This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
Quality of Life After Brain Injury -(QOLIBRI)
Short Name:
QOLIBRI
Description:
The QOLIBRI (Quality of Life after Brain Injury) is the first instrument specifically developed to assess health-related quality of life (HRQoL) of individuals after traumatic brain injury. The QOLIBRI is a comprehensive questionnaire with 37 items covering six dimensions of HRQoL after TBI. The QOLIBRI questionnaire is free to use for researchers, clinicians, and non-profit organisations. Please register here on QOLIBRI website and you will be able to download a copy of the questionnaire. For more information, refer to http://www.qolibrinet.com/;von Steinbuechel N, Wilson L, Gibbons H, et al; QOLIBRI Task Force. Quality of Life after Brain Injury (QOLIBRI): scale validity and correlates of quality of life. J Neurotrauma 2010;27:1157e65.;von Steinbuechel N, Wilson L, Gibbons H, et al. Quality of Life after Brain Injury (QOLIBRI): scale development and metric properties. J Neurotrauma 2010;27:1167e85. Recommended by CDISC for TBI.
Disease:
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:
2016-06-16
Owner:
Number of Data Elements:
59
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

QOLIBRI Cognition scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with concentration scale  Scale for subject's satisfaction with their ability to concentrate, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking QOLIBRITConcentrationScl Recommended CDE
2 Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with self-expression scale  Scale for subject's satisfaction with their ability to express themselves and understand others in a conversation, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking QOLIBRITSelfExpressionScl Recommended CDE
3 Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with remembering everyday things scale  Scale for subject's satisfaction with their ability to remember everyday things, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking QOLIBRITRemembrEvrydyThngsScl Recommended CDE
4 Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with ability to plan scale  Scale for subject's satisfaction with their ability to plan and work out solutions to everyday practical problems, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking QOLIBRITAbilityToPlanScl Recommended CDE
5 Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with decision-making scale  Scale for subject's satisfaction with their ability to make decisions, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking QOLIBRITDecisionMakingScl Recommended CDE
6 Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with sense of direction scale  Scale for subject's satisfaction with their ability to find their way around, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking QOLIBRITSenseDirectionScl Recommended CDE
7 Quality of Life After Brain Injury (QOLIBRI) Thinking - Satisfaction with thinking speed scale  Scale for subject's satisfaction with their speed of thinking, as part of the Quality of Life After Brain Injury (QOLIBRI) Thinking QOLIBRITThinkingSpeedScl Recommended CDE

QOLIBRI Self scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with energy level scale  Scale for subject's satisfaction with their level of energy, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions QOLIBRIEEnergyLvlScl Recommended CDE
2 Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with motivation level scale  Scale for subject's satisfaction with their level of motivation to do things, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions QOLIBRIEMotivationLvlScl Recommended CDE
3 Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with self-esteem scale  Scale for subject's satisfaction with their self-esteem, how valuable they feel, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions QOLIBRIESelfEsteemScl Recommended CDE
4 Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with looks scale  Scale for subject's satisfaction with the way they look, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions QOLIBRIESatisfactnLooksScl Recommended CDE
5 Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with achievements scale  Scale for subject's satisfaction with what they have achieved since their brain injury, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions QOLIBRIEAchievementsScl Recommended CDE
6 Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with self-perception scale  Scale for subject's satisfaction with the way they perceive themselves, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions QOLIBRIESelfPerceptionScl Recommended CDE
7 Quality of Life After Brain Injury (QOLIBRI) Emotions - Satisfaction with perceived future scale  Scale for subject's satisfaction with the way they see their future, as part of the Quality of Life After Brain Injury (QOLIBRI) Emotions QOLIBRIEPerceivedFutureScl Recommended CDE

QOLIBRI Daily Life and Autonomy scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with independence scale  Scale for subject's satisfaction with the extent of their independence from other, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence QOLIBRIIIndependenceScl Recommended CDE
2 Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with ability to go out scale  Scale for subject's satisfaction with their ability to get out and about, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence QOLIBRIIAbilityGoOutScl Recommended CDE
3 Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with ability to do housework scale  Scale for subject's satisfaction with their ability to carry out domestic activities, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence QOLIBRIIAbilityDoHouseworkScl Recommended CDE
4 Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with financial responsibility scale  Scale for subject's satisfaction with their ability to run their personal finances, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence QOLIBRIIFinancialResponsiblScl Recommended CDE
5 Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with work participation scale  Scale for subject's satisfaction with their participation in work or education, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence QOLIBRIIWorkParticipatnScl Recommended CDE
6 Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with social participation scale  Scale for subject's satisfaction with their participation in social and leisure activities, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence QOLIBRIISocialParticipatnScl Recommended CDE
7 Quality of Life After Brain Injury (QOLIBRI) Independence - Satisfaction with extent of being in charge scale  Scale for subject's satisfaction with the extent to which they are in charge of their own life, as part of the Quality of Life After Brain Injury (QOLIBRI) Independence QOLIBRIIExtentInChargeScl Recommended CDE

QOLIBRI Social Relationships scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with ability to feel affection scale  Scale for subject's satisfaction with their ability to feel affection towards others, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships QOLIBRISRFeelAffectnScl Recommended CDE
2 Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with family relationships scale  Scale for subject's satisfaction with their relationships with members of their family, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships QOLIBRISRFamilyRelationshipScl Recommended CDE
3 Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with friendships scale  Scale for subject's satisfaction with their relationships with their friends, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships QOLIBRISRFriendshipsScl Recommended CDE
4 Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with partner relationship scale  Scale for subject's satisfaction with their relationship with a partner or with not having a partner, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships QOLIBRISRPartnerRelationshpScl Recommended CDE
5 Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with sex life scale  Scale for subject's satisfaction with their sex life, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships QOLIBRISRSexLifeScl Recommended CDE
6 Quality of Life After Brain Injury (QOLIBRI) Social Relationships - Satisfaction with others' opinion of subject scale  Scale for subject's satisfaction with the attitudes of other people towards them, as part of the Quality of Life After Brain Injury (QOLIBRI) Social Relationships QOLIBRISROthrOpinionScl Recommended CDE

QOLIBRI Emotions scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling lonely scale  Scale for how bothered the subject is by feeling lonely, even when they are with other people, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings QOLIBRIFBotherFeelLonelyScl Recommended CDE
2 Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling bored scale  Scale for how bothered the subject is by feeling bored, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings QOLIBRIFBotherFeelBoredScl Recommended CDE
3 Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling anxious scale  Scale for how bothered the subject is by feeling anxious, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings QOLIBRIFBotherFeelAnxiousScl Recommended CDE
4 Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling sad or depressed scale  Scale for how bothered the subject is by feeling sad or depressed, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings QOLIBRIFBotherFeelSadScl Recommended CDE
5 Quality of Life After Brain Injury (QOLIBRI) Feelings - Bothered by feeling angry or aggressive scale  Scale for how bothered the subject is by feeling angry or aggressive, as part of the Quality of Life After Brain Injury (QOLIBRI) Feelings QOLIBRIFBotherFeelAngryScl Recommended CDE

QOLIBRI Physical Problems scale (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by slowness scale  Scale for how bothered the subject is by slowness and/or clumsiness of movement, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems QOLIBRIPPBotherSlownessScl Recommended CDE
2 Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by other injuries scale  Scale for how bothered the subject is by the effects of any other injuries sustained at the same time as the brain injury, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems QOLIBRIPPBotherOthrInjScl Recommended CDE
3 Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by pain scale  Scale for how bothered the subject is by pain, including headaches, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems QOLIBRIPPBotherPainScl Recommended CDE
4 Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by vision or hearing scale  Scale for how bothered the subject is by problems with seeing or hearing, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems QOLIBRIPPBotherVisionHearScl Recommended CDE
5 Quality of Life After Brain Injury (QOLIBRI) Physical Problems - Bothered by brain injury scale  Scale for how bothered the subject is by the effects of their brain injury overall, as part of the Quality of Life After Brain Injury (QOLIBRI) Physical Problems QOLIBRIPPBotherBrainInjScl Recommended CDE

QOLIBRI Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life After Brain Injury (QOLIBRI) - Cognition scale score  Cognition scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) QOLIBRICognitionScaleScore Recommended CDE
2 Quality of Life After Brain Injury (QOLIBRI) - Self Scale score  Self scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) QOLIBRISelfScaleScore Recommended CDE
3 Quality of Life After Brain Injury (QOLIBRI) - Daily life and autonomy scale score  Daily life and autonomy scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) QOLIBRIDlyLfAndAutmyScaleScore Recommended CDE
4 Quality of Life After Brain Injury (QOLIBRI) - Social relationships scale score  Social relationships scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) QOLIBRISocialRltnScaleScore Recommended CDE
5 Quality of Life After Brain Injury (QOLIBRI) - Emotions scale score  Emotions scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) QOLIBRIEmotionsScaleScore Recommended CDE
6 Quality of Life After Brain Injury (QOLIBRI) - Physical problems scale score  Physical problems scale score, as part of the Quality of Life After Brain Injury (QOLIBRI) QOLIBRIPhysicalProbsScaleScore Recommended CDE
7 Quality of Life After Brain Injury (QOLIBRI) -Total scale score  Total scale score for Quality of Life After Brain Injury (QOLIBRI) scale, as part of Quality of Life After Brain Injury (QOLIBRI) QOLIBRITotalScaleScore Recommended CDE

 Change History

 Administrative Change History