The Behavioral Assessment Screening Tool for Mobile Health (BASTmHealth): Development and Compliance in 2 Weeks of Daily Reporting in Chronic Traumatic Brain Injury

Published:August 11, 2022DOI:



      To develop and evaluate the feasibility of a short form of the Behavioral Assessment Screening Tool (BASTmHealth) for high frequency in situ self-reported assessment of neurobehavioral symptoms using mobile health technology for community-dwelling adults with traumatic brain injury (TBI).


      Prospective, repeated-measures study of mHealth assessment of self-reported neurobehavioral symptoms in adults with and without a lifetime history of TBI over a 2-week period.




      Community-dwelling adults with (n=52) and without (n=12) a lifetime TBI history consented to the study (N=64).


      Not applicable.

      Main Outcome Measures

      BASTmHealth subscales (2-items each): negative affect, fatigue, executive function, substance abuse, impulsivity; feasibility measured via compliance (assessments assigned/assessments completed) and participant-reported usability.


      We developed the 10-item BASTmHealth as a screener for high frequency in situ self-reported assessment of neurobehavioral symptoms leveraging mHealth. Compliance for 2 weeks of BASTmHealth supports its feasibility. Fifty-six of 64 participants (87.5%) who completed baseline assessments completed the 2 weeks of daily assessments; all 8 participants who did not complete ecological momentary assessment had a history of TBI. Overall compliance was 81.4% (496 completed of 609 assigned assessments) among all 52 participants with TBI and 96.7% (494 completed of 511 assigned assessments) among the 44 who completed any daily measures, compared with 91.8% (135 completed of 147 assigned assessments) among those with no TBI history. Participants thought the daily surveys were easy to understand and complete and the number of prompts were reasonable.


      Conducting daily high-frequency in situ self-reported assessment of neurobehavioral symptoms using the BASTmHealth is feasible among individuals with and without a lifetime history of TBI. Developing and evaluating self-reported assessments for community-based assessment is a critical step toward expanding remote clinical monitoring systems to improve post-TBI outcomes.


      List of abbreviations:

      BAST (Behavioral Assessment Screening Tool), EMA (ecological momentary assessment), ESM (experience sampling method), mHealth (mobile health), TBI (traumatic brain injury)
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        • Bryant RA
        • O'Donnell ML
        • Creamer M
        • McFarlane AC
        • Clark CR
        • Silove D
        The psychiatric sequelae of traumatic injury.
        Am J Psychiatry. 2010; 167: 312-320
        • Riggio S.
        Traumatic brain injury and its neurobehavioral sequelae.
        Neurol Clin. 2011; 29 (vii): 35-47
        • Sabaz M
        • Simpson GK
        • Walker AJ
        • Rogers JM
        • Gillis I
        • Strettles B.
        Prevalence, comorbidities, and correlates of challenging behavior among community-dwelling adults with severe traumatic brain injury: a multicenter study.
        J Head Trauma Rehabil. 2014; 29: E19-E30
        • Bell KR.
        Fatigue and traumatic brain injury.
        Arch Phys Med Rehabil. 2015; 96: 567-568
        • Juengst S
        • Skidmore E
        • Arenth PM
        • Niyonkuru C
        • Raina KD.
        Unique contribution of fatigue to disability in community-dwelling adults with traumatic brain injury.
        Arch Phys Med Rehabil. 2013; 94: 74-79
        • Trexler LE
        • Parrott DR.
        Models of brain injury vocational rehabilitation: the evidence for resource facilitation from efficacy to effectiveness.
        J Vocat Rehabil. 2018; 49: 195-203
        • Wilson L
        • Stewart W
        • Dams-O'Connor K
        • et al.
        The chronic and evolving neurological consequences of traumatic brain injury.
        Lancet Neurol. 2017; 16: 813-825
        • Corrigan JD
        • Hammond FM.
        Traumatic brain injury as a chronic health condition.
        Arch Phys Med Rehabil. 2013; 94: 1199-1201
        • Juengst SB
        • Terhorst L
        • Dicianno BE
        • Niemeier JP
        • Wagner AK.
        Development and content validity of the behavioral assessment screening tool (BASTβ).
        Disabil Rehabil. 2019; 41: 1200-1206
        • Juengst SB
        • Terhorst L
        • Wagner AK.
        Factor structure of the behavioral assessment screening tool (BAST) in traumatic brain injury.
        Disabil Rehabil. 2020; 42: 255-260
        • Osborne CL
        • Kauvar DS
        • Juengst SB.
        Linking the behavioral assessment screening tool to the international classification of functioning, disability, and health as a novel indicator of content validity.
        Disabil Rehabil. 2019; 0: 1-8
        • Juengst S
        • Grattan E
        • Wright B
        • Terhorst L.
        Rasch analysis of the behavioral assessment screening tool (BAST) in chronic traumatic brain injury.
        J Psychosoc Rehabil Ment Health. 2021; 8: 231-246
        • Juengst S
        • Terhorst L.
        Further psychometric development of the behavioral assessment screening tool (BAST).
        Arch Phys Med Rehabil. 2020; 101: e140
        • Higashi R
        • Juengst SB.
        Patient-centered measure development and Spanish validation exemplar.
        Health Lit Res Pract. 2019; 3: e243-e249
        • Shiffman S
        • Stone AA
        • Hufford MR.
        Ecological momentary assessment.
        Annu Rev Clin Psychol. 2008; 4: 1-32
        • Larson R
        • Csikszentmihalyi M.
        • Csikszentmihalyi M
        The experience sampling method.
        (editor)Flow and the foundations of positive psychology: the collected works of Mihaly Csikszentmihalyi. Springer, Netherlands2014: 21-34
        • Juengst SB
        • Terhorst L
        • Nabasny A
        • et al.
        Use of mHealth technology for patient-reported outcomes in community-dwelling adults with acquired brain injuries: a scoping review.
        Int J Environ Res Public Health. 2021; 18: 2173
        • Juengst SB
        • Hart T
        • Sander AM
        • Nalder EJ
        • Pappadis MR.
        Mobile health interventions for traumatic brain injuries.
        Curr Phys Med Rehabil Rep. 2019; 7: 341-356
        • Osborne CL
        • Juengst SB
        • Smith EE.
        Identifying user-centered content, design, and features for mobile health apps to support long-term assessment, behavioral intervention, and transitions of care in neurological rehabilitation: an exploratory study.
        Br J Occup Ther. 2021; 84: 101-110
        • Rabinowitz A
        • Hart T
        • Wilson J.
        Ecological momentary assessment of affect in context after traumatic brain injury.
        Rehabil Psychol. 2021; 66: 442-449
        • Forster SD
        • Gauggel S
        • Petershofer A
        • Völzke V
        • Mainz V.
        Ecological momentary assessment in patients with an acquired brain injury: a pilot study on compliance and fluctuations.
        Front Neurol. 2020; 11: 115
        • Burke LE
        • Shiffman S
        • Music E
        • et al.
        Ecological momentary assessment in behavioral research: addressing technological and human participant challenges.
        J Med Internet Res. 2017; 19: e77
        • Donker T
        • Petrie K
        • Proudfoot J
        • Clarke J
        • Birch MR
        • Christensen H.
        Smartphones for smarter delivery of mental health programs: a systematic review.
        J Med Internet Res. 2013; 15
        • Juengst SB
        • Graham KM
        • Pulantara IW
        • et al.
        Pilot feasibility of an mHealth system for conducting ecological momentary assessment of mood-related symptoms following traumatic brain injury.
        Brain Inj. 2015; 29: 1351-1361
        • Suffoletto B
        • Wagner AK
        • Arenth PM
        • et al.
        Mobile phone text messaging to assess symptoms after mild traumatic brain injury and provide self-care support: a pilot study.
        J Head Trauma Rehabil. 2013; 28: 302-312
        • Rabinowitz AR
        • Juengst SB.
        Introduction to topical issue on mHealth for brain injury rehabilitation.
        J Head Trauma Rehabil. 2022; 37: 131-133
      1. The Standards for Educational and Psychological Testing. Available at: Accessed April 19, 2016.

        • Bond TG
        • Fox CM.
        Applying the Rasch model: fundamental measurement in the human sciences.
        3rd ed. Taylor and Francis Group; Routledge, New York2015
        • Choi BS.
        The use of Rasch model in developing a short form based on self-reported activity measure for low back pain.
        Phys Ther Korea. 2014; 21: 56-66
        • Nishigami T
        • Tanaka K
        • Mibu A
        • Manfuku M
        • Yono S
        • Tanabe A.
        Development and psychometric properties of short form of central sensitization inventory in participants with musculoskeletal pain: a cross-sectional study. Luciano JV, ed.
        PLoS ONE. 2018; 13e0200152
        • Davis AM
        • Perruccio AV
        • Canizares M
        • et al.
        The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative.
        Osteoarthr Cartil. 2008; 16: 551-559
        • Gecht J
        • Mainz V
        • Boecker M
        • et al.
        Development of a short scale for assessing economic environmental aspects in patients with spinal diseases using Rasch analysis.
        Health Qual Life Outcomes. 2017; 15: 196
        • Yan Z.
        Developing a short form of the self-assessment practices scale: psychometric evidence.
        Front Educ. 2020; 4: 153
        • Popova ES
        • Ostrowski RK
        • Wescott JJ.
        Development and validation of the occupational self-assessment–short form.
        Am J Occup Ther. 2019; 73 (7303205020p1-10)
        • Gideon N
        • Hawkes N
        • Mond J
        • Saunders R
        • Tchanturia K
        • Serpell L.
        Development and psychometric validation of the EDE-QS, a 12 item short form of the eating disorder examination questionnaire (EDE-Q). Takei N, ed.
        PLoS ONE. 2016; 11e0152744
        • Cole JC
        • Rabin AS
        • Smith TL
        • Kaufman AS.
        Development and validation of a Rasch-derived CES-D short form.
        Psychol Assess. 2004; 16: 360-372
        • Schmucker A
        • Abberger B
        • Boecker M
        • Baumeister H.
        Parallel short forms for the assessment of activities of daily living in cardiovascular rehabilitation patients (PADL-cardio): development and validation.
        Disabil Rehabil. 2019; 41: 826-832
        • Abberger B
        • Haschke A
        • Tully PJ
        • et al.
        Development and validation of parallel short forms PaSA-cardio for the assessment of general anxiety in cardiovascular rehabilitation patients using Rasch analysis.
        Clin Rehabil. 2017; 31: 104-114
        • Lequerica AH
        • Lucca C
        • Chiaravalloti ND
        • Ward I
        • Corrigan JD.
        Feasibility and preliminary validation of an online version of the Ohio State University Traumatic Brain Injury Identification Method.
        Arch Phys Med Rehabil. 2018; 99: 1811-1817
        • Corrigan JD
        • Bogner J.
        Initial reliability and validity of the Ohio State University TBI Identification Method.
        J Head Trauma Rehabil. 2007; 22: 318-329
        • Driver S
        • Juengst S
        • McShan EE
        • Bennett M
        • Bell K
        • Dubiel R.
        A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI).
        Contemp Clin Trials Commun. 2019; 14100328
        • Williams MT
        • Lewthwaite H
        • Fraysse F
        • Gajewska A
        • Ignatavicius J
        • Ferrar K.
        Compliance with mobile ecological momentary assessment of self-reported health-related behaviors and psychological constructs in adults: systematic review and meta-analysis.
        J Med Internet Res. 2021; 23: e17023
        • Kirk GD
        • Linas BS
        • Westergaard RP
        • et al.
        The exposure assessment in current time study: implementation, feasibility, and acceptability of real-time data collection in a community cohort of illicit drug users.
        AIDS Res Treat. 2013; 2013594671
        • Dunbar MS
        • Scharf D
        • Kirchner T
        • Shiffman S.
        Do smokers crave cigarettes in some smoking situations more than others? Situational correlates of craving when smoking.
        Nicotine Tob Res Off J Soc Res Nicotine Tob. 2010; 12: 226-234