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

 General Details

Title:
Tinnitus Functional Index
Short Name:
TFI
Description:
Tinnitus Functional Index (TFI) is a standardized form with 25 questions. Negative tinnitus impact is evaluated based on 8 suscales and one overall score. Meikle, M. B., Henry, J. A., Griest, S. E., Stewart, B. J., Abrams, H. B., McArdle, R., ... & Folmer, R. L. (2012). The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear and hearing, 33(2), 153-176. Copyright 2008, 2012 Oregon Health & Science University's permission required. http://www.ohsu.edu/xd/health/services/ent/research/clinical-research/upload/Corrected-TFI-scoring-instructions-8-2-12.pdf
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2019-03-06
Version:
1.0
Date Created:
2016-03-04
Owner:
Number of Data Elements:
53
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 Exactly 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
7 Assessment completion status  Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. AssessmentCompletionStat Recommended CDE
8 Assessment completion status text  A free text related to "Assessment completion status" specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion AssessmentCompletionStatTxt Recommended CDE

Tinnitus Functional Index (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Tinnitus post-TBI assessment indicator  Patient's response concerning ringing, roaring, buzzing, etc. post-TBI for more than 5 minutes. TinnitusPostTBIAssmtInd Recommended CDE
2 Tinnitus Functional Index (TFI) - Tinnitus symptom past week indicator  The indicator related tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of Tinnitus Functional Index (TFI). TFITinnitSympWeekInd Recommended CDE
3 Tinnitus Functional Index (TFI) - Tinnitus symptom awake past week percentage value  The percentage value related tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitSymAwakPastWeekPerVal Recommended CDE
4 Tinnitus Functional Index (TFI) - Tinnitus strong loud scale  The intensity related tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitStrongLoudScl Recommended CDE
5 Tinnitus Functional Index (TFI) - Tinnitus symptom awake annoyance past week scale  The percentage value related to annoyance at tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitSymAwAnPastWeekPerVal Recommended CDE
6 Tinnitus Functional Index (TFI) - Tinnitus in control scale  The controllability over tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitInCtrlScl Recommended CDE
7 Tinnitus Functional Index (TFI) - Tinnitus cope scale  The capability to cope with tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitCopeScl Recommended CDE
8 Tinnitus Functional Index (TFI) - Tinnitus ignore scale  The capability to ignore tinnitus or ringing, buzzing, tinkling, and hissing being experienced while awake in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitIgnoreScl Recommended CDE
9 Tinnitus Functional Index (TFI) - Tinnitus concentrate scale  The ability to concentrate in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitConcentrtScl Recommended CDE
10 Tinnitus Functional Index (TFI) - Tinnitus think clearly scale  The ability to think clearly in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitThinkClearScl Recommended CDE
11 Tinnitus Functional Index (TFI) - Tinnitus focus attention scale  The ability to focus attention on other things besides your tinnitus in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitFocusAttenScl Recommended CDE
12 Tinnitus Functional Index (TFI) - Tinnitus fall stay asleep scale  The frequency of having difficulty in falling or staying asleep in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitAsleepScl Recommended CDE
13 Tinnitus Functional Index (TFI) - Tinnitus as much sleep scale  The frequency of having difficulty in getting as much sleep as you needed in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitMuchSleepScl Recommended CDE
14 Tinnitus Functional Index (TFI) - Tinnitus sleep deeply peacefully scale  The frequency of being away from SLEEPING as DEEPLY or as PEACEFULLY as you would have liked in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitDpPcSleepScl Recommended CDE
15 Tinnitus Functional Index (TFI) - Tinnitus hear clearly scale  How much hearing was being interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitHrClrlyScl Recommended CDE
16 Tinnitus Functional Index (TFI) - Tinnitus understand people scale  How much the ability to understand people who are talking has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitUndersdPplScl Recommended CDE
17 Tinnitus Functional Index (TFI) - Tinnitus follow conversations scale  How much the ability to follow conversations in a group or at meetings has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitFollowCvstScl Recommended CDE
18 Tinnitus Functional Index (TFI) - Tinnitus quiet resting activities scale  How much quiet resting activities have been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitQuiRestAcScl Recommended CDE
19 Tinnitus Functional Index (TFI) - Tinnitus relax scale  How much the ability to relax has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitRelaxScl Recommended CDE
20 Tinnitus Functional Index (TFI) - Tinnitus peace and quiet scale  How much the ability to enjoy peace and quiet has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitPeaceQuietScl Recommended CDE
21 Tinnitus Functional Index (TFI) - Tinnitus social activities scale  How much the enjoyment of social activities has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitEnjoySocAcScl Recommended CDE
22 Tinnitus Functional Index (TFI) - Tinnitus enjoyment of life scale  How much enjoyment of life has been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitEnjoymtScl Recommended CDE
23 Tinnitus Functional Index (TFI) - Tinnitus relationships scale  How much the relationships with family, friends and other people have been interfered with tinnitus or ringing, buzzing, tinkling, and hissing in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitRelatScl Recommended CDE
24 Tinnitus Functional Index (TFI) - Tinnitus work tasks scale  The frequency of having difficulty in performing work or other tasks in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitWkTkScl Recommended CDE
25 Tinnitus Functional Index (TFI) - Tinnitus anxious worried scale  The intensity of anxiousness and worry caused by tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitAnxiousWrdScl Recommended CDE
26 Tinnitus Functional Index (TFI) - Tinnitus bothered upset scale  The intensity of being bothered or upset caused by tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitBothrdUpstScl Recommended CDE
27 Tinnitus Functional Index (TFI) - Tinnitus depressed scale  The intensity of being depressed caused by tinnitus or ringing, buzzing, tinkling, and hissing being experienced in the past week, as part of the Tinnitus Functional Index (TFI). TFITinnitDepressedScl Recommended CDE

TFI-Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Tinnitus Functional Index (TFI) - Tinnitus total score scale  The overall TFI score, as part of the Tinnitus Functional Index (TFI). TFITinnitTotalScore Recommended CDE
2 Tinnitus Functional Index (TFI) - Tinnitus intrusive subscale scale  The TFI INTRUSIVE subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitIntrusiveSubscale Recommended CDE
3 Tinnitus Functional Index (TFI) - Tinnitus sense of control subscale scale  The TFI SENSE OF CONTROL subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitSenceControlSubscale Recommended CDE
4 Tinnitus Functional Index (TFI) - Tinnitus cognitive subscale  The TFI COGNITIVE subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitCongnitiveSubscale Recommended CDE
5 Tinnitus Functional Index (TFI) - Tinnitus sleep subscale  The TFI SLEEP subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitSleepSubscale Recommended CDE
6 Tinnitus Functional Index (TFI) - Tinnitus auditory subscale  The TFI AUDITORY subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitAuditorySubscale Recommended CDE
7 Tinnitus Functional Index (TFI) - Tinnitus relaxation subscale  The TFI RELAXATION subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitRelaxationSubscale Recommended CDE
8 Tinnitus Functional Index (TFI) - Tinnitus quality of life subscale  The TFI QUALITY OF LIFE (QOL) subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitQQLSubscale Recommended CDE
9 Tinnitus Functional Index (TFI) - Tinnitus emotional subscale  The TFI EMOTIONAL subscale, as part of the Tinnitus Functional Index (TFI). TFITinnitEmotionalSubscale Recommended CDE

 Change History

 Administrative Change History