CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: Effort/Symptom Validity
CRF: Word Memory Test

Displaying 1 - 28 of 28
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C56524 Word Memory Test (WMT) - Immediate recognition percentage value WMTImmedRecogPerVal The percent of correct answers on the Immediate Recall subtest, as part of the Word Memory Test (WMT). The percent of correct answers on the Immediate Recall subtest, as part of the Word Memory Test (WMT). Immediate Recognition Score Numeric Values

Percentage of words correctly recalled.

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:10:55.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 100
C21114 Visit post baseline day count VisitPostBaselineDayCt The number of days since baseline visit. The number of days since baseline visit. The number of days since baseline Numeric Values

Enter the number of days passed since the baseline visit

Adult;Pediatric Supplemental 1.00 2015-06-12 14:49:48.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

day
C56525 Word Memory Test (WMT) - Delay recognition percentage value WMTDelayRecogPerVal The percent of correct answers on the Delay Recognition subtest, as part of the Word Memory Test (WMT). The percent of correct answers on the Delay Recognition subtest, as part of the Word Memory Test (WMT). Delay Recognition Score Numeric Values

Percentage of words correctly recalled.

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:11:53.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 100 percent
C22682 Case Control Indicator CaseContrlInd The response related to whether subject is in the case or control arm of the study Indicator of whether subject is in the case or control arm of the study Is the subject in the case or control arm of the study? Case;Control;Unknown Case;Control;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2016-07-27 13:36:42.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Multiple Pre-Defined Values Selected

C56526 Word Memory Test (WMT) - Consistency percentage value WMTConsisPerVal The consistency value, as part of the Word Memory Test (WMT). The consistency value, as part of the Word Memory Test (WMT). Consistency Score Numeric Values

Percentage of words correctly recalled.

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:13:08.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 100 percent
C22683 Context type ContextType The context to which the questions were answered, e.g., since the last interview or after the injury. The context to which the questions were answered, e.g., since the last interview or after the injury. Time frame related context (if any) to which the questions were answered After injury;At time of assessment;Before injury;Last 2 weeks;Last 6 months;Last 24 hours;Last month;Last week;Last year;Prior to death;Since last interview;Time of injury;Other, specify After injury;At time of assessment;Before injury;Last 2 weeks;Last 6 months;Last 24 hours;Last month;Last week;Last year;Prior to death;Since last interview;Time of injury;Other, specify Alphanumeric

Provide the time frame related context (if any) to which the questions were answered.

Adult;Pediatric Supplemental 1.00 2016-07-29 10:50:39.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Single Pre-Defined Value Selected

C56527 Word Memory Test (WMT) - Multiple choice percentage value WMTMultChoicePerVal The percent of correct answers on the Multiple Choice portion, as part of the Word Memory Test (WMT). The percent of correct answers on the Multiple Choice portion, as part of the Word Memory Test (WMT). Multiple Choice Score Numeric Values

Percentage of words correctly recalled.

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:13:38.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 100 percent
C00008 Age value AgeVal Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. Subject's age (recorded in years) Numeric Values

The subject's age is typically recorded to the nearest full year completed, e.g. 11 years and 6 months should be recorded as 11 years. For subject's which are under 1 year old, use decimal points and use the following convention- record 1 month as 0.083 (1/12), 2 months as 0.166 (2/12), 3 months as 0.25 (3/12), 4 months as 0.333 (4/12), 5 months as 0.416 (5/12), 6 months as 0.5 (6/12), 7 months as 0.583 (7/12), 8 months as 0.666 (8/12), 9 months as 0.75 (9/12), 10 months as 0.833 (10/12), 11 months as 0.916 (11/12) and 12 months as 1 year. For the individuals 90 or older, in order to preserve PII, please submit "150" and make a note this in the "general notes" column.

Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 1800 month
C22685 Context type other text ContextTypOTH The free-text related to Context type specifying other text. The free-text related to Context type specifying other text. Other, specify Alphanumeric

Enter other text

Adult;Pediatric Supplemental 1.00 2016-08-01 13:25:47.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 4000

Free-Form Entry

C56528 Word Memory Test (WMT) -Paired associate percentage value WMTPairAssocPerVal The percent of correct answers on the Paired Associates subtest, as part of the Word Memory Test (WMT). The percent of correct answers on the Paired Associates subtest, as part of the Word Memory Test (WMT). Paired Associates Score Numeric Values

Percentage of words correctly recalled.

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:14:41.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 100 percent
C04807 Vital status VitStatus Status of participant/subject as alive or dead Status of participant/subject as alive or dead What is the vital status of the subject? Alive;Dead;Unknown Alive;Dead;Unknown Alphanumeric

Status of participant/subject as alive or dead. Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Single Pre-Defined Value Selected

C53953 Language form administration ISO code LangFormAdministratISOCode Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration What is the ISO 639 code for the language the form/instrument has been administrated? chi;cze;dan;dut;eng;fin;fre;ger;gre;heb;hin;hun;ira;ita;jpn;nor;Other, specify;por;rus;sgn;spa;vie Chinese;Czech;Danish;Dutch;English;Finnish;French;German;Greek;Hebrew;Hindi;Hungarian;Iranian languages;Italian;Japanese;Norwegian;Other specify;Portuguese;Russian;Sign language;Spanish;Vietnamese Alphanumeric

Data Sharing Instructions: The language data should be coded using the ISO 639-2 codes ( (https://www.loc.gov/standards/iso639-2/php/code_list.php) prior to aggregation or sharing. Enter ISO 639-2 code for the language used to administer the CRF/instrument/scale/test/etc. If the language is not specified, the default value is 'eng'- English.

ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) Adult;Pediatric Supplemental 1.00 2017-02-10 00:00:00.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Single Pre-Defined Value Selected

C56529 Word Memory Test (WMT) -Free recall percentage value WMTFreeRecalPerVal The percent of correct answers on the Free Recall subtest, as part of the Word Memory Test (WMT). The percent of correct answers on the Free Recall subtest, as part of the Word Memory Test (WMT). Free Recall Score Numeric Values

Percentage of words correctly recalled.

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:15:37.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 100 percent
C08147 Data source DataSource Source of the data provided on the case report form Source of the data provided on the case report form Who is the source of this information in relation to the subject? Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Alphanumeric

"Select all that apply. "

Adult;Pediatric Supplemental 3.00 2013-07-20 10:46:24.96 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Multiple Pre-Defined Values Selected

C53954 Language form administration ISO code other text LangFormAdministratISOCodeOTH The free-text field related to 'Language form administration ISO code' specifying other text. The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. Other, specify Alphanumeric

"Other text for form administration language ISO 639-2 code. Should be used only if 1) the ISO code is not available under LangCRFAdministratISOCode permissible values or 2) the ISO code is not available at all. If the language is not specified, the default value is 'eng'- English. "

"ISO 639-2 language codes (http: //www.loc.gov/standards/iso639-2/php/code_list.php) " Adult;Pediatric Supplemental 1.00 2017-02-10 00:00:00.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 4000

Free-Form Entry

C56530 Word Memory Test (WMT) -Delay free recall percentage value WMTLonDelayFreeRecalPerVal The percent of correct answers on the Delay Free Recall subtest, as part of the Word Memory Test (WMT). The percent of correct answers on the Delay Free Recall subtest, as part of the Word Memory Test (WMT). Delay Free Recall Score Numeric Values

Percentage of words correctly recalled.

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:16:37.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 100 percent
C17399 Global unique identifier number GlobalUniqueIdNum Global Unique ID (GUID) which uniquely identifies a subject Global Unique ID which uniquely identifies a subject Global Unique ID (GUID) which uniquely identifies the subject Alphanumeric Johnson, S.B., Whitney, G., McAuliffe, M., Wang, H., McCreedy, E., Rozenblit, L., and Evans, C.C. (2010). Using Global Unique identifiers to link autism collections. J. Am. Med. Inform. Assoc., in press. Published online July 17, 2010. 10.1136/jamia.2009.002063. Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Word Memory Test Effort/Symptom Validity Outcomes and End Points 255

Free-Form Entry

C56000 General note text GenNtTxt The free-field related to general notes. The free-field related to general notes. Additional information (if any) Alphanumeric

Use this field to capture additional information

Adult;Pediatric Supplemental 1.00 2016-12-15 16:03:39.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 255

Free-Form Entry

C56531 Word Memory Test (WMT) - Immediate recognition average response time WMTImmedRecogAvRespTime The subject's average response time on the Immediate Recognition subtest, as part of the Word Memory Test (WMT). The subject's average response time on the Immediate Recognition subtest, as part of the Word Memory Test (WMT) Immediate Recognition Average Response Time Numeric Values

Average response time for immediate recognition test

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:17:28.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 second
C17402 Site name SiteName The name of the site for the study The name of the site for the study Name of the site Alphanumeric

Enter the name of the study site

Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 255

Free-Form Entry

C56521 Word Memory Test (WMT) - Diagnosis text WMTDiagnosisTxt Text describing the subject's diagnosis, as part of the Word Memory Test (WMT). Text describing the subject's diagnosis, as part of the Word Memory Test (WMT). Diagnosis Alphanumeric

Indicate diagnosis for participant

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:08:13.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 4000

Free-Form Entry

C56532 Word Memory Test (WMT) -Delay recognition average response time WMTDelayRecogAvRespTime The subject's average response time on the Delay Recognition subtest,, as part of the Word Memory Test (WMT). The subject's average response time on the Delay Recognition subtest,, as part of the Word Memory Test (WMT). Delay Recognition Average Response Time Numeric Values

Average response time for delay recognition test

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:19:28.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 second
C17409 Visit date VisitDate Date of interview or visit (actually the date when data in the form were captured) Date of interview or visit Visit date Date or Date & Time

Data Sharing Instructions: When date/time data are prepared for aggregation or sharing they should be converted to the format specified by ISO 8601, YYYY-MM-DDThh:mm:ss.

21 CFR 50.20 General requirements for informed consent A Guide to Informed Consent - Information Sheet: Guidance for Institutional Review Boards and Clinical Investigators Contents (http://www.fda.gov/RegulatoryInformation/Guidances/ucm126431.htm#general) Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

C56522 Word Memory Test (WMT) - Diagnosis comment text WMTDiagnosisCommentTxt Text describing any comments about the subject's diagnosis, as part of the Word Memory Test (WMT). Text describing any comments about the subject's diagnosis, as part of the Word Memory Test (WMT). Other(please specify) Alphanumeric

Use for other category reasons or diagnosis not specified

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:09:04.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 4000

Free-Form Entry

C56533 Word Memory Test (WMT) - Multiple choice average response time WMTMultChoiceAvRespTime The subject's average response time on the Multiple Choice portion, as part of the Word Memory Test (WMT) . The subject's average response time on the Multiple Choice portion, as part of the Word Memory Test (WMT) . Multiple Choice Average Response Time Numeric Values

Average response time for multiple choice test

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:20:17.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points

Free-Form Entry

0 second
C18667 Data source other text DataSourcOTH The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form Other, specify Alphanumeric

Enter other data source text

Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 4000

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C56523 Word Memory Test (WMT) - Diagnosis subcategory text WMTDiagnosisSubcategoryTxt Text describing the subcategory of diagnosis, as part of the Word Memory Test (WMT). Text describing the subcategory of diagnosis, as part of the Word Memory Test (WMT). Subcategory Alphanumeric

Subcategory of diagnosis

Green, P. (2003). Green's Word Memory Test for Windows User's Manual. Edmonton, Alberta, Canada:Green's Publishing;Green, P., Allen L., & Astner, K. (1996). Manual for computerized Word Memory Test.Durham, NC:CogniSyst; Armistead-Jehle, P., Green, P., Gervais, R. O., & Hungerford, L. D. (2015). An examination of the Word Memory Test as a measure of memory. Applied Neuropsychology: Adult, 22(6), 415-426. Adult;Pediatric Supplemental 1.00 2017-06-14 15:10:05.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 4000

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C19247 Subject ID SubIDNam Subject identification ID Subject identification ID Subject ID Number Alphanumeric

The participant or subject identifiers or IDs should be assigned by the study.

"Alexander MS, Biering-Sorensen F, Elliott S, Kreuter M, Saanksen J. International Spinal Cord Injury Female Sexual and Reproductive Function Basic Data Set. Spinal Cord. 2011 Jul;49(7):787-90. Alexander MS, Biering-Sorensen F, Elliott S, Kreuter M, Saanksen J. International Spinal Cord Injury Male Sexual Function Basic Data Set. Spinal Cord. 2011 Jul;49(7):795-8. Bauman WA, Biering-Sorensen F, Krassioukov A. International spinal cord injury endocrine and metabolic function basic data set. Spinal Cord. 2011 Oct;49(10):1068-72. Biering-Sorensen F, Craggs M, Kennelly M, Schick E, Wyndaele JJ. International Lower Urinary Tract Function Basic Spinal Cord Injury Data Set. Spinal Cord 2008 May;46(5):325-30. Krogh K, Perkash I, Stiens SA, Biering-Sorensen F. International bowel function extended spinal cord injury data set. Spinal Cord. 2009 Mar;47(3):235-41. Widerstraam-Noga E, Biering-Sorensen F, Bryce T, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ. The international spinal cord injury pain basic data set. Spinal Cord. 2008 Dec;46(12):818-23." Adult;Pediatric Supplemental 1.00 2014-06-05 13:10:49.0 Word Memory Test Effort/Symptom Validity Outcomes and End Points 255

Free-Form Entry

CSV