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

 General Details

Title:
PROMIS Bank v1.0 - Sleep Related Impairment
Short Name:
PROMISSleepImpairment
Description:
PROMIS - Sleep Related Impairment. 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-Related Impairment 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:
30
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) - hard time get things done because sleepy past week scale  The scale which represents how often the participant had a hard time getting things done because he/she was sleepy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISHardDoThingsSleepyScale Optional CDE
2 Patient-Reported Outcome Measurement Information System (PROMIS) - hard time concentrate because sleepy past week scale  The scale which represents how often the participant had a hard time concentrating because he/she was sleepy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISHardConcntratSleepyScale Optional CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - feel alert wake up past week scale  The scale which represents how often the participant felt alert when he/she woke up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISAlertWhenWakeUpScale Optional CDE
4 Patient-Reported Outcome Measurement Information System (PROMIS) - feel ready start day when wake past week scale  The scale which represents the extent to which the participant felt ready to start the day upon waking up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. PROMISReadyToStartDayScale Optional CDE
5 Patient-Reported Outcome Measurement Information System (PROMIS) - difficult wake up past week scale  The scale which represents how often the participant had difficulty waking up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISDifficultyWakingUpScale Optional CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - feel sleepy still when wake up past week scale  The scale which represents how often the participant still felt sleepy when he/she woke up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISStillSleepyWhenWakeScale Optional CDE
7 Patient-Reported Outcome Measurement Information System (PROMIS) - feel tired past week scale  The scale which represents how often the participant felt tired in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltTiredScale Optional CDE
8 Patient-Reported Outcome Measurement Information System (PROMIS) - try sleep whenever can past week scale  The scale which represents how often the participant tried to sleep whenever he/she could in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepWheneverCouldscale Optional CDE
9 Patient-Reported Outcome Measurement Information System (PROMIS) - day problem because poor sleep past week scale  The scale which represents how often the participant had problems during the day because of poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. PROMISDayProblemPoorSleepScale Optional CDE
10 Patient-Reported Outcome Measurement Information System (PROMIS) - hard concentrate because poor sleep past week scale  The scale which represents how often the participant had a hard time concentrating because of poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. PROMISTrblCncntratPoorSlpScale Optional CDE
11 Patient-Reported Outcome Measurement Information System (PROMIS) - daytime activity disturb by poor sleep past week scale  The scale which represents how often the participant's daytime activities were disturbed by poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System. PROMISDayActDstrbPoorSlpScale Optional CDE
12 Patient-Reported Outcome Measurement Information System (PROMIS) - feel irritable because poor sleep past week scale  The scale which represents how often the participant felt irritable because of poor sleep in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltIrritablPoorSlpScale Optional CDE
13 Patient-Reported Outcome Measurement Information System (PROMIS) - hard control emotions because poor sleep past week scale  The scale which represents how often the participant had a hard time controlling emotions because of poor sleep in the past 7 days, as part of Patient-Reported Outcome Measurement Information System. PROMISHrdCntrlEmoPoorSlpScale Optional CDE
14 Patient-Reported Outcome Measurement Information System (PROMIS) - have enough energy past week scale  The scale which represents how often the participant had enough energy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISHadEnoughEnergyScale Optional CDE
15 Patient-Reported Outcome Measurement Information System (PROMIS) - sleepy during daytime past week scale  The scale which represents how often the participant was sleepy during the daytime in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSleepyDuringDaytimeScale Optional CDE
16 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble stay awake during day past week scale  The scale which represents how often the participant had trouble staying awake during the day in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTrblStayAwakeInDayScale 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