This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
TBI-QOL Item Bank v1.0 - Satisfaction with Social Roles and Activities Short Form 10a
Short Name:
TBIQOLSatSocRolAct
Description:
TBI-QOL Satisfaction with Social Roles and Activities Short Form includes 10 items from NeuroQol and PROMIS item banks. This instrument assesses satisfaction with involvement in the participant's usual social roles, activities, and responsibilities, including work, family, friends, and leisure. 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:
2016-06-01
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 (Repeat Infinitely)

# 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 Satisfaction with Social Roles and Activities (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Family need disappointment past week scale  The scale which represents the extent to which the participant was disappointed in their ability to meet the needs of their family in the past 7 days, as part of Neuro-QOL Satisfaction with SRA. QoLFamilyNeedDisappointmentScl Recommended CDE
2 Quality of Life - Friend need ability disappointment past week scale  The scale which represents the extent to which the participant was disappointed in their ability to meet the needs of their friends in the past 7 days, as part of Neuro-QOL Satisfaction with SRA. QoLFriendNeedAbilityDisappScl Recommended CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with amount of time spent doing leisure activities past week scale  The scale which represents the extent of the participant's satisfaction with the amount of time he spent doing leisure activities in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyLeisureTimeScale Recommended CDE
4 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability do things for family past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do things for his family in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyAbiDoForFamlyScale Recommended CDE
5 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability do work really important past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do the work that is really important to him in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyAbiImprtntWrkScale Recommended CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for friends past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do things for his friends in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyDoForFriendsScale Recommended CDE
7 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with amount time spend work past week scale  The scale which represents the extent of the participant's satisfaction with the amount of time he/she spent doing work in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyTimeDoWorkScale Recommended CDE
8 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for fun outside of home past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do things for fun outside of the home in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyDoFunOutHomeScale Recommended CDE
9 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability to do things for fun at home past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to do things for fun at home in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyAbiFunAtHomeScale Recommended CDE
10 Patient-Reported Outcome Measurement Information System (PROMIS) - satisfaction with ability perform daily routine past week scale  The scale which represents the extent of the participant's satisfaction with his/her ability to perform daily routines in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISSatsfyAbiDoDayRoutnScale Recommended CDE

TBI-QOL Satisfaction with SRA Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI- Quality of Life (TBI-QOL) - Raw score for satisfaction with social roles and activities  Raw score for satisfaction with social roles and activities for TBI-QOL Satisfaction with Social Roles and Activities Short Form. TBIQOLSatSocRolActRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Satisfaction social roles activities T-score  The T-Score related to communication comprehension, as part of the TBI Quality of Life (TBI-QOL). TBIQOLSatSRATScore 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