Abstract
Objective
To develop an item response theory (IRT)-calibrated, patient-reported outcome measure
of subjective independence for individuals with traumatic brain injury (TBI).
Design
Large-scale item calibration field testing; confirmatory factor analysis (CFA) and
graded response model IRT analyses.
Setting
Five TBI Model System centers across the United States.
Participants
Adults with complicated mild, moderate, or severe TBI (N=556).
Outcome Measures
Traumatic Brain Injury–Quality of Life (TBI-QOL) Independence item bank and the TBI-QOL
Asking for Help scale.
Results
A total of 556 individuals completed 44 items in the Independence item pool. Initial
factor analyses indicated that items related to the idea of “asking for help” were
measuring a different construct from other items in the pool. These 9 items were set
aside. Twenty-two other items were removed because of bimodal distributions and/or
low item-total correlations. CFA supported unidimensionality of the remaining Independence
items. Graded response model IRT analysis was used to estimate slopes and thresholds
for the final 13 Independence items. An 8-item fixed-length short form was also developed.
The 9 Asking for Help items were analyzed separately. One misfitting item was deleted,
and the final 8 items became a fixed-length IRT-calibrated scale. Reliability was
high for both measures.
Conclusions
The IRT-calibrated TBI-QOL Independence item bank and short form and TBI-QOL Asking
for Help scale may be used to measure important issues for individuals with TBI in
research and clinical applications.
Keywords
List of abbreviations:
CAT (computer adaptive test), CFA (confirmatory factor analysis), CFI (comparative fit index), CHART (Craig Handicap Assessment and Reporting Technique), CIQ (Community Integration Questionnaire), DIF (differential item functioning), GRM (graded response model), IRT (item response theory), PROM (patient-reported outcomes measure), PROMIS (Patient-Reported Outcomes Measurement Information System), RMSEA (root mean square error of approximation), SCI (spinal cord injury), TBI (traumatic brain injury), TBI-QOL (Traumatic Brain Injury–Quality of Life measurement system), TLI (Tucker-Lewis Index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 29, 2019
Footnotes
Supported by grant numbers H133G070138, H133A070037, H133A070043, H133A080045, H133A080044, and H133A70038 from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). Additional support for the preparation of this manuscript was provided by NIDILRR grant # H133A120100.
Disclosures: All TBI-QOL items, parameters, and data are © 2015 David Tulsky and Kessler Foundation. All rights reserved. The items are freely available to the public via [email protected] and there are currently no plans for Dr. Tulsky or Kessler Foundation to profit from the use of the TBI-QOL instruments. No other authors declare a conflict of interest.
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© 2019 by the American Congress of Rehabilitation Medicine
