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

 General Details

Title:
PROMIS Bank v1.0 - Emotional Distress - Anxiety
Short Name:
PROMISAnxiety
Description:
PROMIS - Emotional Distress - Anxiety. This form should be used for any version of the PROMIS forms that are derived from this bank of questions, including (but not limited to) the Emotional Distress - Anxiety v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 8a.
Disease:
General (For all diseases) , Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-02-11
Version:
1.1
Date Created:
2015-01-12
Owner:
Number of Data Elements:
43
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.

In the past 7 days (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Patient-Reported Outcome Measurement Information System (PROMIS) - feel fearful past week scale  The scale which represents how often the participant felt fearful in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltFearfulScale Optional CDE
2 Patient-Reported Outcome Measurement Information System (PROMIS) - feel frightened past week scale  The scale which represents how often the participant felt frightened in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltFrightenedScale Optional CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - feel scared when nervous past week scale  The scale which represents how often the participant was scared when he/she felt nervous in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISScaredWhenNervousScale Optional CDE
4 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 Optional CDE
5 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 Optional CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - concerned about mental health past week scale  The scale which represents how often the participant was concerned about his mental health in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISCncrndAbtMentalHlthScale Optional CDE
7 Patient-Reported Outcome Measurement Information System (PROMIS) - feel upset past week scale  The scale which represents how often the participant felt upset in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltUpsetScale Optional CDE
8 Patient-Reported Outcome Measurement Information System (PROMIS) - racing pounding heart past week scale  The scale which represents how often the participant had a racing or pounding heart in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISRacePoundHeartScale Optional CDE
9 Patient-Reported Outcome Measurement Information System (PROMIS) - anxious if normal routine disturbed past week scale  The scale which represents how often the participant was anxious if his normal routine was disturbed in the past 7 days as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISAnxsIfRoutinDstrbedScale Optional CDE
10 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 Optional CDE
11 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 Optional CDE
12 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble pay attention past week scale  The scale which represents how often the participant had trouble paying attention in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTrblPayingAttentionScale Optional CDE
13 Patient-Reported Outcome Measurement Information System (PROMIS) - avoid public places and activities past week scale  The scale which represents how often the participant avoided public places or activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISAvdPubPlaceActivityScale Optional 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 Optional 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 Optional 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 Optional CDE
17 Patient-Reported Outcome Measurement Information System (PROMIS) - feel terrified past week scale  The scale which represents how often the participant felt terrified in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltTerrifiedScale Optional CDE
18 Patient-Reported Outcome Measurement Information System (PROMIS) - worry reaction other people past week scale  The scale which represents how often participant was worried about other people's reactions to him in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISWorriedAbtOthReactnScale Optional CDE
19 Patient-Reported Outcome Measurement Information System (PROMIS) - hard focus anything anxiety past week scale  The scale which represents how often participant found it hard to focus on anything other than anxiety in the past 7 days, as part of Patient-Reported Outcome Measurement Information System (PROMIS). PROMISConcntrtOnlyOnAnxtyScale Optional CDE
20 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 Optional CDE
21 Patient-Reported Outcome Measurement Information System (PROMIS) - twitch or tremble muscles past week scale  The scale which represents how often the participant had twitching or trembling muscles in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTwitchTrembleMuscleScale Optional CDE
22 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 Optional CDE
23 Patient-Reported Outcome Measurement Information System (PROMIS) - feel indecisive past week scale  The scale which represents how often the participant felt indecisive in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltIndecisiveScale Optional CDE
24 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 Optional CDE
25 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 Optional CDE
26 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 Optional CDE
27 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 Optional CDE
28 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 Optional CDE
29 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 Optional CDE

Scoring (Appears Exactly 1 Time)

# Title Short Description Variable Name Required? Type
1 Patient-Reported Outcome Measure Information System (PROMIS) - form administered type  The specific PROMIS form type administered, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFormType Required CDE
2 Patient-Reported Outcome Measure Information System (PROMIS) - raw score  The participant's raw score on the PROMIS form, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISRawScore Optional CDE
3 Patient-Reported Outcome Measure Information System (PROMIS) - items completed count  The count of items on the PROMIS form completed by the participant, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISItemCompletedCount Optional CDE
4 Patient-Reported Outcome Measure Information System (PROMIS) - T-score value  The T-score value, a standardized score with a mean of 50 and standard deviation of 10 representing the rescaled raw score, as part of the Patient-Reported Outcome Measurement Information System. PROMISTScore Recommended CDE
5 Patient-Reported Outcome Measure Information System (PROMIS) - Standard error  Standard error, as part of the Patient-Reported Outcome Measurement Information System (PROMIS) PROMISStandardError Recommended CDE
6 Patient-Reported Outcome Measure Information System (PROMIS) - theta value  The value of theta reported from the CAT PROMIS results, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTheta Optional CDE

 Change History

 Administrative Change History