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Development and Psychometric Characteristics of the TBI-QOL Independence Item Bank and Short Form and the TBI-QOL Asking for Help Scale

  • Pamela A. Kisala
    Affiliations
    Center for Health Assessment Research and Translation, University of Delaware College of Health Sciences, Newark, Delaware, United States
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  • David S. Tulsky
    Correspondence
    Corresponding author David S. Tulsky, PhD, University of Delaware, Departments of Physical Therapy and Psychological & Brain Sciences, Center for Health Assessment Research and Translation, STAR Tower, 3rd Floor, 100 Discovery Blvd Newark, DE 19713 USA. Tel: +1 302 831 4606.
    Affiliations
    Center for Health Assessment Research and Translation, University of Delaware College of Health Sciences, Newark, Delaware, United States

    Department of Psychological & Brain Sciences, University of Delaware, Newark, Delaware, United States

    Department of Physical Therapy, University of Delaware, Newark, Delaware, United States
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  • Aaron J. Boulton
    Affiliations
    Center for Health Assessment Research and Translation, University of Delaware College of Health Sciences, Newark, Delaware, United States
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  • Allen W. Heinemann
    Affiliations
    Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States

    Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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  • David Victorson
    Affiliations
    Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States

    Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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  • Mark Sherer
    Affiliations
    Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, United States

    Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, United States
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  • Angelle M. Sander
    Affiliations
    Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, United States

    Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, United States
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  • Nancy Chiaravalloti
    Affiliations
    Kessler Foundation, East Hanover, New Jersey, United States
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  • Noelle E. Carlozzi
    Affiliations
    Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, United States
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  • Robin Hanks
    Affiliations
    Department of Physical Medicine & Rehabilitation, Wayne State University, Detroit, Michigan, United States
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Published:August 29, 2019DOI:https://doi.org/10.1016/j.apmr.2019.08.469

      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)
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