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

 General Details

Title:
Pediatric Quality of Life Inventory(PedsQL) Multidimensional Fatigue Scale
Short Name:
PedsQLMultiDimFatiScale
Description:
The PedsQL 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 integrates seamlessly both generic core scales and disease-specific modules into one measurement system. Pediatric Quality of Life Inventory Multidimensional Fatigue Scale includes the Parent-report for Toddlers: 2-4 years; Parent- and self-report for other age groups.
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:
1.0
Date Created:
2016-02-22
Owner:
Number of Data Elements:
35
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 Recommended CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Recommended 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 Recommended CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Recommended CDE
9 General notes text   General notes GeneralNotesTxt Recommended CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Repeat Infinitely)

# 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 Exactly 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 Recommended CDE

General Fatigue (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - Feeling tired scale  Scale of problems with feeling tired, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTiredScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) - Feeling physically weak (not strong) Scale  Scale of problems with feeling physically weak (not strong), as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLPhysicalWeakScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) - Feeling too tired to do things he/she likes to do scale  Scale of problems with feeling too tired to do things that he/she likes to do, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTiredDoThingsScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) - Feeling too tired to spend time with friends scale  Scale of problems with feeling too tired to spend time with his/her friends, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLSpendTimeFriendScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) - Trouble finishing things scale  Scale of problems with trouble finishing things, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTroubleFinishScl Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) - Trouble starting things scale  Scale of problems with trouble starting things,as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTroubleStartScl Recommended CDE

Sleep/Rest Fatigue (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - Sleeping a lot scale  Scale of problems with sleeping a lot, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLSleepALotScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) - Difficulty sleeping through night scale  Scale of problems with difficulty sleeping through the night, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLDifficultSleepScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) - Feeling tired when he/she wakes up in the morning scale  Scale of problems with feeling tired when you wake up in the morning, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTiredMorningScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) - Resting a lot scale  Scale of problems with resting a lot, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLRestALotScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) - Taking a lot of naps scale  Scale of problems with taking a lot of naps, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLNapALotScl Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) - Spending a lot of time in bed scale  Scale of problems with spending a lot of time in bed, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTimeInBedScl Recommended CDE

Cognitive Fatigue (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) - Difficulty keeping his/her attention on things scale  Scale of problems with difficulty keeping his/her attention on things, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLAttnScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) - Difficulty remembering what people told them scale  Scale of problems with remembering what people told him/her, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLRemToldScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) - Difficulty remembering what he/she had just heard scale  Scale of problems with remembering what he/she just heard, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLRemHearScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) - Difficulty thinking quickly scale  Scale of problems with difficulty thinking quickly, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLThkQukScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) - Trouble remembering what you was just thinking scale  Scale of problems with remembering what you were just thinking, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLTrblThkScl Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) - Trouble remembering more than one thing at a time  Scale of problems with remembering more than one thing at a time, as part of the Pediatric Quality of Life Inventory (PedsQL). PedsQLRemMultScl Recommended CDE

PedsQL_Score (Appears Up To 1 Time)

# 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