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

 General Details

Title:
36-Item Short Form Health Survey (SF-36) version 1
Short Name:
SF_36_FITBIR_V1
Description:
Contains data elements for the SF-36 version 1 instrument. SF-36 version 1.0 is reproduced (in its entirety) with permission from the RAND Corporation. Recommended by CDISC for TBI (TAUG TBI) Copyright by the RAND Corporation. http://www.rand.org/health/surveys_tools/mos/36-item-short-form.html RAND's permission to reproduce the survey is not an endorsement of the products, services, or other uses in which the survey appears or is applied. Hays, RD (1994). The Medical Outcomes Study (MOS) Measures of Patient Adherence. Retrieved April 19, 2004, from the RAND Corporation web site: http://www.rand.org/health/surveys/MOS.adherence.measures.pdf
Disease:
General (For all diseases)
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-07
Version:
1.3
Date Created:
2014-10-31
Owner:
Number of Data Elements:
58
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 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 Recommended CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administation (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

SF-36 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 36-item Short Form Health Survey (SF-36) - General health scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36GenHlthScore Recommended CDE
2 36-item Short Form Health Survey (SF-36) - Now heath scaled score  Scaled score that reflects surveyee-reported present general heath compared to a year ago as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36NowHlthScore Recommended CDE
3 36-item Short Form Health Survey (SF-36) - Health limited vigorous activities scaled score  Scaled score that reflects surveyee-reported limited vigorous activities due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLmtVigorActScore Recommended CDE
4 36-item Short Form Health Survey (SF-36) - Health limited moderate activities scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36HlthLmtModActScore Recommended CDE
5 36-item Short Form Health Survey (SF-36) - Health limited carrying groceries scaled score  Scaled score that reflects surveyee-reported limited lifting or carrying groceries due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLmtCrryGrocryScore Recommended CDE
6 36-item Short Form Health Survey (SF-36) - Health limited climbing several stairs scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36HlthLmtClmbSvrlStairScore Recommended CDE
7 36-item Short Form Health Survey (SF-36) - Health limited climbing one stair scaled score  Scaled score that reflects surveyee-reported limited climbing one flight of stairs due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLmtClmb1StairScore Recommended CDE
8 36-item Short Form Health Survey (SF-36) - Health limited bending kneeling stooping scaled score  Scaled score that reflects surveyee-reported limited bending, kneeling, or stooping due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLmtBndKnlStpScore Recommended CDE
9 36-item Short Form Health Survey (SF-36) - Health limited walking miles scaled score  Scaled score that reflects surveyee-reported limited walking more than one mile due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLmtWlkSvrlMilScore Recommended CDE
10 36-item Short Form Health Survey (SF-36) - Health limited walking several blocks scaled score  Scaled score that reflects surveyee-reported limited walking several blocks/several hundred yards due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLmtWlkSvrlBlckScore Recommended CDE
11 36-item Short Form Health Survey (SF-36) - Health limited walking one block scaled score  Scaled score that reflects surveyee-reported limited walking one block/one hundred yards due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLmtWlk1BlckScore Recommended CDE
12 36-item Short Form Health Survey (SF-36) - Health limited bathing dressing scaled score  Scaled score that reflects surveyee-reported limited bathing or dressing due to physical health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthLimtBthDrssScore Recommended CDE
13 36-item Short Form Health Survey (SF-36) - Cut time on work activities physical health indicator  Indicator for surveyee-reported cut down time on work or other activities as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36CutTimeWrkActPhyHlthInd Recommended CDE
14 36-item Short Form Health Survey (SF-36) - Less accomplished physical health indicator  Indicator for surveyee-reported less accomplishment as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36LesAccompPhyHlthInd Recommended CDE
15 36-item Short Form Health Survey (SF-36) - Limited work activities physical health indicator  Indicator for surveyee-reported limited work or activities as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36LmtWrkActPhyHlthInd Recommended CDE
16 36-item Short Form Health Survey (SF-36) - Difficulty work activities physical health indicator  Indicator for surveyee-reported difficulty performing work or other activities as a result of physical health during past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36DiffcltWrkActPhyHlthInd Recommended CDE
17 36-item Short Form Health Survey (SF-36) - Cut time on work activities emotional problems indicator  Indicator for surveyee-reported cut down time on work or other activities as a result of emotional problems during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36CutTmeWrkActEmotProbInd Recommended CDE
18 36-item Short Form Health Survey (SF-36) - Less accomplished emotional problems indicator  Indicator for surveyee-reported less accomplishment as a result of emotional problems during past 4 weeks as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36LesAccompEmotProbInd Recommended CDE
19 36-item Short Form Health Survey (SF-36) - Work not carefully emotional problems indicator  Indicator for surveyee-reported doing work or other activities not as carefully as usual as a result of emotional problems during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36WkNotCarefulEmotProbInd Recommended CDE
20 36-item Short Form Health Survey (SF-36) - Interfered social activities physical emotional problems scaled score  Scaled score that reflects interfered normal social activities with family, friends, neighbors, or groups due to physical health or emotional problems during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36InterfSocPhyEmotScore Recommended CDE
21 36-item Short Form Health Survey (SF-36) - Bodily pain scaled score  Scaled score that reflects bodily pain during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36BodyPainScore Recommended CDE
22 36-item Short Form Health Survey (SF-36) - Pain interfere work scaled score  Scaled score that reflects surveyee-reported general health as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) and 12-item Short Form Health Survey (SF-12) SF36PainInterfWrkScore Recommended CDE
23 36-item Short Form Health Survey (SF-36) - Times pep scaled score  Scaled score that reflects times feeling full of pep during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesPepScore Recommended CDE
24 36-item Short Form Health Survey (SF-36) - Times nervous scaled score  Scaled score that reflects times being a very nervous person during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesNervsScore Recommended CDE
25 36-item Short Form Health Survey (SF-36) - Times down scaled score  Scaled score that reflects times feeling so down in the dumps that nothing could cheer up during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesDownScore Recommended CDE
26 36-item Short Form Health Survey (SF-36) - Times calm peaceful scaled score  Scaled score that reflects times feeling calm and peaceful during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesCalmPcfulScore Recommended CDE
27 36-item Short Form Health Survey (SF-36) - Times energy scaled score  Scaled score that reflects times having a lot of energy during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesEnrgyScore Recommended CDE
28 36-item Short Form Health Survey (SF-36) - Times downhearted blue scaled score  Scaled score that reflects times feeling downhearted and blue during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesDownBlueScore Recommended CDE
29 36-item Short Form Health Survey (SF-36) - Times worn out scaled score  Scaled score that reflects times feeling worn out during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesWornOutScore Recommended CDE
30 36-item Short Form Health Survey (SF-36) - Times happy scaled score  Scaled score that reflects times being a happy person during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesHppyScore Recommended CDE
31 36-item Short Form Health Survey (SF-36) - Times tired scaled score  Scaled score that reflects times feeling tired during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesTiredScore Recommended CDE
32 36-item Short Form Health Survey (SF-36) - Times interfered social physical or emotional scaled score  Scaled score that reflects times physical health or emotional problems interfered with social activities (like visiting with friends, relatives, etc.) during the past 4 weeks as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36TimesInterSocPhyEmtScore Recommended CDE
33 36-item Short Form Health Survey (SF-36) - Sick easier scaled score  Scaled score that reflects how true or false surveyee perceived the statement: I seem to get sick a little easier than other people, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36SckEasierScore Recommended CDE
34 36-item Short Form Health Survey (SF-36) - Health as anybody scaled score  Scaled score that reflects how true or false surveyee perceived the statement: I am as healthy as anybody I know, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36HlthyAsAnybodyScore Recommended CDE
35 36-item Short Form Health Survey (SF-36) - Expect worse health scaled score  Scaled score that reflects how true or false surveyee perceived the statement: I expect my health to get worse, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36ExpWorsHlthScore Recommended CDE
36 36-item Short Form Health Survey (SF-36) - Excellent health scaled score  Scaled score that reflects how true or false surveyee perceived the statement: My health is excellent, as part of version 1.0 and 2.0 of 36-item Short Form Health Survey (SF-36) SF36ExcelHlthScore Recommended CDE

SF-36 Scores (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 36-item Short Form Health Survey (SF-36) version 1.0 - Emotional well-being total score  Score of subject's emotional well-being as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1EmotlWellBeingTotalScore Recommended CDE
2 36-item Short Form Health Survey (SF-36) version 1.0 - Energy/fatigue total score  Score of subject's energy or fatigue as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1EnrgyFatigueTotalScore Recommended CDE
3 36-item Short Form Health Survey (SF-36) version 1.0 - Role functioning/physical total score  Score of subject's role functioning (physical) as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1RoleFuncPhysicTotalScore Recommended CDE
4 36-item Short Form Health Survey (SF-36) version 1.0 - Change in health total score  Score of change in subject's health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1HlthChangeTotalScore Recommended CDE
5 36-item Short Form Health Survey (SF-36) version 1.0 - General health total score  Score of subject's general health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1GenHlthTotalScore Recommended CDE
6 36-item Short Form Health Survey (SF-36) version 1.0 - Pain total score  Score of pain experienced by the subject as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1PainTotalScore Recommended CDE
7 36-item Short Form Health Survey (SF-36) version 1.0 - Physical functioning total score  Score of subject's physical functioning as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1PhysFunctTotalScore Recommended CDE
8 36-item Short Form Health Survey (SF-36) version 1.0 - Role functioning/emotional total score  Score of subject's role functioning (emotional ) as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1RoleFunctEmotlTotalScore Recommended CDE
9 36-item Short Form Health Survey (SF-36) version 1.0 - Social functioning total score  Score of subject's social functioning as part of version 1.0 of 36-item Short Form Health Survey (SF-36) SF36V1SocialFunctTotalScore Recommended CDE

 Change History

 Administrative Change History