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Rasch Analysis, Dimensionality, and Scoring of the Neuropsychiatric Inventory Irritability and Aggression Subscales in Individuals With Traumatic Brain Injury

  • James F. Malec
    Correspondence
    Corresponding author James F. Malec, PhD, ABPP-Cn, Rp, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, 355 W 16th St, Goodman Hall, Suite 4300, Indianapolis, IN 46202.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN

    Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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  • Timothy E. Stump
    Affiliations
    Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN

    Department of Public Health, Indiana University School of Medicine, Indianapolis, IN
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  • Patrick O. Monahan
    Affiliations
    Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN

    Department of Public Health, Indiana University School of Medicine, Indianapolis, IN
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  • Jacob Kean
    Affiliations
    VA Salt Lake City Health Care System, Salt Lake City, UT

    Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT
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  • Dawn Neumann
    Affiliations
    Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN

    Rehabilitation Hospital of Indiana, Indianapolis, IN
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  • Flora M. Hammond
    Affiliations
    Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN

    Rehabilitation Hospital of Indiana, Indianapolis, IN
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Published:September 13, 2017DOI:https://doi.org/10.1016/j.apmr.2017.07.020

      Abstract

      Objectives

      To develop, for versions completed by individuals with traumatic brain injury (TBI) and an observer, a more precise metric for the Neuropsychiatric Inventory (NPI) Irritability and Aggression subscales using all behavioral item ratings for use with individuals with TBI and to address the dimensionality of the represented behavioral domains.

      Design

      Rasch and confirmatory factor analyses of retrospective baseline NPI data from 3 treatment studies.

      Setting

      Postacute rehabilitation clinic.

      Participants

      NPI records (N = 525) consisting of observer ratings (n = 287) and self-ratings (n = 238) by participants with complicated mild, moderate, or severe TBI at least 6 months postinjury.

      Interventions

      Not applicable.

      Main Outcome Measures

      Frequency and severity ratings from NPI Irritability/Lability and Agitation/Aggression subscales.

      Results

      Confirmatory factor analyses of both observer and participant ratings showed good fit for either a 1-factor or a 2-factor solution. Consistent with this, the Rasch model also fit the data well with aggression items indicating the more severe end of the construct and irritability items populating the milder end.

      Conclusions

      Irritability and aggression appear to represent different levels of severity of a single construct. The derived Rasch metric offers a measure of this construct based on responses to all specific items that is appropriate for parametric statistical analysis and may be useful in research and clinical assessments of individuals with TBI.

      Keywords

      List of abbreviations:

      CFI (comparative fit index), FXS (frequency times severity), NFI (Neurobehavioral Functioning Inventory), NPI (Neuropsychiatric Inventory), PCA (principal component analysis), RMSEA (root mean square error of approximation), TBI (traumatic brain injury), WRMR (weighted root mean square residual)
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