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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 Mental Health Measures

      Abstract

      Objective

      To provide important reliability and validity data to support the use of the Patient-Reported Outcomes Measurement Information System (PROMIS) mental health measures in caregivers of civilians or service members/veterans (SMVs) with traumatic brain injury (TBI).

      Design

      Patient-reported outcome surveys administered through an electronic data collection platform.

      Setting

      Three TBI model systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.

      Participants

      Caregivers (N=560) of individuals with a documented TBI (344 civilians and 216 military).

      Intervention

      Not applicable.

      Main Outcome Measures

      PROMIS anxiety, depression, and anger item banks.

      Results

      Internal consistency for all the PROMIS Mental Health item banks was very good (all α>.86) and 3-week test-retest reliability was good to adequate (ranged from .65 to .85). Convergent validity and discriminant validity of the PROMIS measures were also supported. Caregivers of individuals who were low functioning had worse emotional health-related quality of life (HRQOL) (as measured by the 3 PROMIS measures) than caregivers of high-functioning individuals, supporting known groups validity. Finally, levels of distress, as measured by the PROMIS measures, were elevated for those caring for low-functioning individuals in both samples (rates ranged from 26.2% to 43.6% for caregivers of low-functioning individuals).

      Conclusions

      Results support the reliability and validity of the PROMIS anxiety, depression, and anger item banks in caregivers of civilians and SMVs with TBI. Ultimately, these measures can be used to provide a standardized assessment of HRQOL because it relates to mental health in these caregivers.

      Keywords

      List of abbreviations:

      CAS (Caregiver Appraisal Scale), CAT (Computer Adaptive Test), HRQOL (health-related quality of life), MHC (mental health composite), MPAI-4 (Mayo-Portland Adaptability Inventory-Fourth Edition), PHC (physical health composite), 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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