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 - Attention/Concentration - Short Form 6a
Short Name:
TBIQOlAttnConc
Description:
TBI-QOL Attention and Concentration is a 6 item short form that is content specific within the TBI-QOL General Concerns item bank, and includes items from the Neuro-QOL Adult Bank Cognitive Function. 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:
2016-05-31
Owner:
Number of Data Elements:
24
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 Attention and Concentration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Quality of Life - Trouble keep track interrupt past week scale  The scale representing how often the participant had trouble keeping track of what they were doing if they were interrupted in the past 7 days, as part of Neuro-QOL Cognitive Function. QoLTrbleKeepTrackInteruptScl Recommended CDE
2 Quality of Life - Maintain task thought trouble past week scale  The scale representing how often the participant had trouble keeping their mind on what they were doing in the past 7 days, as part of Neuro-QOL Depression. QoLMntainTaskThoughtTroublScl Recommended CDE
3 TBI Quality of Life (TBI-QOL) - Difficulty paying attention scale  The scale representing how often in the past 7 days the participant had difficulty paying attention for a long period of time. TBIQOLDiffcltyAttnScl Recommended CDE
4 Quality of Life - Trouble concentrate past week scale  The scale representing how often the participant had trouble concentrating in the past 7 days, as part of Neuro-QOL Cognitive Function. QoLTroubleConcentrateScl Recommended CDE
5 TBI Quality of Life (TBI-QOL) - Felt confused scale  The scale representing how often in the past 7 days the participant felt confused. TBIQOLIFeltConfusedScl Recommended CDE
6 TBI Quality of Life (TBI-QOL) - Difficulty following the topic of conversation scale  The scale representing how often in the past 7 days the subject had difficulty following the topic of conversation. TBIQOLDiffcltyTopicConvrstnScl Recommended CDE

TBI-QOL Attention and Concentration Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI Quality of Life (TBI-QOL) - Attention Concentration Raw score  Raw score for TBI-QOL Attention and Concentration TBIQOLAttnConcRawScore Recommended CDE
2 TBI Quality of Life (TBI-QOL) - Attention concentration T-score  The T-Score related to attention/concentration. TBIQOLAttConcTScore 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