation Assessment with Recombined Tools-Objective (PART-O) - School study degree time scale  Scale for the number of hours the participant/subject spends in a typical week in school working toward a degree or in an accredited technical training program, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOSchoolStdyDegreeTimeScore Recommended CDE
3 Participation Assessment with Recombined Tools-Objective (PART-O) - Active homemaker time scale  Scale for the number of hours in a typical week the participant/subject will spend in active homemaking, including cleaning, cooking, and raising children as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOActiveHomemakeTimeScore Recommended CDE
4 Participation Assessment with Recombined Tools-Objective (PART-O) - Socialize friend number scale  Scale for the number of times the participant/subject will socialize with friends in person or by phone, in a typical week as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOSocializeFriendNumScore Recommended CDE
5 Participation Assessment with Recombined Tools-Objective (PART-O) - Socialize family number scale  Scale for the number of times the participant/subject will socialize with family and relatives in person or by phone in a typical week as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOSocializeFamilyNumScore Recommended CDE
6 Participation Assessment with Recombined Tools-Objective (PART-O) - Emotional support number scale  Scale for the number of times the participant/subject will give emotional support to other people by listening or helping them with their problems as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOEmotionalSuprtNumScore Recommended CDE
7 Participation Assessment with Recombined Tools-Objective (PART-O) - Internet communication number scale  Scale for the number of times the participant/subject uses the Internet for communication, such as for e-mail, visiting chat rooms or instant messaging in a typical week as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOInternetComunictnNumScore Recommended CDE
8 Participation Assessment with Recombined Tools-Objective (PART-O) - Go out house day scale  Scale for the number of days the participant/subject goes out of the house to go somewhere in a typical week. It could be anywhere, it doesn't have to be anyplace special as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOGoOutHouseDayScore Recommended CDE
9 Participation Assessment with Recombined Tools-Objective (PART-O) - Eat restaurant number scale  Scale for the number of times the participant/subject eats out in a restaurant in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOEatRestaurantNumScore Recommended CDE
10 Participation Assessment with Recombined Tools-Objective (PART-O) - Shop number scale  Scale for the number of times the participant/subject goes shopping in a typical month, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOShopNumScore Recommended CDE
11 Participation Assessment with Recombined Tools-Objective (PART-O) - Engage sport exercise outside scale  Scale for the number of times the participant/subject engages in sports or exercise outside the house in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOEngageSprtExrcsOutsdScore Recommended CDE
12 Participation Assessment with Recombined Tools-Objective (PART-O) - Movie trip number scale  Scale for the number of times the participant/subject goes to see a movie in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOMovieTripNumScore Recommended CDE
13 Participation Assessment with Recombined Tools-Objective (PART-O) - Sport spectator number scale  Scale for the number of times the participant/subject has attended a sports event in person as a spectator in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOSportSpectatorNumScore Recommended CDE
14 Participation Assessment with Recombined Tools-Objective (PART-O) - Religious spiritual service number scale  Scale for the number of times the participant/subject attends religious or spiritual services in a typical month as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTORlgsSpiritlSrvcNumScore Recommended CDE
15 Participation Assessment with Recombined Tools-Objective (PART-O) - Live significant other indicator scale  Scale for indicating whether the participant/subject lives with a spouse or a significant other as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOLiveSignifcntOthrIndScore Recommended CDE
16 Participation Assessment with Recombined Tools-Objective (PART-O) - Ongoing intimate relationship indicator scale  Scale for indicating whether the participant/subject is currently in an ongoing intimate, romantic or sexual, relationship as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOOngngIntimtRelateIndScore Recommended CDE
17 Participation Assessment with Recombined Tools-Objective (PART-O) - Confidant indicator scale  Scale for indicating whether the participant/subject has a close friend to confide in, not including your spouse or significant other as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOConfidantIndScore Recommended CDE

Supplemental (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Participation Assessment with Recombined Tools (PART-O) supplemental - Spend day category/scale  Supplemental scale that best describes how does the subject spends their days in a typical month, as part of Participation Assessment with Recombined Tools - Objective (PART-O). SpendDayCat Recommended CDE
2 Participation Assessment with Recombined Tools (PART-O) supplemental - Public transit hours week frequency  Scale representing in a typical week, how many hours does he subject drives in trains, buses, taxis, and other public transportation, as part of Participation Assessment with Recombined Tools - Objective (PART-O) PublicTransitHrsWkFrq Recommended CDE
3 Participation Assessment with Recombined Tools (PART-O) supplemental - Classes last 3 months indicator  Supplemental indicator representing if the subject was taking in the last 3 month adult education classes, GED classes, continuing education, special courses, or used other opportunities for learning, for example, seminars or conferences? ClassLast3MonthsInd Recommended UDE
4 Participation Assessment with Recombined Tools (PART-O) supplemental - Club month count scale  Scale that represents in a typical month, how many times does the subject participate in a club or organization, such as the PTA, a choir, sorority, hobby group, neighborhood organization, or brain injury or other support group? ClubMonthCt Recommended CDE
5 Participation Assessment with Recombined Tools (PART-O) supplemental - Car use hours week frequency  Scale representing in a typical week, how many hours does the subject drives or rides in a car, as part of Participation Assessment with Recombined Tools - Objective (PART-O) CarUseHrsWkFrq Recommended UDE
6 Participation Assessment with Recombined Tools (PART-O) supplemental- Volunteer work month count scale  Scale representing in a typical month, how many times does the subject do volunteer work, as part of Participation Assessment with Recombined Tools - Objective (PART-O) VolWorkMonthCt Recommended CDE
7 Participation Assessment with Recombined Tools (PART-O) supplemental- Home maintenance hours week count  Scale representing in a typical week, how many hours do you spend in home maintenance activities, such as home repairs, home improvements, and gardening, as part of Participation Assessment with Recombined Tools - Objective (PART-O) HomeMaintHrsWkCt Recommended CDE

Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Participation Assessment with Recombined Tools-Objective (PART-O) - Average total score  Average total score calculated as an average of scores for 3 domains - Productivity, Social Relations and Out and About, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOAverageTotalScore Recommended CDE
2 Participation Assessment with Recombined Tools-Objective (PART-O) - Balanced total score  Balanced total score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOBalancedTotalScore Recommended CDE
3 Participation Assessment with Recombined Tools-Objective (PART-O) - Productivity domain sub-score  Productivity domain sub-score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOProductivitySubScore Recommended CDE
4 Participation Assessment with Recombined Tools-Objective (PART-O) - Social Relations  Productivity domain sub-score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOSocialRelSubScore Recommended CDE
5 Participation Assessment with Recombined Tools-Objective (PART-O) - Out and About domain sub-score  Out and About domain sub-score, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOOutAboutSubScore Recommended CDE
6 Participation Assessment with Recombined Tools-Objective (PART-O) - Standard deviation of domain scores value  Value of standard deviation (STD) of domain scores, as part of Participation Assessment with Recombined Tools - Objective (PART-O). PARTOSTDVal Recommended CDE

 Change History

 Administrative Change History