Original research| Volume 101, ISSUE 1, P54-61, January 2020

Download started.


Responsiveness of the Traumatic Brain Injury–Quality of Life (TBI-QOL) Measurement System

Published:February 03, 2018DOI:



      To assess the responsiveness of the Traumatic Brain Injury–Quality of Life (TBI-QOL) measurement system.


      Participants completed the 20 TBI-QOL item banks and the Participation Assessment with Recombined Tools–Objective (PART-O) Productivity Subscale at baseline and 6-month follow-up assessments. Participants were categorized into 4 groups (increased productivity, unchanged productivity, and decreased productivity) based on PART-O Productivity scores. Paired sample t tests were used to compare TBI-QOL scores at baseline and 6 months, and standardized response means and Cohen's d were computed to estimate effect sizes.


      Three traumatic brain injury (TBI) Model Systems rehabilitation centers in the United States.


      Two hundred one community-dwelling adults with TBI.


      Not applicable.

      Main Outcome Measures

      20 TBI-QOL item banks.


      As expected, given that there was no intervention, group mean TBI-QOL subdomain scores for the entire sample showed no change or small improvement over the 6-month study period. At the follow-up assessment, 72 participants reported increased productivity, 71 reported decreased productivity, and 58 reported the same level of productivity as they had 6 months prior. When compared with participants who reported unchanged or decreased productivity, participants who reported increased productivity on the PART-O subscale had clinically meaningful (d≥0.30) improvements on 7 TBI-QOL measures. The largest improvement was in the Independence subdomain (mean change, 7.06; df=0.84), with differences also observed in the Mobility, Positive Affect and Well-Being, Resilience, Grief/Loss, Ability to Participate, and Satisfaction with Participation subdomains.


      The 20 TBI-QOL item banks demonstrate responsiveness to change and measurement stability in a community-dwelling sample. Researchers may use the TBI-QOL to detect changes in HRQOL after a clinical intervention and clinicians may use it in their daily practices to monitor patient recovery.


      List of Abbreviations:

      GRC (global ratings of change), HRQOL (health-related quality of life), Neuro-QOL (Neurology Quality of Life measurement initiative), PART-O (Participation Assessment with Recombined Tools–Objective), PF-10a (short-form version of the PROMIS physical function scale), PROMIS (Patient-Reported Outcomes Measurement Information System), SRM (standardized response mean), TBI (traumatic brain injury), TBI-QOL (Traumatic Brain Injury– Quality of Life measurement system)
      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 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


        • Cella D.F.
        Measuring quality of life in palliative care.
        Semin Oncol. 1995; 22: 73-81
        • Ware J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Polinder S.
        • Haagsma J.A.
        • van Klaveren D.
        • Steyerberg E.W.
        • van Beeck E.F.
        Health-related quality of life after TBI: a systematic review of study design, instruments, measurement properties, and outcome.
        Popul Health Metr. 2015; 13: 1-12
        • Tulsky D.S.
        • Kisala P.A.
        • Victorson D.
        • et al.
        TBI-QOL: development and calibration of item banks to measure patient reported outcomes following traumatic brain injury.
        J Head Trauma Rehabil. 2016; 31: 40-51
        • Cella D.
        • Yount S.
        • Rothrock N.
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH roadmap cooperative group during its first two years.
        Med Care. 2007; 45: S3-11
        • Cella D.
        • Nowinski C.
        • Peterman A.
        • et al.
        The neurology quality of life measurement initiative.
        Arch Phys Med Rehabil. 2011; 92: S28-36
        • Carlozzi N.E.
        • Tulsky D.S.
        • Kisala P.A.
        Traumatic brain injury patient-reported outcome measure: identification of health-related quality of life issues relevant to individuals with traumatic brain injury.
        Arch Phys Med Rehabil. 2011; 92: S52-60
        • Hays R.D.
        • Hadorn D.
        Responsiveness to change: an aspect of validity, not a separate dimension.
        Qual Life Res. 1992; 1: 73-75
        • Hays R.D.
        • Spritzer K.L.
        • Fries J.F.
        • Krishnan E.
        Responsiveness and minimally important difference for the patient-reported outcomes measurement and information system (PROMIS) 20-item physical functioning short-form in a prospective observational study of rheumatoid arthritis.
        Ann Rheum Dis. 2015; 74: 104-107
        • Kean J.
        • Monahan P.O.
        • Kroenke K.
        • et al.
        Comparative responsiveness of the PROMIS pain interference short forms, brief pain inventory, PEG, and SF-36 bodily pain subscale.
        Med Care. 2016; 54: 414-421
        • Hahn E.A.
        • Beaumont J.L.
        • Pilkonis P.A.
        • et al.
        The PROMIS satisfaction with social participation measures demonstrated responsiveness in diverse clinical populations.
        J Clin Epidemiol. 2016; 73: 135-141
        • Stratford P.W.
        • Riddle D.L.
        Assessing sensitivity to change: choosing the appropriate change coefficient.
        Health Qual Life Outcomes. 2005; 3: 23-29
        • Jensen R.E.
        • Moinpour C.M.
        • Potosky A.L.
        • et al.
        Responsiveness of 8 patient-reported outcomes measurement information system (PROMIS) measures in a large, community-based cancer study cohort.
        Cancer. 2017; 123: 327-335
        • Wahl E.
        • Gross A.
        • Chernitskiy V.
        • et al.
        Validity and responsiveness of a 10-item patient-reported measure of physical function in a rheumatoid arthritis clinic population.
        Arthritis Care Res (Hoboken). 2017; 69: 338-346
        • Aletaha D.
        • Nell V.P.K.
        • Stamm T.
        • et al.
        Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score.
        Arthritis Res Ther. 2005; 7: R796-806
        • Salsman J.M.
        • Victorson D.
        • Choi S.W.
        • et al.
        Development and validation of the positive affect and well-being scale for the neurology quality of life (Neuro-QOL) measurement system.
        Qual Life Res. 2013; 22: 2569-2580
        • Miller D.M.
        • Bethoux F.
        • Victorson D.
        • et al.
        Validating Neuro-QOL short forms and targeted scales with people who have multiple sclerosis.
        Mult Scler. 2016; 22: 830-841
        • Nowinksi C.J.
        • Siderowf A.
        • Simuni T.
        • et al.
        Neuro-QOL health-related quality of life measurement system: validation in Parkinson's disease.
        Mov Disord. 2016; 31: 725-733
        • 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
        • Sherer M.
        • Sander A.M.
        • Nick T.G.
        • et al.
        Key dimensions of impairment, self-report, and environmental supports in persons with traumatic brain injury.
        Rehabil Psychol. 2015; 60: 138-146
        • Sherer M.
        • Nick T.G.
        • Sander A.M.
        • et al.
        Groupings of persons with traumatic brain injury: a new approach to classifying traumatic brain injury in the post-acute period.
        J Head Trauma Rehabil. 2017; 32: 125-133
        • Bogner J.A.
        • Whiteneck G.G.
        • Corrigan J.D.
        • et al.
        Comparison of scoring methods for the Participation Assessment with Recombined Tools–Objective.
        Arch Physl Med Rehabil. 2011; 92: 552-563
        • Sherer M.
        • Poritz J.M.P.
        • Tulsky D.
        • et al.
        Conceptual structure of health-related quality of life for persons with traumatic brain injury: confirmatory factor analysis of the TBI-QOL.
        Arch Phys Med Rehabil. 2020; 101: 62-71
        • Keith R.A.
        • Granger C.V.
        • Hamilton B.B.
        • Sherwin F.S.
        The functional independence measure: a new tool for rehabilitation.
        Adv Clin Rehabil. 1987; 1: 6-8