Original research| Volume 100, ISSUE 4, SUPPLEMENT , S13-S21, April 2019

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The Development of a New Computer-Adaptive Test to Evaluate Strain in Caregivers of Individuals With TBI: TBI-CareQOL Caregiver Strain


      • The Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system includes new and existing self-report measures.
      • Measures were developed specific to caring for someone with traumatic brain injury.
      • Generic measures also evaluate important quality of life constructs for caregivers.



      To develop a new measure of caregiver strain for use in caregivers of individuals with traumatic brain injury (TBI), Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver Strain.


      Qualitative data, literature reviews, and cross-sectional survey study.


      Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.


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


      Not applicable.

      Main Outcome Measure

      TBI-CareQOL Caregiver Strain Item Bank.


      Exploratory and confirmatory factor analyses, a graded response model (GRM) and differential item functioning supported the retention of 33 items in the final measure. GRM calibration data was used to inform the selection of a 6-item static short form, and to program the TBI-CareQOL Caregiver Strain computer-adaptive test (CAT). CAT simulation analyses indicated a 0.97 correlation between the CAT scores and the full item-bank. Three-week test-retest reliability was strong (r=0.83).


      The new TBI-CareQOL Caregiver Strain CAT and corresponding 6-item short form were developed using established rigorous measurement development standards; this is the first self-reported measure developed to evaluate caregiver strain in caregivers of individuals with TBI.


      List of abbreviations:

      CAT (computer adaptive test), CFA (confirmatory factor analysis), CFI (comparative fit index), DIF (differential item functioning), EFA (exploratory factor analysis), GRM (graded response model), HRQOL (health-related quality of life), IRT (item response theory), PRO (patient-reported outcome), PROMIS (Patient-Reported Outcomes Measurement Information System), RMSEA (root mean squared error of approximation), SF (short form), SMV (service member/veteran), TBI (traumatic brain injury), TBI-CareQOL (Traumatic Brain Injury Caregiver Quality of Life), TLI (Tucker-Lewis index)
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