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

 General Details

Title:
Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionnaire
Short Name:
PedsQLPPQ
Description:
The PedsQL 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 Pediatric Pain Questionnaire is composed of 3 items. opyright 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:
Traumatic Brain Injury , General (For all diseases)
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-11-02
Owner:
Number of Data Elements:
23
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 Pediatric Pain Questionnaire (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire - Pain description word text  Free form text entry in words to describe the subject's pain, as a part of the Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire PedsQLPPQPainDescriptnWrdTxt Recommended CDE
2 Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire - Present pain scale  Scale of how the patient feels right now, as part of the Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire. PedsQLPPQPresentPainScl Recommended CDE
3 Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire - Worst pain week scale  Scale of the worst pain the patient has felt this week, as part of the Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire. PedsQLPPQWorstPainWeekScl Recommended CDE
4 Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire - Pain place anatomic site number  Anatomical site indicating exact location of any pain currently being felt by the patient, as part of the Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire. PedsQLPPQPainPlaceAnatSite Recommended CDE
5 Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire - Pain place anatomic site  Number for the any pain indicated at the anatomic site currently being felt by the patient, as part of the Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire. PedsQLPPQPainPlaceAnatSiteNum Recommended CDE
6 Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire - Pain color type  Type of the color that corresponds to each level of pain (no pain, mild pain, moderate pain, or severe pain), as a part of the Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire. PedsQLPPQChildPainColorTyp Recommended CDE
7 Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire - Pain color place anatomic site  Provides the loction of the areas on the body are which color (and therefore which level of pain), as a part of the Pediatric Quality of Life Inventory (PedsQL) Pediatric Pain Questionaire. PedsQLPPQChildPainColrAnatSite Recommended CDE

 Change History

 Administrative Change History