An Overview of the Traumatic Brain Injury–Quality of Life (TBI-QOL) Measurement System No abstract available

Measuring Fatigue in TBI: Development of the TBI-QOL Fatigue Item Bank and Short Form 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: Five TBI Model Systems rehabilitation centers in the US Participants: Adults with complicated mild, moderate, or severe TBI confirmed by medical record review. Design: Cross-sectional field testing via phone or in-person interview. Main Measures: 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.

Development of the TBI-QOL Headache Pain Item Bank and Short Form 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: Six TBI Model Systems rehabilitation centers in the United States. Participants: Adults with medically confirmed documentation of TBI. Design: Cross-sectional calibration field testing and test-retest reliability analyses. Main Measures: 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: 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.

Measuring Self-Reported Cognitive Function Following TBI: Development of the TBI-QOL Executive Function and Cognition-General Concerns Item Banks Objective: To develop and calibrate new patient-reported outcome measures of cognitive concerns for individuals with traumatic brain injury (TBI). Setting: Five TBI model systems rehabilitation centers in the United States. Participants: Adults with medically confirmed history of TBI. Design: Cross-sectional survey in interview format. Main Measures: 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: 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.

Development and Psychometric Characteristics of the TBI-QOL Communication Item Bank Objective: To develop an item response theory (IRT)-based patient-reported outcome measure of functional communication for adults with traumatic brain injury (TBI). Setting: Five medical centers that were TBI Model Systems sites. Participants: A total of 569 adults with TBI (28% complicated-mild; 13% moderate; and 58% severe). Design: Grounded theory-based qualitative item development, large-scale item calibration testing, confirmatory factor analyses, psychometric analyses with graded response model IRT. Main Measure: 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.

Measuring Self-Reported Physical Function in Individuals With TBI: Development of the TBI-QOL Mobility and Upper Extremity Item Banks and Short Forms Objectives: 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: Five rehabilitation facilities funded as part of the TBI Model Systems network. Participants: Individuals with complicated mild, moderate, or severe traumatic brain injury (n = 590). Interventions: Not available. Outcome Measures: 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.

Linking the GAD-7 and PHQ-9 to the TBI-QOL Anxiety and Depression Item Banks 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: 5 Traumatic Brain Injury Model Systems. Participants: A total of 385 individuals with traumatic brain injury (TBI) (31% complicated mild; 14% moderate; and 54% severe). Design: Observational cohort. Main Measures: 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: 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.

A Narrative of Advocacy, Resilience, and Recovery Following Severe Brain Injury No abstract available

Conquering Brain Injury No abstract available

Suicide and Traumatic Brain Injury Among Individuals Seeking Veterans Health Administration Services Between Fiscal Years 2006 and 2015 Objective: Examine associations between traumatic brain injury (TBI) and (1) suicide and (2) suicide method among individuals receiving Veterans Health Administration (VHA) care. Setting: VHA, Fiscal Years 2006-2015. Participants: Veterans with a TBI diagnosis during/prior to the study window (n = 215 610), compared with a 20% random sample of those without TBI (n = 1 187 639). Design: Retrospective, cohort study. Cox proportional hazards models were fit accounting for time-dependent measures, chronic conditions, and demographics for those with TBI compared with those without. Additional models evaluated the impact of TBI severity on the association between TBI and suicide, and method. Main Outcome Measures: Death by and method of suicide. Results: The hazard of suicide was 2.19 times higher for those with TBI than for those without TBI (95% CI = 2.02-2.37), and was still significant after accounting for covariates (hazard ratio [HR] = 1.71; 95% confidence interval [CI] = 1.56-1.87). Considering severity, mild TBI compared with no TBI was significantly associated with an elevated hazard of suicide, after adjusting for covariates (HR = 1.62; 95% CI = 1.47-1.78). There was also a significant difference in death by suicide between moderate/severe TBI when compared with no TBI, after adjusting for covariates (HR = 2.45; 95% CI = 2.02-2.97). Moderate/severe TBI was significantly associated with an increase in the odds of suicide by firearm among decedents (odds ratio = 2.39; 95% CI = 1.48-3.87). Conclusion: Traumatic brain injury is associated with an elevated risk for suicide. Particular concern is warranted for those with moderate/severe TBI. Lethal means safety should be explored as an intervention.