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

 General Details

Title:
TBI-QOL Item Bank v1.0 - Cognition: General Concerns - Short Form 10a.
Short Name:
TBIQOLCognitionGeneralConc
Description:
TBI-QOL Item Bank v1.0 -Cognition: General Concerns - Short Form 10a Tulsky, D. S., Kisala, P. A., Victorson, D., Carlozzi, N., Bushnik, T., Sherer, M., & Englander, J. (2016). TBI-QOL: development and calibration of item banks to measure patient reported outcomes following traumatic brain injury.The Journal of head trauma rehabilitation, 31(1), 40. TBI-QOL Items Copyright 2015 David Tulsky and Kessler Foundation. All rights reserved. http://www.assessmentcenter.net/ 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
Publication Date:
2016-09-30
Version:
1.1
Date Created:
2016-05-31
Owner:
Number of Data Elements:
26
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 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

TBI-QOL Cognition (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Trouble remembering things scale  The scale which represents how often the participant had trouble remembering things in the past 7 days, as part of TBI-QOL. TBIQOLTrblRembringThingsScl Recommended CDE
2 Quality of Life - Trouble keep track interrupt past week scale  The scale representing how often the participant had trouble keeping track of what they were doing if they were interrupted in the past 7 days, as part of Neuro-QOL Cognitive Function. QoLTrbleKeepTrackInteruptScl Recommended CDE
3 Quality of Life - Maintain task thought trouble past week scale  The scale representing how often the participant had trouble keeping their mind on what they were doing in the past 7 days, as part of Neuro-QOL Depression. QoLMntainTaskThoughtTroublScl Recommended CDE
4 TBI Quality of Life (TBI-QOL) - Hard to pay attention scale  The scale which represents how often the participant had to work really hard to pay attention or he/she would make a mistake in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLTrblHardToPayAttenScl Recommended CDE
5 Quality of Life - Trouble concentrate past week scale  The scale representing how often the participant had trouble concentrating in the past 7 days, as part of Neuro-QOL Cognitive Function. QoLTroubleConcentrateScl Recommended CDE
6 TBI Quality of Life (TBI-QOL) - Felt confused scale  The scale representing how often in the past 7 days the participant felt confused. TBIQOLIFeltConfusedScl Recommended CDE
7 TBI Quality of Life (TBI-QOL) - Difficulty following the topic of conversation scale  The scale representing how often in the past 7 days the subject had difficulty following the topic of conversation. TBIQOLDiffcltyTopicConvrstnScl Recommended CDE
8 TBI Quality of Life (TBI-QOL) - Trouble thinking clearly scale  The scale which represents how often the participant had trouble thinking clearly in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLTrblThinkingClearlyScl Recommended CDE
9 TBI Quality of Life (TBI-QOL) - Slow thinking scale  The scale which represents how often the participant had slow thinking in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLSlowThinkingScl Recommended CDE
10 TBI Quality of Life (TBI-QOL) - Reacted slowly scale  The scale which represents how often the participant reacted slowly to things that were said or done in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLReactedSlowlyScl Recommended CDE

TBI-QOL Cognition- scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Cognition general concerns raw score  The raw score related to perceived difficulties in everyday cognitive abilities such as learning, memory, attention, and concentration, as part of the TBI Quality of Life (TBI-QOL). TBIQOLCogGenRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Cognition general concerns T-score  The T-Score related to perceived difficulties in everyday cognitive abilities such as learning, memory, attention. TBIQOLCogGenTScore Recommended CDE
3 TBI-Quality of Life (TBI-QOL) - Standard error  Standard error, as part of TBI-Quality of Life (TBI-QOL) measures TBIQOLStandardError Recommended CDE

 Change History

 Administrative Change History