Original research| Volume 101, ISSUE 1, P11-19, January 2020

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Measuring Pain in TBI: Development of the TBI-QOL Pain Interference Item Bank and Short Form

Published:September 25, 2019DOI:



      To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI).


      Cross-sectional survey study.


      Five TBI Model Systems rehabilitation hospitals.


      Individuals with TBI (N=590).


      Not applicable.

      Outcome Measures

      Traumatic Brain Injury–Quality of Life (TBI-QOL) Pain Interference item bank.


      Confirmatory factor analysis provided evidence of a single underlying trait (χ2 [740]=3254.030; P<.001; Comparative Fix Index=0.988; Tucker-Lewis Index=0.980; Root Mean Square Error of Approximation=0.076) and a graded response model (GRM) supported item fit of 40 Pain Interference items. Items did not exhibit differential item functioning or local item dependence. GRM calibration data were used to inform the selection of a 10-item static short form and to program a TBI-QOL Pain Interference CAT. Comparative analyses indicated excellent comparability and reliability across test administration formats.


      The 40-item TBI-QOL Pain Interference item bank demonstrated strong psychometric properties. End users can administer this measure as either a 10-item short form or CAT.


      List of abbreviations:

      CAT (computer adaptive test), CFA (confirmatory factor analysis), CFI (comparative fit index), DIF (differential item functioning), GRM (graded response model), IRT (item response theory), PRO (patient-reported outcome), PROMIS (Patient-Reported Outcomes Measurement Information System), RMSEA (Root Mean Square Error of Approximation), TBI (traumatic brain injury), TBI-QOL (Traumatic Brain Injury–Quality of Life measurement system), TLI (Tucker-Lewis index)
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