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

 General Details

Title:
TBI-QOL Item Bank v1.0 - Depression - Short Form 10a
Short Name:
TBIQOLDepress
Description:
TBI-QOL Item Bank v1.0 – Depression– Short Form 10a. Ten items are included. 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:
2017-09-25
Version:
1.1
Date Created:
2016-05-27
Owner:
Number of Data Elements:
28
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 Exactly 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

TBI-QOL Depression (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - No reason for living scale  The scale which represents how often the participant felt he/she had no reason for living in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLNoRsnForLivingScl Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Give up on everything scale  The scale which represents how often the participant felt that he/she wanted to give up on everything in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLGiveUpOnEverythingScl Recommended CDE
3 TBI Quality of Life (TBI-QOL) - Worthless scale  The scale which represents how often the participant felt worthless in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLWorthlessScl Recommended CDE
4 TBI Quality of Life (TBI-QOL) - Nothing interesting scale  The scale which represents how often the participant felt nothing was interesting in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLNothingInterestingScl Recommended CDE
5 TBI Quality of Life (TBI-QOL) - Depressed scale  The scale which represents how often the participant felt depressed in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLDepressedScl Recommended CDE
6 TBI Quality of Life (TBI-QOL) - Empty life scale  The scale which represents how often the participant felt his/her life was empty in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLEmptyLifeScl Recommended CDE
7 TBI Quality of Life (TBI-QOL) - Nothing cheer up scale  The scale which represents how often the participant felt nothing could cheer him/her up in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLNothingCheerUpScl Recommended CDE
8 TBI Quality of Life (TBI-QOL) - Hopeless scale  The scale which represents how often the participant felt hopeless in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLHopelessScl Recommended CDE
9 TBI Quality of Life (TBI-QOL) - Unhappy scale  The scale which represents how often the participant felt unhappy in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLUnhappyScl Recommended CDE
10 TBI Quality of Life (TBI-QOL) - Nothing to look forward to scale  The scale which represents how often the participant felt that he/she had nothing to look forward to in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLNothingToLookFrdToScl Recommended CDE

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

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Depression raw score  The raw score related to self-reported negative mood, views of self, and social cognition, as well as decreased positive affect and engagement (loss of interest, meaning, and purpose), as part of the TBI Quality of Life (TBI-QOL). TBIQOLDepressRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Depression T-score  The T-Score related to self-reported negative mood, views of self, and social cognition, as well as decreased positive affect and engagement (loss of interest, meaning, and purpose. TBIQOLDepressTScore 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