Faculty Bibliography

OBJECTIVE:To develop traumatic brain injury (TBI)-optimized versions of the Neuro-QoL Ability to Participate in Social Roles and Activities (SRA) and Satisfaction with Participation in SRA item banks; evaluate the psychometric properties of the item banks developed for adults with TBI; develop short form and computer adaptive test (CAT) versions; and report information to facilitate research and clinical applications. DESIGN/METHODS:We used a mixed-methods design to develop and evaluate Ability to Participate in SRA and Satisfaction with SRA items. Focus groups defined the constructs; cognitive interviews guided item revisions; and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics. SETTING/METHODS:Five TBI Model Systems centers in the United States. PARTICIPANTS/METHODS:556 community-dwelling adults with TBI. INTERVENTIONS/METHODS:None. OUTCOME MEASURES/METHODS:Traumatic Brain Injury-Quality of Life (TBI-QOL) Ability to Participate in SRA and TBI-QOL Satisfaction with SRA item banks. RESULTS:Forty-five Ability to Participate in SRA and 41 Satisfaction with SRA items demonstrated good psychometric properties. Although some of the items are new, most were drawn from analogous banks in the Quality of Life in Neurological Disorders (Neuro-QoL) measurement system. Consequently, the two TBI-QOL item banks were linked to the Neuro-QoL metric and scores are comparable to the general population. All CAT and short forms correlated highly (> 0.90) with the full item banks and demonstrate comparable construct coverage and measurement error. CONCLUSION/CONCLUSIONS:The TBI-QOL Ability to Participate in SRA and TBI-QOL Satisfaction with SRA item banks are TBI-optimized versions of the Neuro-QoL Ability to Participate in SRA and Satisfaction with SRA item banks and demonstrate excellent measurement properties in individuals with TBI. These measures, particularly in CAT or short form format, are suitable for efficient and precise measurement of social outcomes in clinical and research applications.

OBJECTIVE:To develop an item response-theory (IRT)-calibrated, patient-reported outcome measure of subjective independence for individuals with traumatic brain injury (TBI). DESIGN/METHODS:Large-scale item calibration field testing; confirmatory factor analysis (CFA) and graded response model item response theory (IRT) analyses. SETTING/METHODS:Five TBI Model System centers across the United States. PARTICIPANTS/METHODS:Adults with complicated mild, moderate, or severe TBI. OUTCOME MEASURES/METHODS:Traumatic Brain Injury-Quality of Life (TBI-QOL) Independence item bank and the TBI-QOL Asking for Help scale. RESULTS: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 were 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.

OBJECTIVE:To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI). DESIGN/METHODS:Cross-sectional survey study. SETTING/METHODS:Five TBI Model Systems rehabilitation hospitals. PARTICIPANTS/METHODS:Five hundred ninety individuals with TBI. INTERVENTIONS/METHODS:Not Applicable. OUTCOME MEASURES/METHODS:TBI-QOL Pain Interference item bank. RESULTS:(740) = 3254.030, p < .001; Comparative Fix Index = .988; Tucker Lewis Index = .980; Root Mean Square Error of Approximation = .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. CONCLUSION/CONCLUSIONS: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.

OBJECTIVE:To develop a set of composite scores that can be used for interpreting quality of life (QOL) after traumatic brain injury (TBI) using 9 of the patient-reported outcomes measures from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. DESIGN/METHODS:Participants completed 20 item banks from the TBI-QOL as part of a larger assessment. Composite index scores were created with normalized transformation with nonlinear area conversion using scores from 9 of the banks, and are expressed in index score units, with higher composite scores indicating better functioning. For descriptive purposes, associations among composites and individual banks were evaluated using regression, along with patterns of composite scores by injury severity groups using analysis of variance. SETTING/METHODS:Three medical centers in the United States. PARTICIPANTS/METHODS:Community-dwelling adults (n=504) with a history of TBI. INTERVENTIONS/METHODS:Not applicable. MAIN OUTCOMES MEASURE/METHODS:TBI-QOL. RESULTS:Five composite indices were generated: global QOL, physical health, emotional health, cognitive health, and social health. Lookup tables are provided herein. Composite scores were highly intercorrelated (all r>.60, P<.0001), and individual TBI-QOL banks all correlate strongly with the global QOL composite in the expected direction (all r>.50, P<.0001). CONCLUSION/CONCLUSIONS:Researchers and clinicians can use the TBI-QOL global QOL, physical health, emotional health, cognitive health, and social health composite scores to aggregate results from multiple TBI-QOL banks, which is anticipated to ease interpretation and reliability. This work additionally highlights the importance of considering nonphysical symptoms as outcomes variables for TBI research, as cognitive, social, and emotional domains were some of the most strongly correlated banks with the global QOL composite.

OBJECTIVE:To link scores on commonly used measures of anxiety (7-item Generalized Anxiety Disorder Scale; GAD-7) and depression (9-item Patient Health Questionnaire; PHQ-9) to the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. SETTING/METHODS:5 Traumatic Brain Injury Model Systems. PARTICIPANTS/METHODS:A total of 385 individuals with traumatic brain injury (TBI) (31% complicated mild; 14% moderate; and 54% severe). DESIGN/METHODS:Observational cohort. MAIN MEASURES/METHODS:GAD-7, PHQ-9, TBI-QOL Anxiety v1.0 and TBI-QOL Depression v1.0. RESULTS:Item response theory-based linking methods were used to create crosswalk tables that convert scores on the GAD-7 to the TBI-QOL Anxiety metric and scores on the PHQ-9 to the TBI-QOL Depression metric. Comparisons between actual and crosswalked scores suggest that the linkages were successful and are appropriate for group-level analysis. Linking functions closely mirror crosswalks between the GAD-7/PHQ-9 and the Patient-Reported Outcomes Measurement Information System (PROMIS), suggesting that general population linkages are similar to those from a TBI sample. CONCLUSION/CONCLUSIONS:Researchers and clinicians can use the crosswalk tables to transform scores on the GAD-7 and the PHQ-9 to the TBI-QOL metric for group-level analyses.

OBJECTIVES/OBJECTIVE:To describe the development and field testing of the patient-reported outcome measures of Mobility and Upper Extremity function from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system, and to evaluate the use of computer adaptive testing. SETTING/METHODS:Five rehabilitation facilities funded as part of the TBI Model Systems network. PARTICIPANTS/METHODS:Individuals with complicated mild, moderate, or severe traumatic brain injury (n = 590). INTERVENTIONS/METHODS:Not available. OUTCOME MEASURES/METHODS:TBI-QOL Mobility and Upper Extremity item banks. RESULTS:Item response theory and factor analyses supported the unidimensionality of the Mobility and Upper Extremity banks. Descriptive statistics showed a ceiling effect for both measures. Simulated computer adaptive tests (CATs) showed that measurement precision was maintained across administration formats for both measures. The Upper Extremity CAT showed a loss of precision for individuals without impairment and that a higher number of items were required to achieve sufficiently precise measurement, compared to the Mobility CAT. CONCLUSIONS:The TBI-QOL Upper Extremity and Mobility item banks achieved good breadth of coverage, particularly among those individuals who have experienced some degree of functional limitation. The use of CAT administration minimizes respondent burden, while allowing for the comprehensive assessment of adults with TBI. The combined use of the TBI-QOL with performance-based measures could guide the development of targeted rehabilitation treatments.

OBJECTIVE:To develop, calibrate, and evaluate the test-retest reliability of a new patient-reported outcome measure of headache pain relevant for individuals with traumatic brain injury (TBI). SETTING/METHODS:Six TBI Model Systems rehabilitation centers in the United States. PARTICIPANTS/METHODS:Adults with medically confirmed documentation of TBI. DESIGN/METHODS:Cross-sectional calibration field testing and test-retest reliability analyses. MAIN MEASURES/METHODS:Traumatic Brain Injury-Quality of Life Headache Pain item bank. RESULTS:Thirteen headache pain items were calibrated as a unidimensional measure using data from 590 participants. The new measure was reliable (α = .98; item-total correlation range: 0.71-0.91). Item parameter estimates were estimated using Samejima's Graded Response Model and a 10-item calibrated short form was created. Simulation testing confirmed that both the computer-adaptive test and the short-form administrations were equivalent to the full item bank. One- to-2-week test-retest reliability of the computer-adaptive test was high (Pearson r and intraclass correlation coefficients = 0.81). Approximately two-thirds of the sample reported at least 1 headache symptom. CONCLUSION/CONCLUSIONS:The Traumatic Brain Injury-Quality of Life Headache Pain item bank and short form provide researchers and clinicians with reliable measures of the subjective experience of headache symptoms for individuals with a history of TBI.

OBJECTIVE:To develop a traumatic brain injury (TBI)-specific, item response theory (IRT)-calibrated Fatigue item bank, short form, and computer adaptive test (CAT) as part of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system. SETTING/METHODS:Five TBI Model Systems rehabilitation centers in the US PARTICIPANTS:: Adults with complicated mild, moderate, or severe TBI confirmed by medical record review. DESIGN/METHODS:Cross-sectional field testing via phone or in-person interview. MAIN MEASURES/METHODS:TBI-QOL Fatigue item bank, short form, and CAT. RESULTS:A total of 590 adults with TBI completed 95 preliminary fatigue items, including 86 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) and 9 items from the Quality of Life in Neurological Disorders (Neuro-QOL) system. Through 4 iterations of factor analysis, 22 items were deleted for reasons such as local item dependence, misfit, and low item-total correlations. Graded response model IRT analyses were conducted on the 73-item set, and Stocking-Lord equating was used to transform the item parameters to the PROMIS (general population) metric. A short form and CAT, which demonstrate similar reliability to the full item bank, were developed. Test-retest reliability of the CAT was established in an independent sample (Pearson's r and intraclass correlation coefficient = 0.82 [95% confidence interval: 0.72-0.88]). CONCLUSIONS:The TBI-QOL Fatigue item bank, short form, and CAT provide rehabilitation researchers and clinicians with TBI-optimized tools for assessment of the patient-reported experience and impact of fatigue on individuals with TBI.

OBJECTIVE:To develop an item response theory (IRT)-based patient-reported outcome measure of functional communication for adults with traumatic brain injury (TBI). SETTING/METHODS:Five medical centers that were TBI Model Systems sites. PARTICIPANTS/METHODS:A total of 569 adults with TBI (28% complicated-mild; 13% moderate; and 58% severe). DESIGN/METHODS:Grounded theory-based qualitative item development, large-scale item calibration testing, confirmatory factor analyses, psychometric analyses with graded response model IRT. MAIN MEASURE/METHODS:Traumatic Brain Injury-Quality of Life (TBI-QOL) Communication Item Bank, version 1.0. RESULTS:From an initial pool of 48 items, 31 items were retained in the final instrument based on adequate fit to a unidimensional model and absence of bias across several demographic and clinical subgroupings. The TBI-QOL Communication Item Bank demonstrated excellent score precision (reliability ≥ 0.95) across a wide range of communication impairment levels, particularly for individuals with more severe difficulties. The TBI-QOL Communication Item Bank is available as a full item bank, fixed-length short form, and as a computerized adaptive test. CONCLUSIONS:The TBI-QOL Communication Item Bank permits precise measurement of patient-reported functional communication after TBI. Future development will validate the instrument against performance-based, clinician-reported, and surrogate-reported assessments.

OBJECTIVE:To develop and calibrate new patient-reported outcome measures of cognitive concerns for individuals with traumatic brain injury (TBI). SETTING/METHODS:Five TBI model systems rehabilitation centers in the United States. PARTICIPANTS/METHODS:Adults with medically confirmed history of TBI. DESIGN/METHODS:Cross-sectional survey in interview format. MAIN MEASURES/METHODS:Traumatic Brain Injury-Quality of Life (TBI-QOL) Executive Function and TBI-QOL Cognition-General Concerns item banks. RESULTS:A total of 569 adults with complicated-mild, moderate, or severe TBI completed preliminary item pools, which included 65 Executive Function items and 56 Cognition-General Concerns items. Confirmatory factor analysis supported the retention of 37 Executive Function and 39 Cognition-General Concerns items. Samejima's graded response model was used to estimate item parameters for associated computer adaptive test administrations, and informed the selection of corresponding static short forms. Data from an independent sample of 77 adults with complicated-mild, moderate, or severe TBI supported the test-retest reliability of these newly developed measures. CONCLUSION/CONCLUSIONS:The TBI-QOL Executive Function and Cognition-General Concerns item banks provide researchers and clinicians with reliable tools for assessing patient-reported post-TBI cognitive difficulties as part of the comprehensive TBI-QOL measurement system.