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

 General Details

Title:
TBI-QOL Item Bank v1.0 - Executive Function - Short Form 10a
Short Name:
TBIQOLExecFunc
Description:
TBI-QOL Executive Function is a 10 item instrument that assesses perceived difficulties in applications of mental function related to planning, organizing, calculating, and problem solving. 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:
2016-12-14
Version:
1.1
Date Created:
2016-06-01
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 (Repeat Infinitely)

# 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 Executive Function (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI-Quality of Life (TBI-QOL) - Difficulty explaining how to do something involving several steps to another person scale  The scale representing how much difficulty the participant currently has explaining how to do something involving several steps to another person TBIQOLDiffcltyExplnngStepsScl Recommended CDE
2 TBI-Quality of Life (TBI-QOL) - Difficulty thinking about two tasks at the same time scale  The scale representing how much difficulty the participant currently has thinking about two tasks at the same time TBIQOLDiffcltyThnkngTwoTsksScl Recommended CDE
3 Quality of Life - Plan keep appointment not weekly routine difficulty scale  The scale which represents amount of difficulty the participant currently has in planning for and keeping appointments that are not part of their weekly routine as part of Neuro-QOL Cognitive Function. QoLPlanKeepAppmntNtWklyRtneScl Recommended CDE
4 Quality of Life - Manage time daily activity difficulty scale  The scale which represents the amount of difficulty the participant currently has in managing their time to do most of their daily activities, as part of Neuro-QOL Cognitive Function. QoLManagTmeDlyActvityDiffScl Recommended CDE
5 Quality of Life - Organize difficulty scale  The scale which represents the amount of difficulty the participant currently has in getting things organized, as part of Neuro-QOL Cognitive Function. QoLOrganizeDiffScl Recommended CDE
6 Quality of Life - Learn new task difficulty scale  The scale which represents the amount of difficulty the participant currently has in learning new tasks or instructions, as part of Neuro-QOL Cognitive Function. QoLLearnNewTaskDiffScl Recommended CDE
7 TBI - Quality of Life (TBI-QOL) - Trouble finding new ways to solve problems scale  The scale which represents how often in the past 7 days the participant had trouble finding new ways to solve problems TBIQOLTrbleSolveProblemsScl Recommended CDE
8 Quality of Life - Trouble make decision past week scale  The scale representing how often the participant had trouble making decisions in the past 7 days, as part of Neuro-QOL Cognitive Function. QoLTroubleMakeDecisionScl Recommended CDE
9 TBI-Quality of Life (TBI-QOL) - Trouble deciding where to start scale  The scale which represents how often in the past 7 days the participant had trouble deciding where to start when he or she had something to do that takes a long time TBIQOLTrbleDecidingStartScl Recommended CDE
10 Quality of Life - Trouble plan task step past week scale  The scale representing how often the participant had trouble planning out steps of a task in the past 7 days, as part of Neuro-QOL Cognitive Function. QoLTroublePlanTaskStepScl Recommended CDE

TBI-QOL Executive Function - Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI-Quality of Life (TBI-QOL) - Cognition executive function raw score  The raw score for TBI-QOL Cognition Executive Function TBIQOLExecFuncRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Cognition executive function T-score  The T-Score related to perceived difficulties in applications of mental function related to planning, organizing, calculating, and problem solving. TBIQOLExecFxnTScore 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