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

 General Details

Title:
PROMIS Bank v1.0 - Sleep Disturbance
Short Name:
PROMISSleepDisturbance
Description:
PROMIS - Sleep Disturbance. 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 Sleep Disturbance v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 8b.
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:
41
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) - sleep restful past week scale  The scale which represents how often the participant's sleep was restful in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepWasRestfulScale Optional CDE
2 Patient-Reported Outcome Measurement Information System (PROMIS) - sleep light past week scale  The scale which represents how often the participant's sleep was light in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepWasLightScale Optional CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - sleep deep past week scale  The scale which represents how often the participant's sleep was deep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepWasDeepScale Optional CDE
4 Patient-Reported Outcome Measurement Information System (PROMIS) - sleep restless past week scale  The scale which represents how often the participant's sleep was restless in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepWasRestlessScale Optional CDE
5 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfied sleep past week scale  The scale which represents how often the participant was satisfied with his/her sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatisfiedWithSleepScale Optional CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - sleep refreshing past week scale  The scale which represents how often the participant's sleep was refreshing in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepWasRefreshingScale Optional CDE
7 Patient-Reported Outcome Measurement Information System (PROMIS) - feel lousy wake up past week scale  The scale which represents how often the participant felt lousy when he/she woke up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltLousyWhenWakeScale Optional CDE
8 Patient-Reported Outcome Measurement Information System (PROMIS) - problem sleep past week scale  The scale which represents how often the participant had a problem with sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISProblemWithSleepScale Optional CDE
9 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 Optional CDE
10 Patient-Reported Outcome Measurement Information System (PROMIS) - feel physical tense bedtime past week scale  The scale which represents how often the participant felt physically tense at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltTenseAtBedtimeScale Optional CDE
11 Patient-Reported Outcome Measurement Information System (PROMIS) - worry not able fall asleep past week scale  The scale which represents how often the participant worried about not being able to fall asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISWorryNotFallAsleepScale Optional CDE
12 Patient-Reported Outcome Measurement Information System (PROMIS) - feel worry at bedtime past week scale  The scale which represents how often the participant felt worried at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltWorriedBedtimeScale Optional CDE
13 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 Optional CDE
14 Patient-Reported Outcome Measurement Information System (PROMIS) - feel sad at bedtime past week scale  The scale which represents how often the participant felt sad at bedtime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltSadAtBedtimeScale Optional CDE
15 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble get comfortable position sleep past week scale  The scale which represents how often the participant had trouble getting into a comfortable position to sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System PROMISTrblCmfrtblPositionScale Optional CDE
16 Patient-Reported Outcome Measurement Information System (PROMIS) - try hard to get to sleep past week scale  The scale which represents how often the participant tried hard to get to sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTryHardGetToSleepScale Optional CDE
17 Patient-Reported Outcome Measurement Information System (PROMIS) - stress disturbed sleep past week scale  The scale which represents how often the Stress disturbed the participant's sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISStressDisturbSleepScale Optional CDE
18 Patient-Reported Outcome Measurement Information System (PROMIS) - toss and turn at night past week scale  The scale which represents how often the participant tossed and turned at night in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTossTurnAtNightScale Optional CDE
19 Patient-Reported Outcome Measurement Information System (PROMIS) - afraid not get back to sleep after wake past week scale  The scale which represents how often the participant was afraid he/she would not get back to sleep after waking up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISAfrdNotGetBackSleepScale Optional CDE
20 Patient-Reported Outcome Measurement Information System (PROMIS) - sleep enough past week scale  The scale which represents how often the participant got enough sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISGotEnoughSleepScale Optional CDE
21 Patient-Reported Outcome Measurement Information System (PROMIS) - easy to fall asleep past week scale  The scale which represents how often the It was easy for the participant to fall asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISEasyToFallAsleepScale Optional CDE
22 Patient-Reported Outcome Measurement Information System (PROMIS) - lay in bed for hours wait fall asleep past week scale  The scale which represents how often the participant laid in bed for hours waiting to fall asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISLaidInBedWaitingScale Optional CDE
23 Patient-Reported Outcome Measurement Information System (PROMIS) - wake early can not fall back asleep past week scale  The scale which represents how often the participant woke too early and could not fall back asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISWokeUpTooEarlyNoSlpScale Optional CDE
24 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble stay asleep past week scale  The scale which represents how often the participant had trouble staying asleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTrblStayAsleepNightScale Optional CDE
25 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble sleep past week scale  The scale which represents how often the participant had trouble sleeping in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTroubleSleepingScale Optional CDE
26 Patient-Reported Outcome Measurement Information System (PROMIS) - wake up have trouble fall back sleep past week scale  The scale which represents how often the participant woke up and had trouble falling back to sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISWokeUpTrblFallBackScale Optional CDE
27 Patient-Reported Outcome Measurement Information System (PROMIS) - sleep quality past week scale  The scale which represents the participant's description of his/her sleep quality in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepQualityScale Optional CDE

Scoring (Appears At Least 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