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

 General Details

Title:
TBI-QOL Item Bank v1.0 - Fatigue - Short Form 10a
Short Name:
TBIQOLFatigue
Description:
TBI-QOL Item Bank v1.0 - Fatigue - 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:
2016-12-08
Version:
1.1
Date Created:
2016-05-26
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 Fatigue (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Trouble starting scale  The scale representing to what degree the participant had trouble starting things because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLTroubleStartScl Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Trouble finishing scale  The scale representing to what degree the participant had trouble finishing things because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLTroubleFinishScl Recommended CDE
3 TBI Quality of Life (TBI-QOL) - Fatigue on average scale  The scale which represents how fatigued was the participant on average in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLFatigueOnAveScl Recommended CDE
4 TBI Quality of Life (TBI-QOL) - Tired even no anything done scale  The scale which represents to what degree the participant felt tired even he/she hadn't done anything in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLTrdEvnNoAnythingDoneScl Recommended CDE
5 TBI Quality of Life (TBI-QOL) - Push to get things done scale  The scale which represents to what degree the participant had to push himself/herself to get things done because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLPushToGtThingsDoneScl Recommended CDE
6 TBI Quality of Life (TBI-QOL) - Carry on conversation scale  The scale which represents how hard it was for the participant to carry on a conversation because of fatigue in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLCarryOnConversatnScl Recommended CDE
7 TBI Quality of Life (TBI-QOL) - Run out of energy scale  The scale which represents how often the participant run out of energy in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLRunOutOfEnergyScl Recommended CDE
8 TBI Quality of Life (TBI-QOL) - Tired socialize with family scale  The scale which represents how often the participant was too tired to socialize with his/her family in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLTrdSocilzeWFmlyScl Recommended CDE
9 TBI Quality of Life (TBI-QOL) - Tired leave the house scale  The scale which represents how often the participant was too tired to leave the house in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLTrdLeaveTheHsScl Recommended CDE
10 TBI Quality of Life (TBI-QOL) - Feel tired scale  The scale which represents how often the participant felt tired in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLFeelTiredScl Recommended CDE

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

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Fatigue raw score  The raw score related to sensations ranging from tiredness to an overwhelming, debilitating and sustained sense of exhaustion, as part of the TBI Quality of Life (TBI-QOL). TBIQOLFatigueRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Fatigue T-score  The T-Score related to fatigue and sensations ranging from tiredness to an overwhelming, debilitating and sustained sense of exhaustion, as part of the TBI Quality of Life (TBI-QOL). TBIQOLFatigueTScore 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