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

 General Details

Title:
TBI-QOL Item Bank v1.0 - Independence - Short Form 8a
Short Name:
TBIQOLIndependence
Description:
TBI-QOL Item Bank v1.0 - Independence -Short Form 8a. Eight 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
Version:
1.0
Date Created:
2016-05-27
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 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 Independence (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Independent scale  The scale representing how often the participant was able to be independent in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLIndependentScl Recommended CDE
2 TBI Quality of Life (TBI-QOL) - As independent as ever seen scale  The scale representing how often the participant was as independent as he/she has ever been in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLAsIndepndntAsEvrSnScl Recommended CDE
3 TBI Quality of Life (TBI-QOL) - Do things without help scale  The scale which represents how often the participant was able to do things without help from other people in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLDoThingsWtHelpScl Recommended CDE
4 TBI Quality of Life (TBI-QOL) - Satisfied being independent scale  The scale which represents how often the participant was satisfied with his/her ability to be independent in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLSatsfidBeingIndepScl Recommended CDE
5 TBI Quality of Life (TBI-QOL) - Satisfied with ability to take care scale  The scale which represents how often the participant was satisfied with his/her ability to take care of himself/herself in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLSatsfidWAbToTakeCareScl Recommended CDE
6 TBI Quality of Life (TBI-QOL) - Limited ability scale  The scale which represents how often the participant was limited in his/her activities because he/she depends on other people. in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLLimitedAbScl Recommended CDE
7 TBI Quality of Life (TBI-QOL) - Felt worse because of dependence scale  The scale which represents how often the participant felt worse about himself/herself because of the dependence on others in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLFeltWrsBczOfDpndnceScl Recommended CDE
8 TBI Quality of Life (TBI-QOL) - Burden to other people scale  The scale which represents how often the participant felt that he/she was a burden to other people in the past 7 days, as part of Traumatic Brain Injury-Quality of Life (TBI-QOL). TBIQOLBurdnToOthrPplScl Recommended CDE

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

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Independence raw score  The raw score related to perceived independence, ability to tell others about one's needs, and sense of control over one's life, as part of the TBI Quality of Life (TBI-QOL). TBIQOLIndepRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Independence T-score  The T-Score related to perceived independence, ability to tell others about one's needs, and sense of control over one's life, as part of the TBI Quality of Life (TBI-QOL). TBIQOLIndepTScore 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