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

 General Details

Title:
Pediatric Quality of Life Inventory(PedsQL) Generic Core Scale
Short Name:
PedsQLGenericCoreScale
Description:
PedsQL (TM) Pediatric Quality of Life Inventor (TM) PedsQL ver. 4.0 Measurement Model is a modular approach to measuring health related quality of life (HRQOL) in healthy children and adolescents and those with acute and chronic health conditions. The PedsQL Measurement Model covers 4 domains: physical (8 items), emotional (5 items), social (5 items) and school (5 items). It provides a total scales score from 23 items, of which 8 are for physical health summary score and 15 are for psycho-social health summary score. The model includes the Parent-report for Toddlers: 2-4 years; Parent- and self-report for other age groups. Copyright: 1998 JWVarni, Ph.D.Varni J.W., Seid M., and Rode C.A. (1998). Pediatric Quality of Life Inventory. Lyon: Mapi Research Trust. Survey copyright by James W. Varni 1998.
Disease:
Traumatic Brain Injury
Organization:
BRICS/CIT/NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-03-02
Version:
1.1
Date Created:
2016-02-16
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 Vital status type   The type of vital status held by the patient on discharge VitalStatusTyp Recommended 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 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

Context Age Group (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - AgeRange  Age Range as a part of Pediatric Quality of Life Inventory (PedsQL). AgeRange Required CDE

Physical Functioning/ABOUT MY HEALTH AND ACTIVITIES (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - Walking more than one block scale  Scale of problems with walking more than one block, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLWalkScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) - Run scale  Scale of problems with running, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLRunScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) - Participating in sports activity or exercise scale  Scale of problems with participating in sports activity or exercise, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLSportsScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) - Difficulty lifting something heavy scale  Scale of problems with lifting something heavy, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLLiftScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) - Taking a bath or shower by him or herself scale  Scale of problems with taking a bath or shower by themselves, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLBathScl Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) - Difficulty doing chores around the house scale  Scale of problems with doing chores around the house, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLChoresScl Recommended CDE
7 Pediatric Quality of Life Inventory (PedsQL) - Hurts or aches scale  Scale of problems with having hurts or aches, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLAchesScl Recommended CDE
8 Pediatric Quality of Life Inventory (PedsQL) - Low energy scale  Scale of problems with low energy, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLEnergyScl Recommended CDE

Emotional Functioning/ABOUT MY FEELINGS (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - Feeling of being afraid or scared scale  Scale of problems with feeling afraid or scared, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLAfraidScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) - With feeling sad or blue scale  Scale of problems with feeling sad or blue, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLSadScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) - Feeling of being angry scale  Scale of problems with feeling mad, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLAngryScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) - Trouble sleeping scale  Scale of problems with trouble sleeping, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLSleepScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) - Worrying about what will happen to him or her scale  Scale of problems worrying about what will happen to you, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLWorryScl Recommended CDE

Social Functioning/HOW I GET ALONG WITH OTHERS (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - Getting along with others scale  Scale of problems with getting along with other kids, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLGetAlongScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) - With other kids not wanting to be his or her friend scale  Scale of problems with other kids not wanting to be their friend, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLFriendsScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) - Getting teased by other teens/kids scale  Scale of problems with getting teased by other teen/kids, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTeasedScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) - With not being able to do things that other teens/kids their age can do scale  Scale of problems with not being able to do things that other teens/kids their age can do, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLNotDoThingScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) - With keeping up with other teens/kids when playing scale  Scale of problems with keeping up when playing with other children, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLKeepUpScl Recommended CDE

School Functioning/ABOUT MY WORK/STUDIES (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - With difficulty paying attention in class scale  Scale of problems paying attention in class, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLAttClssScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) - With problems forgetting things scale  Scale of problems forgetting things, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLForgetScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) - Difficulty keeping up with schoolwork scale  Scale of problems keeping up with schoolwork, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLKeepUpSchoolScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) - Missing school because of not feeling well scale  Scale of problems with missing school because of not feeling well, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLMisSchSickScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) - Missing school to go to the doctor or hospital scale  Scale of problems with missing school to go to the doctor or hospital, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLMisSchDocScl Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) - Doing same school activities as peers  Scale of problems with missing school to go to the doctor or hospital, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLSamSchActScl Recommended CDE

PedsQL_Score (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory(PedsQL) - Total Score  Total Score as a part of Pediatric Quality of Life Inventory (PedsQL). PedsQLTtlScore Recommended CDE
2 Pediatric Quality of Life Inventory(PedsQL) - Psychosocial Health Summary Score  Psychosocial Health Summary Score as a part of Pediatric Quality of Life Inventory (PedsQL). PedsQLPsyHeaSumScore Recommended CDE
3 Pediatric Quality of Life Inventory(PedsQL) - Physical Health Summary Score  Summary Score of the Physical Functioning Scale Score as a part of Pediatric Quality of Life Inventory (PedsQL). PedsQLPhyHeaSumScore Recommended CDE

 Change History

 Administrative Change History