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Understanding Health-Related Quality of Life in Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury: Establishing the Reliability and Validity of PROMIS Fatigue and Sleep Disturbance Item Banks

      Highlights

      • The Patient-Reported Outcomes Measurement Information System (PROMIS) sleep and fatigue measures are both reliable and valid.
      • The PROMIS sleep and fatigue measures are clinically relevant for caregivers.
      • Caregivers of persons with brain injury have problems with sleep and fatigue.

      Abstract

      Objective

      To examine the reliability and validity of Patient-Reported Outcomes Measurement Information System (PROMIS) measures of sleep disturbance and fatigue in traumatic brain injury (TBI) caregivers and to determine the severity of fatigue and sleep disturbance in these caregivers.

      Design

      Cross-sectional survey data collected through an online data capture platform.

      Setting

      A total of 4 rehabilitation hospitals and Walter Reed National Military Medical Center.

      Participants

      Caregivers (N=560) of civilians (n=344) and service member/veterans (SMVs) (n=216) with TBI.

      Intervention

      Not applicable.

      Main Outcome Measures

      PROMIS sleep and fatigue measures administered as both computerized adaptive tests (CATs) and 4-item short forms (SFs).

      Results

      For both samples, floor and ceiling effects for the PROMIS measures were low (<11%), internal consistency was very good (all α≥0.80), and test-retest reliability was acceptable (all r≥0.70 except for the fatigue CAT in the SMV sample r=0.63). Convergent validity was supported by moderate correlations between the PROMIS and related measures. Discriminant validity was supported by low correlations between PROMIS measures and measures of dissimilar constructs. PROMIS scores indicated significantly worse sleep and fatigue for those caring for someone with high levels versus low levels of impairment.

      Conclusions

      Findings support the reliability and validity of the PROMIS CAT and SF measures of sleep disturbance and fatigue in caregivers of civilians and SMVs with TBI.

      Keywords

      List of abbreviations:

      CAS (Caregiver Appraisal Scale), CAT (Computer Adaptive Test), HRQOL (health-related quality of life), MPAI-4 (Mayo-Portland Adaptability Inventory-Fourth Edition), PROMIS (Patient-Reported Outcomes Measurement Information System), SF (short form), SMV (service member/veteran), TBI (traumatic brain injury), ZBI (Zarit Burden Interview)
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