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

 General Details

Title:
Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales
Short Name:
PedsQLPFVSA
Description:
The PedsQL Present Functioning Visual Analogue Scale is composed of 6 items. Copyright 1998 JW Varni, PhD. All rights reserved. Varni JW, Seid M, Kurtin PD. PedsQL 4.0: Reliability and validity of the pediatric quality of life inventory Version 4.0 generic core scales in healthy and patient populations. Medical Care. 2001; 38(8): 800-12.
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-31
Owner:
Number of Data Elements:
24
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   Status of participant/subject as alive or dead VitStatus Optional 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 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 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 (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 Recommended CDE

PedsQL PF Visual Analogue Scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen afraid scale  Scale indicating how afraid or scared the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. PedsQLPFVASAfraidScl Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen sad scale  Scale indicating how sad or blue the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. PedsQLPFVASSadScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen angry scale  Scale indicating how angry the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. PedsQLPFVASAngryScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen worry scale  Scale indicating how worried about what will happen to him or her the child or teen patient is at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. PedsQLPFVASWorryScl Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen tired scale  Scale indicating how tired the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. PedsQLPFVASTiredScl Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Child teen pain hurt scale  Scale indicating how much pain or hurt the child or teen patient feels at the moment, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. PedsQLPFVASPainHurtScl Recommended CDE

PedsQL PF Visual Analogue Scale Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Total symptom score  Total symptom score, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. PedsQLVASTotalSymptomScore Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales - Emotional distress summary score  Emotional distress score, as part of the Pediatric Quality of Life Inventory (PedsQL) Present Functioning Visual Analogue Scales. , PedsQLVASEmotDistSumScore Recommended CDE

 Change History

 Administrative Change History