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

 General Details

Title:
PROMIS Global Health Short Form 8a
Short Name:
PROMISGlobalHealth
Description:
The PROMIS Global Health form is a carefully standardized psychometric instrument which measures the individuals global health. Copyright 2008-2012 PROMIS Health Organization and PROMIS Cooperative Group
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-12-14
Owner:
Number of Data Elements:
31
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

Global Health (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - General health scale  Scale relating to how good the individual filling out the form believes his or her general health to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHGeneralHealthScl Recommended CDE
2 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Quality life scale  Scale relating to how good the individual filling out the form believes his or her quality of life to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHQualityLifeScl Recommended CDE
3 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Physical health scale  Scale relating to how good the individual filling out the form believes his or her physical health to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHPhysicalHealthScl Recommended CDE
4 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Mental health scale  Scale relating to how good the individual filling out the form believes his or her mental health (including his or her mood and ability to think) to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHMentalHealthScl Recommended CDE
5 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Social activity satisfaction scale  Scale relating to how good the individual filling out the form believes his or her satisfaction with his or her social activities to be, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHSocActvtStsfctnScl Recommended CDE
6 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Social activity rating scale  Scale relating to how good the individual filling out the form would rate his or her ability to carry out usual social activities and roles, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHSocActvtRatngScl Recommended CDE
7 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Everyday physical activity scale  Scale relating to the extent the individual filling out the form would is able to carry out everyday physical activities (such as walking), as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHEverydayPhysclActvtScl Recommended CDE
8 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Bother emotional problem scale  Scale relating to the extent the individual filling out the form has been bothered with emotional problems (such as feeling anxious) in the past 7 days, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHBotherEmtnlPrblmScl Recommended CDE
9 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Average fatigue rating scale  Scale relating to the rating the individual filling out the form would give to his or her level of fatigue in the past 7 days, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHAvrgFatigueRtngScl Recommended CDE
10 Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale - Average pain rating scale  Scale relating to the rating the individual filling out the form would give to his or her level of pain in the past 7 days, as part of the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale. PROMISGHAvrgPainRtngScl Recommended CDE

PROMIS Scoring (Appears Up To 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 Recommended 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 Recommended 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 Recommended 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 Recommended CDE

 Change History

 Administrative Change History