Advertisement

Another Look at the PART-O Using the Traumatic Brain Injury Model Systems National Database: Scoring to Optimize Psychometrics

Published:September 14, 2015DOI:https://doi.org/10.1016/j.apmr.2015.09.001

      Highlights

      • We developed a unidimensional measure of participation by rescoring the Participation Assessment with Recombined Tools-Objective (PART-O).
      • A total of 9911 PART-O assessments in the Traumatic Brain Injury Model Systems National Database were analyzed.
      • Rasch analysis used summated items to address competing personal preferences.
      • A unidimensional, psychometrically sound measure of participation resulted.
      • Item scaling was consistent across time from 1 to 25 years postinjury.

      Abstract

      Objective

      To integrate previous approaches to scoring the Participation Assessment with Recombined Tools-Objective (PART-O) in a unidimensional scale.

      Design

      Retrospective analysis of PART-O data from the Traumatic Brain Injury Model Systems.

      Setting

      Community.

      Participants

      Data from individuals (N=469) selected randomly from participants who completed 1-year follow-up in the Traumatic Brain Injury Model Systems were used in Rasch model development. The model was subsequently tested on data from additional random samples of similar size at 1-, 2-, 5-, 10-, and >15-year follow-ups.

      Interventions

      Not applicable.

      Main Outcome Measure

      PART-O.

      Results

      After combining items for productivity and social interaction, the initial analysis at 1-year follow-up indicated relatively good fit to the Rasch model (person reliability=.80) but also suggested item misfit and that the 0-to-5 scale used for most items did not consistently show clear separation between rating levels. Reducing item rating scales to 3 levels (except combined and dichotomous items) resolved these issues and demonstrated good item level discrimination, fit, and person reliability (.81), with no evidence of multidimensionality. These results replicated in analyses at each additional follow-up period.

      Conclusions

      Modifications to item scoring for the PART-O resulted in a unidimensional parametric equivalent measure that addresses previous concerns about competing item relations, and it fit the Rasch model consistently across follow-up periods. The person-item map shows a progression toward greater community participation from solitary and dyadic activities, such as leaving the house and having a friend through social and productivity activities, to group activities with others who share interests or beliefs.

      Keywords

      List of abbreviations:

      DIF (differential item functioning), PART-O (Participation Assessment with Recombined Tools-Objective), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • World Health Organization
        International classification of impairments, disabilities and handicaps. A manual of classification relating to the consequences of disease.
        World Health Organization, Geneva1993
        • World Health Organization
        ICIDH-2: International classification of impairments, activities, and participation. A manual of dimensions for disablement and functioning.
        World Health Organization, Geneva1997
        • World Health Organization
        International classification of functioning, disability and health.
        World Heatlh Organization, Geneva2001
        • Whiteneck G.G.
        • Dijkers M.P.
        • Heinemann A.W.
        • et al.
        Development of the Participation Assessment with Recombined Tools-Objective for use after traumatic brain injury.
        Arch Phys Med Rehabil. 2011; 92: 542-551
        • Dijkers M.P.
        • Cicerone K.D.
        • Heinemann A.W.
        • Brown M.
        • Whiteneck G.G.
        PART-S: a new measure of satisfaction with participation.
        Arch Phys Med Rehabil. 2009; 90: e39
        • Whiteneck G.
        • Charlifue S.
        • Gerhart K.
        • Overholser J.
        • Richardson G.
        Quantifying handicap: a new measure of long-term rehabilitation outcomes.
        Arch Phys Med Rehabil. 1992; 73: 519-526
        • Brown M.
        • Dijkers M.P.
        • Gordon W.A.
        • Ashman T.
        • Charatz H.
        Participation objective, participation subjective: a measure of participation combining outsider and insider perspectives.
        J Head Trauma Rehabil. 2004; 19: 259-281
        • Johnston M.V.
        • Goverover Y.
        • Dijkers M.P.
        Community activities and individuals satisfaction with them: quality of life in the first year after traumatic brain injury.
        Arch Phys Med Rehabil. 2005; 86: 735-745
        • Bogner J.A.
        • Whiteneck G.G.
        • Corrigan J.D.
        • Lai J.-S.
        • Dijkers M.P.
        • Heinemann A.W.
        Comparison of scoring methods for the Participation Assessment with Recombined Tools-Objective.
        Arch Phys Med Rehabil. 2011; 92: 552-563
        • Dijkers M.P.
        Issues in the conceptualization and measurement of participation: an overview.
        Arch Phys Med Rehabil. 2010; 91: S5-16
        • Heinemann A.W.
        • Tulsky D.
        • Dijkers M.
        • et al.
        Issues in participation measurement in research and clinical applications.
        Arch Phys Med Rehabil. 2010; 91: S72-S76
        • Whiteneck G.
        • Dijkers M.P.
        Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.
        Arch Phys Med Rehabil. 2009; 90: S22-35
        • Alonso J.
        • Bartlett S.J.
        • Rose M.
        • et al.
        The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative.
        Health Qual Life Outcomes. 2013; 11: 210
        • Tulsky D.S.
        • Carlozzi N.E.
        • Cella D.
        Advances in outcomes measurement in rehabilitation medicine: current initiatives from the National Institutes of Health and the National Institute on Disability and Rehabilitation Research.
        Arch Phys Med Rehabil. 2011; 92: S1-6
        • Bond T.M.
        • Fox C.G.
        Applying the Rasch model: fundamental measurement in the human sciences.
        Lawrence Erlbaum, Mahwah2007
        • Merbitz C.
        • Morris J.
        • Grip J.
        Ordinal scales and foundations of misinference.
        Arch Phys Med Rehabil. 1989; 70: 308-312