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

 General Details

Title:
PROMIS Bank v1.0 - Satisfaction with Participation in Discretionary Social Activities
Short Name:
PROMISSatSocActivity
Description:
PROMIS - Satisfaction with Participation in Discretionary Social Activities. 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 Satisfaction with Participation in Discretionary Social Activities v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 7a.
Disease:
Traumatic Brain Injury , General (For all diseases)
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:
26
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) - satisfaction with amount of time spent doing leisure activities past week scale  The scale which represents the extent of the participant's satisfaction with the amount of time he spent doing leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyLeisureTimeScale Optional CDE
2 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with current level of social activity past week scale  The scale which represents the extent of the participant's satisfaction with his/her current level of social activity in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyLvlSocActvtyScale Optional CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do all of important community activities past week scale  The scale which represents the extent of the participant's satisfaction with ability to do all of the important community activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyCommunityActScale Optional CDE
4 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for friends past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do things for his friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyDoForFriendsScale Optional CDE
5 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do leisure activities past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyAbiDoLeisrActScale Optional CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with current level of activities with friends past week scale  The scale which represents the extent of the participant's satisfaction with his/her current level of activities with friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyLvlActWthFrndScale Optional CDE
7 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for fun outside of home past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do things for fun outside of the home in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyDoFunOutHomeScale Optional CDE
8 Patient-Reported Outcome Measurement Information System (PROMIS) - feel good ability do for friend past week scale  The scale which represents the extent to which the participant felt good about his/her ability to do things for his friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFltGoodAbiDoForFrndScale Optional CDE
9 Patient-Reported Outcome Measurement Information System (PROMIS) - happy how much do for friend past week scale  The scale which represents how often the participant was happy with how much he/she did for his friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISHpyHowMuchDidFrndsScale Optional CDE
10 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with amount of time spent visiting friends past week scale  The scale which represents the extent of the participant's satisfaction with the amount of time spent visiting his/her friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyTimeVisitFrndScale Optional CDE
11 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for fun at home past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do things for fun at home in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyAbiFunAtHomeScale Optional CDE
12 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability do all leisure activity really important past week scale  The scale which represents the extent of the participant's satisfaction with ability to do all of the important leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyAbiLeisureActScale 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