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Tyner CE, Slotkin J, Kisala PA, Levin LS, Tintle SM, Tulsky DS. Assessment of quality of life after upper extremity transplantation: Framework for patient-reported outcome scale domains. Front Psychol 2023; 13:989593. [PMID: 36760917 PMCID: PMC9902934 DOI: 10.3389/fpsyg.2022.989593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/31/2022] [Indexed: 01/26/2023] Open
Abstract
Upper extremity transplantation offers the promise of restored function and regained quality of life (QOL) for individuals who have sustained hand or arm amputation. However, a major challenge for this procedure becoming an accessible treatment option for patients is the lack of standard measures to document benefits to QOL. Patient-reported outcomes (PRO) measures are well-suited for this kind of intervention, where the perspective of the patient is central to defining treatment success. To date, qualitative work with experts, clinicians, and patients has been used to identify the most important domains of QOL for PRO item development. Specifically, our group's qualitative work has identified several domains of QOL that are unique to individuals who have received upper extremity transplants, which are distinct from topics covered by existing PRO measures. These include emotional and social aspects of upper extremity transplant, such as Expectations and Perceived Outcomes, Integration and Assimilation of Transplant, Fitting in, and Post-Surgical Challenges and Complications. The broad topic of Satisfaction with Transplant was subdivided into three subtopics: Function, Sensation, and Aesthetics. Satisfaction with Sensation was also identified as a unique domain not evaluated by existing PRO measures. This report operationalizes these eight QOL domains by presenting scoping definitions. This manuscript describes the work that has been completed for domain characterization as an early step toward developing standardized PRO measures to evaluate these important outcomes specific to upper extremity transplantation.
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Affiliation(s)
- Callie E. Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States,*Correspondence: Callie E. Tyner,
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - L. Scott Levin
- Department of Orthopedic Surgery, Penn Medicine, Philadelphia, PA, United States,Department of Surgery, Division of Plastic Surgery, Penn Medicine, Philadelphia, PA, United States
| | - Scott M. Tintle
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - David S. Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States,Department of Physical Therapy, University of Delaware, Newark, DE, United States,Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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Cohen ML, Harnish SM, Lanzi AM, Brello J, Hula WD, Victorson D, Nandakumar R, Kisala PA, Tulsky DS. Establishing severity levels for patient-reported measures of functional communication, participation, and perceived cognitive function for adults with acquired cognitive and language disorders. Qual Life Res 2022; 32:1659-1670. [PMID: 36572789 PMCID: PMC10172211 DOI: 10.1007/s11136-022-03337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To empirically assign severity levels (e.g., mild, moderate) to four relatively new patient-reported outcome measures (PROMs) for adults with acquired cognitive/language disorders. They include the Communicative Participation Item Bank, the Aphasia Communication Outcome Measure, and Neuro-QoL's item banks of Cognitive Function (v2.0) and Ability to Participate in Social Roles and Activities (v1.0). METHOD We conducted 17 focus groups that comprised 22 adults with an acquired cognitive/language disorder from stroke, Parkinson's disease, or traumatic brain injury; 30 care partners of an adult with an acquired cognitive/language disorder; and 42 speech-language pathologists who had experience assessing/treating individuals with those and other cognitive/language disorders. In a small, moderated focus-group format, participants completed "PROM-bookmarking" procedures: They discussed hypothetical vignettes based on PROM item responses about people with cognitive/language disorders and had to reach consensus regarding whether their symptoms/function should be categorized as within normal limits or mild, moderate, or severe challenges. RESULTS There was generally good agreement among the stakeholder groups about how to classify vignettes, particularly when they reflected very high or low functioning. People with aphasia described a larger range of functional communication challenges as "mild" compared to other stakeholder types. Based on a consensus across groups, we present severity levels for specific score ranges for each PROM. CONCLUSION Standardized, stakeholder-informed severity levels that aid interpretation of PROM scores can help clinicians and researchers derive better clinical meaning from those scores, for example, by identifying important clinical windows of opportunity and assessing when symptoms have returned to a "normal" range.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, 100 Discovery Blvd 6th Floor, Newark, DE, 19713, USA. .,Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, 19713, USA.
| | - Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, 43210, USA
| | - Alyssa M Lanzi
- Department of Communication Sciences and Disorders, University of Delaware, 100 Discovery Blvd 6th Floor, Newark, DE, 19713, USA
| | - Jennifer Brello
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, 43210, USA
| | - William D Hula
- Geriatric Research, Education, and Clinical Center, VA Health Care System, and Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Victorson
- School of Medicine Department of Medical Social Science, Northwestern University, Chicago, IL, 60611, USA
| | - Ratna Nandakumar
- University of Delaware School of Education, Newark, DE, 19713, USA
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, 19713, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, 19713, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
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Tyner CE, Kisala PA, Boulton AJ, Sherer M, Chiaravalloti ND, Sander AM, Bushnik T, Tulsky DS. Responsiveness of the Traumatic Brain Injury Quality of Life Cognition Banks in Recent Brain Injury. Front Hum Neurosci 2022; 16:763311. [PMID: 35308618 PMCID: PMC8931768 DOI: 10.3389/fnhum.2022.763311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Patient report of functioning is one component of the neurocognitive exam following traumatic brain injury, and standardized patient-reported outcomes measures are useful to track outcomes during rehabilitation. The Traumatic Brain Injury Quality of Life measurement system (TBI-QOL) is a TBI-specific extension of the PROMIS and Neuro-QoL measurement systems that includes 20 item banks across physical, emotional, social, and cognitive domains. Previous research has evaluated the responsiveness of the TBI-QOL measures in community-dwelling individuals and found clinically important change over a 6-month assessment interval in a sample of individuals who were on average 5 years post-injury. In the present study, we report on the responsiveness of the TBI-QOL Cognition–General Concerns and Executive Function item bank scores and the Cognitive Health Composite scores in a recently injured sample over a 1-year study period. Data from 128 participants with complicated mild, moderate, or severe TBI within the previous 6 months were evaluated. The majority of the sample was male, white, and non-Hispanic. The participants were 18–92 years of age and were first evaluated from 0 to 5 months post-injury. Eighty participants completed the 1-year follow-up assessment. Results show acceptable standard response mean values (0.47–0.51) for all measures and minimal detectable change values ranging from 8.2 to 8.8 T-score points for Cognition–General Concerns and Executive Functioning measures. Anchor rating analysis revealed that changes in scores on the Executive Function item bank and the Cognitive Health Composite were meaningfully associated with participant-reported changes in the areas of attention, multitasking, and memory. Evaluation of change score differences by a variety of clinical indicators demonstrated a small but significant difference in the three TBI-QOL change scores by TBI injury severity grouping. These results support the responsiveness of the TBI-QOL cognition measures in newly injured individuals and provides information on the minimal important differences for the TBI-QOL cognition measures, which can be used for score interpretation by clinicians and researchers seeking patient-reported outcome measures of self-reported cognitive QOL after TBI.
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Affiliation(s)
- Callie E. Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
- *Correspondence: Callie E. Tyner,
| | - Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - Aaron J. Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - Mark Sherer
- TIRR Memorial Hermann Research Center, Houston, TX, United States
- Baylor College of Medicine, Houston, TX, United States
| | - Nancy D. Chiaravalloti
- Kessler Foundation, East Hanover, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Angelle M. Sander
- TIRR Memorial Hermann Research Center, Houston, TX, United States
- Baylor College of Medicine, Houston, TX, United States
| | - Tamara Bushnik
- NYU School of Medicine, New York, NY, United States
- NYU Langone Medical Center, New York, NY, United States
| | - David S. Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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Kisala PA, Boulton AJ, Slavin MD, Cohen ML, Keeney T, Ni P, Tate D, Heinemann AW, Charlifue S, Fyffe DC, Felix ER, Jette AM, Tulsky DS. Spinal Cord Injury-Functional Index/Capacity: Responsiveness to Change Over Time. Arch Phys Med Rehabil 2022; 103:199-206. [PMID: 34717921 PMCID: PMC8810572 DOI: 10.1016/j.apmr.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish responsiveness of 3 Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI). DESIGN Longitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set. SETTING A total of 8 SCI Model Systems rehabilitation hospitals in the United States. PARTICIPANTS Study 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418). INTERVENTIONS In study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures' responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness. MAIN OUTCOME MEASURES The SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only). RESULTS In study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P<.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65). CONCLUSIONS The SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use.
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Affiliation(s)
- Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Aaron J. Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Mary D. Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Matthew L. Cohen
- Dept. of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital,Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
| | - Pengsheng Ni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Denise Tate
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Denise C. Fyffe
- Kessler Foundation, West Orange, NJ and New Jersey Medical School, Newark, NJ
| | - Elizabeth R. Felix
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Alan M. Jette
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - David S. Tulsky
- Center for Health Assessment Research and Translation and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE
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Cohen ML, Harnish SM, Lanzi AM, Brello J, Victorson D, Kisala PA, Nandakumar R, Tulsky DS. Adapting a Patient-Reported Outcome Bookmarking Task to be Accessible to Adults With Cognitive and Language Disorders. J Speech Lang Hear Res 2021; 64:4403-4412. [PMID: 34699261 DOI: 10.1044/2021_jslhr-21-00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Patient-reported outcome (PRO) measures produce scores that do not always have obvious clinical meaning. The PRO-bookmarking procedure is a new and promising way to make PRO measures more meaningful and interpretable. However, the materials and procedures of the task may benefit from adaptations to be more accessible to individuals with cognitive and language disorders. Aims This study aims to provide an overview of the iterative refinement process used to modify the materials and procedures of the PRO-bookmarking task so that they are more accessible to adults with acquired cognitive and language impairments. Method and Procedures Our team of health psychologists, neuropsychologists, and speech-language pathologists (SLPs) conducted two focus groups with SLPs and care partners of people with aphasia using the same PRO-bookmarking materials and procedures as previous reports. These PRO-bookmarking materials and procedures were then refined iteratively based on discussion with those who participated in focus groups and among the research team, and three more times in the course of 16 additional focus groups of different stakeholders: people with Parkinson's disease, aphasia, or traumatic brain injury; care partners of people with those conditions; and SLPs who have experience with those, and other adult-acquired conditions. Outcomes and Results The PRO-bookmarking materials and procedures underwent four iterations to make them clearer, simpler, and more accessible. For example, the materials included more structured text and graphic supports where appropriate and the procedures were clustered into smaller discrete tasks and displayed graphically when possible and appropriate. Conclusions PRO-bookmarking materials and procedures were made simpler and more structured to increase their accessibility to adults with cognitive and language impairments. In fact, these adaptations made the tasks simpler and clearer for all types of stakeholders.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Alyssa M Lanzi
- Department of Communication Sciences and Disorders, University of Delaware, Newark
| | - Jennifer Brello
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | | | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Physical Therapy, University of Delaware, Newark
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Tulsky DS, Kisala PA. Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances. Arch Phys Med Rehabil 2021; 103:185-190. [PMID: 34756875 DOI: 10.1016/j.apmr.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
The Spinal Cord Injury - Functional Index is a system of patient reported outcomes (PRO) measures of functional activities developed specifically with and for individuals with spinal cord injury (SCI). The SCI-FI was designed to overcome limitations in measurement of the full range of activities and breadth of content of physical functioning commonly used in SCI research. Generic measurement tools of physical function (i.e., those focused on the general population) tend to overemphasize mobility and do not contain enough items at the lower end of the functional range (e.g., appropriate for individuals with tetraplegia). The SCI-FI consists of nine item response theory (IRT)-calibrated item banks that represent relevant and meaningful item content for individuals with SCI, span a wide range of functional abilities, and subdivide physical functioning into important subdomains, including basic mobility, self-care, and fine motor function. Since the original publication of the SCI-FI in 2012, there have been significant advances in and publications on the reliability and psychometric properties of the measures. The manuscripts presented in this special section clarify the SCI-FI structure and present new research on the SCI-FI measurement system.
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Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE
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Tulsky DS, Boulton AJ, Kisala PA, Heinemann AW, Charlifue S, Kalpakjian C, Kozlowski AJ, Felix ER, Fyffe DC, Slavin MD, Tate DG. Physical Function Recovery Trajectories following Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:215-223. [PMID: 34678295 DOI: 10.1016/j.apmr.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Explore trajectories of functional recovery that occur during the first two years after spinal cord injury (SCI). DESIGN Observational cohort study. SETTING Eight SCI Model System sites. PARTICIPANTS 479 adults with SCI completed four Spinal Cord Injury-Functional Index (SCI-FI) item banks within 4 months of injury and again at 2 weeks, 3, 6, 12, and 24 months following baseline assessment. INTERVENTION None. MAIN OUTCOME MEASURES SCI-FI Basic Mobility/Capacity (C), Fine Motor Function/C, Self-Care/C, and Wheelchair Mobility/Assistive Technology (AT) item banks. RESULTS Growth mixture modeling was used to identify groups with similar trajectory patterns. For the Basic Mobility/C and Wheelchair Mobility/AT domains, models specifying 2 trajectory groups were selected. For both domains, a majority class exhibited average functional levels and gradual improvement, primarily in the first six months. A smaller group of individuals made gradual improvements but had greater initial functional limitations. The Self Care/C domain exhibited a similar pattern; however, a third, small class emerged that exhibited substantial improvement in the first six months. Finally, for individuals with tetraplegia, trajectories of Fine Motor Function/C scores followed two patterns, with individuals reporting generally low initial scores and then making either modest or large improvements. In individual growth curve models, injury/demographic factors predicted initial functional levels but less so with regard to rates of recovery. CONCLUSIONS Trajectories of functional recovery followed a small number of change patterns, though variation around these patterns emerged. During the first two years after initial hospitalization, SCI-FI scores showed modest improvements; however, substantial improvements were noted for a small number of individuals with severe limitations in fine motor and self-care function. Future studies should further explore the personal, medical, and environmental characteristics that influence functional trajectories during these first two years and beyond.
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Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, DE.
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation
| | | | - Claire Kalpakjian
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI
| | - Allan J Kozlowski
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI; Michigan State University College of Human Medicine, Department of Epidemiology and Biostatistics, Grand Rapids, MI
| | - Elizabeth R Felix
- University of Miami Miller School of Medicine, Department of Physical Medicine & Rehabilitation, Miami, FL
| | - Denise C Fyffe
- Kessler Foundation, East Hanover, NJ; Rutgers-New Jersey Medical School, Newark, NJ
| | - Mary D Slavin
- Boston University School of Public Health, Boston, MA
| | - Denise G Tate
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI
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Boulton AJ, Kisala PA, Ni P, Tulsky DS. Linking the Spinal Cord Injury-Functional Index (SCI-FI) to the PROMIS Physical Functioning Item Bank. Arch Phys Med Rehabil 2021; 103:207-214. [PMID: 33684365 DOI: 10.1016/j.apmr.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To link 3 Spinal Cord Injury-Functional Index (SCI-FI) item banks (Basic Mobility, Fine Motor Function, Self-Care) to the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) metric. DESIGN Observational study SETTING: Six SCI Model Systems rehabilitation hospitals in the United States. PARTICIPANTS Adults with SCI (n=855) and healthy individuals (n=730) (N=1585). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three SCI-FI item banks (Basic Mobility, Fine Motor Function, Self-Care), PROMIS PF v1.0 item bank. RESULTS SCI-FI item banks (including 30 items from the PROMIS PF item bank) were administered to 855 adults with SCI as part of the original SCI-FI development study. The data were used to attempt to link 3 SCI-FI banks to the PROMIS PF metric via 2 item-response theory methods: fixed-parameter calibration and separate calibration. Sixteen items common to SCI-FI and PROMIS and verified as free of differential item functioning were used as anchor items to implement the methods. Of the 3 banks, only SCI-FI Basic Mobility could be linked with sufficient precision to PROMIS PF. Comparisons of actual vs linked PROMIS PF scores and test characteristic curves suggested the fixed-parameter method provided slightly more precision than the separate calibration method. CONCLUSIONS The linkage between PROMIS PF and SCI-FI Basic Mobility was considered satisfactory for group-level usage. Score equivalents computed from SCI-FI Basic Mobility will be useful for researchers comparing functional levels in SCI to those observed in other clinical and nonclinical groups (eg, in comparative effectiveness research).
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Affiliation(s)
- Aaron J Boulton
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware, Newark, DE
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware, Newark, DE
| | - Pengsheng Ni
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, DE.
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Tyner CE, Kisala PA, Heinemann AW, Fyffe D, Tate DG, Slavin MD, Jette AM, Tulsky DS. Validation of the Spinal Cord Injury Functional Index for Use in Community-Dwelling Individuals With SCI. Arch Phys Med Rehabil 2021; 103:191-198. [PMID: 33453193 DOI: 10.1016/j.apmr.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Spinal Cord Injury Functional Index (SCI-FI) instruments in a community-dwelling sample. DESIGN Cross-sectional study. SETTING Community setting. PARTICIPANTS Individuals (N=269) recruited from 6 SCI Model Systems sites. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity. RESULTS Pearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms. CONCLUSION Findings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals.
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Affiliation(s)
- Callie E Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Denise Fyffe
- Kessler Foundation, West Orange, NJ; New Jersey Medical School, Newark, NJ
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - Mary D Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA; Massachusetts General Hospital, Institute of Health Professions, Boston, MA
| | - Alan M Jette
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA; Massachusetts General Hospital, Institute of Health Professions, Boston, MA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE; Department of Physical Therapy, University of Delaware, Newark, DE; Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
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Kisala PA, Victorson D, Nandakumar R, Shermeyer A, Fyffe D, Heinemann AW, Dyson-Hudson TA, Tulsky DS. Applying a Bookmarking Approach to Setting Clinically Relevant Interpretive Standards for the Spinal Cord Injury: Functional Index/Capacity Basic Mobility and Self-Care Item Bank Scores. Arch Phys Med Rehabil 2020; 103:224-236. [DOI: 10.1016/j.apmr.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
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Raad JH, Tulsky DS, Lange RT, Brickell TA, Sander AM, Hanks RA, French L, Miner JA, Kisala PA, Carlozzi NE. Establishing the Factor Structure of a Health-Related Quality of Life Measurement System for Caregivers of Persons Living With Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 101:1220-1232. [PMID: 32315649 PMCID: PMC7311311 DOI: 10.1016/j.apmr.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To understand the factor structure of health-related quality of life specific to caregivers of people living with traumatic brain injury (TBI). DESIGN Prospective, cross-sectional data collection. SETTING Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS Caregivers (N=558) of people who have sustained a TBI (344 caregivers of civilians and 214 caregivers of service members or veterans; 85% women; 58% spouses; mean age, 46.12±14.07y) who have provided care for an average of 5.82±5.40 years. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES The Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system including 10 Patient-Reported Outcomes Measurement Information System item banks (anger, anxiety, depression, social isolation, sleep disturbance, fatigue, ability to participate in social roles and activities, satisfaction with social roles and activities, emotional support, informational support) and 5 TBI-CareQOL banks (feelings of loss-self, feelings of loss-person with TBI, feeling trapped, caregiver-specific anxiety, caregiver strain). RESULTS Confirmatory factor analysis model fit indices were compared for 14 empirically derived and 5 theoretically derived models. Confirmatory factor analysis results indicated that the best model fit was for a 6-factor model with dimensions that included mental health, social support, social participation, social isolation, physical health, and caregiver emotion. CONCLUSIONS Results indicated that a 6-factor model provided the best model fit for health-related quality of life in caregivers of individuals with TBI. These results have utility for both research and clinical applications. Establishing the TBI-CareQOL's factor structure provides preliminary evidence of the measurement system's construct validity, helps inform the selection of measures for specific research or clinical interventions, and informs the development of composite scores.
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Affiliation(s)
- Jason H Raad
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - David S Tulsky
- Center for Assessment Research and Translation, Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Defense and Veterans Brain Injury Center, Silver Spring, MD; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Defense and Veterans Brain Injury Center, Silver Spring, MD; Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine & Harris Health System, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
| | - Robin A Hanks
- Rehabilitation Institute of Michigan, Department of Psychology and Neuropsychology, Detroit, MI; Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Louis French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Pamela A Kisala
- Center for Assessment Research and Translation, Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
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Kalpakjian CZ, Kreschmer JM, Slavin MD, Kisala PA, Quint EH, Chiaravalloti ND, Jenkins N, Bushnik T, Amtmann D, Tulsky DS, Madrid R, Parten R, Evitts M, Grawi CL. Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures. J Womens Health (Larchmt) 2020; 29:1427-1436. [PMID: 32429740 DOI: 10.1089/jwh.2019.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Barriers in the built environment, enduring stereotypes and biases, and limited disability competency of health care providers compromise access to and quality of reproductive health care for women with physical disabilities. One way to improve our understanding of critical factors that drive reproductive health inequity and its impact on access to care is to use patient-reported outcome measures (PROMs) that capture relevant and meaningful information about experience. In this study, we developed a conceptual framework as the foundation for relevant and clinically meaningful patient-reported outcome measures targeting the interface of disability and reproductive health. Materials and Methods: We conducted semistructured focus groups and interviews to assess women's experiences around their reproductive health and contextual factors related to disability. We used deductive and inductive qualitative coding approaches to develop the conceptual framework. Results: Eighty-one women between the ages of 16 and 50 with a self-reported physical disability, defined by an impairment of mobility, participated in 13 focus groups (N = 64) and 17 individual interviews. Five major themes characterized the conceptual framework that emerged-knowledge about reproductive health, communication about reproductive health, relationships, the reproductive health care environment, and self-advocacy/identity-all of which had some relationship with five major reproductive health issues-pregnancy and labor/delivery, periods and menstrual management, contraception, sexuality and sexual functioning, and pelvic examinations. Conclusions: This conceptual framework will serve as a foundation for PROM and guide intervention development to reduce reproductive health inequity and improve reproductive health outcomes of women with physical disabilities.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mary D Slavin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Natalie Jenkins
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Tamara Bushnik
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Roxanne Madrid
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Evitts
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Carolyn L Grawi
- Ann Arbor Center for Independent Living, Ann Arbor, Michigan, USA
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Carlozzi NE, Kisala PA, Boulton AJ, Roth E, Kratz AL, Sherer M, Sander AM, Heinemann AW, Chiaravalloti ND, Bushnik T, Tulsky DS. Measuring Pain in TBI: Development of the TBI-QOL Pain Interference Item Bank and Short Form. Arch Phys Med Rehabil 2020; 101:11-19. [DOI: 10.1016/j.apmr.2019.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022]
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Kisala PA, Tulsky DS, Boulton AJ, Heinemann AW, Victorson D, Sherer M, Sander AM, Chiaravalloti N, Carlozzi NE, Hanks R. Development and Psychometric Characteristics of the TBI-QOL Independence Item Bank and Short Form and the TBI-QOL Asking for Help Scale. Arch Phys Med Rehabil 2019; 101:33-42. [PMID: 31473207 DOI: 10.1016/j.apmr.2019.08.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/19/2019] [Accepted: 08/17/2019] [Indexed: 10/26/2022]
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.
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Affiliation(s)
- Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware College of Health Sciences, Newark, Delaware, United States
| | - David S Tulsky
- 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.
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware College of Health Sciences, Newark, Delaware, United States
| | - Allen W Heinemann
- 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
| | - David Victorson
- 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
| | - Mark Sherer
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, United States; Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, United States
| | - Angelle M Sander
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, United States; Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, United States
| | | | - Noelle E Carlozzi
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, United States
| | - Robin Hanks
- Department of Physical Medicine & Rehabilitation, Wayne State University, Detroit, Michigan, United States
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Kisala PA, Boulton AJ, Cohen ML, Slavin MD, Jette AM, Charlifue S, Hanks R, Mulcahey MJ, Cella D, Tulsky DS. Interviewer- versus self-administration of PROMIS® measures for adults with traumatic injury. Health Psychol 2019; 38:435-444. [PMID: 31045427 DOI: 10.1037/hea0000685] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess differential item functioning and observed mean differences across two modes of administration for PROMIS® measure scores in a sample of adults with traumatic injury. METHOD Items from 7 PROMIS® adult measures (v1.0 Physical Function, Fatigue, Pain Interference, Anger, Anxiety, and Depression and v2.0 Social Health-Emotional Support) were administered as fixed-length short forms in random order to a cross-sectional sample. Participants were randomly assigned to interviewer-administered (phone or in-person) or self-administered (via the Assessment Center website) conditions. The research was conducted at 5 medical rehabilitation institutions across the U.S. Participants included 277 adults with spinal cord injury (n = 148) or traumatic brain injury (n = 129). RESULTS DIF analyses indicated that all items were invariant to mode of administration. There was no significant effect of mode of administration for the majority of PROMIS® measures tested. Regarding observed scores, there were small but significant effects of mode of administration on the Emotional Support and Depression measures, with participants in the interview condition reporting better support/fewer symptoms. CONCLUSIONS PROMIS® instruments demonstrated measurement equivalence across interviewer-administered and self-administered conditions. These findings are particularly important for research or clinical applications where administration of PROMIS® measures by independent web- or tablet-based administration is not ideal, for example with individuals with physical or cognitive disabilities or with individuals who lack computer and/or Internet access. PROMIS® v1.0 Depression and PROMIS® v2.0 Emotional Support scores displayed a tendency toward social desirability that should be considered when these measures are interviewer-administered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Pamela A Kisala
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware
| | - Matthew L Cohen
- Department of Communication Sciences & Disorders, College of Health Sciences, University of Delaware
| | - Mary D Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Alan M Jette
- Massachusetts General Hospital Institute of Health Professions
| | | | - Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine
| | - M J Mulcahey
- Department of Occupational Therapy, College of Health Professions, Thomas Jefferson University
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - David S Tulsky
- Center for Health Assessment Research and Translation, Department of Physical Therapy, College of Health Sciences, University of Delaware
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16
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Cohen ML, Tulsky DS, Boulton AJ, Kisala PA, Bertisch H, Yeates KO, Zonfrillo MR, Durbin DR, Jaffe KM, Temkin N, Wang J, Rivara FP. Reliability and Construct Validity of the TBI-QOL Communication Short Form as a Parent-Proxy Report Instrument for Children With Traumatic Brain Injury. J Speech Lang Hear Res 2019; 62:84-92. [PMID: 30950756 DOI: 10.1044/2018_jslhr-l-18-0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to evaluate the internal consistency and construct validity of the Traumatic Brain Injury Quality of Life Communication Item Bank (TBI-QOL COM) short form as a parent-proxy report measure. The TBI-QOL COM is a patient-reported outcome measure of functional communication originally developed as a self-report measure for adults with traumatic brain injury (TBI), but it may also be valid as a parent-proxy report measure for children who have sustained TBI. Method One hundred twenty-nine parent-proxy raters completed the TBI-QOL COM short form 6 months postinjury as a secondary aim of a multisite study of pediatric TBI outcomes. The respondents' children with TBI were between 8 and 18 years old ( M age = 13.2 years old) at the time of injury, and the proportion of TBI severity mirrored national trends (73% complicated-mild; 27% moderate or severe). Results The parent-proxy report version of the TBI-QOL COM displayed strong internal consistency (ordinal α = .93). It also displayed evidence of known-groups validity by virtue of more severe injuries associated with more abnormal scores. The instrument also showed evidence of convergent and discriminant validity by displaying a pattern of correlations with other constructs according to their conceptual relatedness to functional communication. Conclusions This preliminary psychometric investigation of the TBI-QOL COM supports the further development of a parent report version of the instrument. Future development of the TBI-QOL COM with this population may include expanding the content of the item bank and developing calibrations specifically for parent-proxy raters. Supplemental Material https://doi.org/10.23641/asha.7616534.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Psychological and Brain Sciences, University of Delaware, Newark
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Physical Therapy, University of Delaware, Newark
- Department of Psychological and Brain Sciences, University of Delaware, Newark
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Hilary Bertisch
- Rusk Rehabilitation, New York University Langone Medical Center, New York
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Canada
| | | | - Dennis R Durbin
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Kenneth M Jaffe
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
| | - Nancy Temkin
- Departments of Biostatistics and Neurological Surgery, University of Washington, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
- Department of Pediatrics and Department of Epidemiology, University of Washington, Seattle
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Tyner C, Slotkin J, Kisala PA, Tulsky D. Developing a New Patient Reported Outcome Measure for Health-Related Quality of Life After Limb Trauma. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cohen ML, Holdnack JA, Kisala PA, Tulsky DS. A comparison of PHQ-9 and TBI-QOL depression measures among individuals with traumatic brain injury. Rehabil Psychol 2018; 63:365-371. [PMID: 30024199 DOI: 10.1037/rep0000216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE To compare and contrast how individuals with traumatic brain injury (TBI) are classified (positive or negative screen) by different cut-offs on two self-report measures of depressive symptoms: the PHQ-9, which assesses somatic symptoms, and the TBI-QOL Depression item bank, which does not. Research Method/Design: Three hundred eighty-five individuals with TBI were recruited from six rehabilitation hospitals in the U.S. as part of the calibration data collection for the TBI-QOL patient-reported outcome measurement system. RESULTS The TBI-QOL and PHQ-9 total scores correlated strongly (disattenuated r = .83). The correlation was even stronger (disattenuated r = .92) when the four PHQ-9 somatic items were removed from the total score. When the PHQ-9 was scored traditionally, the rate of agreement was approximately 80-85% using standard cut-offs for each scale. Depending on the cut-off score, 23-26% of participants screened positive on the PHQ-9, whereas 9-38% screened positive on the TBI-QOL Depression. Individuals who screened positive on the PHQ-9 alone reported more somatic symptoms than those who screened positive on the TBI-QOL alone. Individuals who screened positive on the TBI-QOL alone were at slightly greater risk for other negative psychological functioning than individuals who screened positive on the PHQ-9 alone. CONCLUSIONS/IMPLICATIONS The PHQ-9 and TBI-QOL Depression performed similarly in screening for depressive symptoms among individuals with TBI. The PHQ-9 identified more individuals with somatic symptoms, which may overlap with other medical issues, whereas the TBI-QOL Depression instrument identified more individuals who reported other forms of emotional distress. (PsycINFO Database Record
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Cohen ML, Kisala PA, Dyson-Hudson TA, Tulsky DS. Measuring pain phenomena after spinal cord injury: Development and psychometric properties of the SCI-QOL Pain Interference and Pain Behavior assessment tools. J Spinal Cord Med 2018; 41:267-280. [PMID: 28185477 PMCID: PMC6055945 DOI: 10.1080/10790268.2017.1279805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To develop modern patient-reported outcome measures that assess pain interference and pain behavior after spinal cord injury (SCI). DESIGN Grounded-theory based qualitative item development; large-scale item calibration field-testing; confirmatory factor analyses; graded response model item response theory analyses; statistical linking techniques to transform scores to the Patient Reported Outcome Measurement Information System (PROMIS) metric. SETTING Five SCI Model Systems centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. INTERVENTIONS N/A. OUTCOME MEASURES Spinal Cord Injury - Quality of Life (SCI-QOL) Pain Interference item bank, SCI-QOL Pain Interference short form, and SCI-QOL Pain Behavior scale. RESULTS Seven hundred fifty-seven individuals with traumatic SCI completed 58 items addressing various aspects of pain. Items were then separated by whether they assessed pain interference or pain behavior, and poorly functioning items were removed. Confirmatory factor analyses confirmed that each set of items was unidimensional, and item response theory analyses were used to estimate slopes and thresholds for the items. Ultimately, 7 items (4 from PROMIS) comprised the Pain Behavior scale and 25 items (18 from PROMIS) comprised the Pain Interference item bank. Ten of these 25 items were selected to form the Pain Interference short form. CONCLUSIONS The SCI-QOL Pain Interference item bank and the SCI-QOL Pain Behavior scale demonstrated robust psychometric properties. The Pain Interference item bank is available as a computer adaptive test or short form for research and clinical applications, and scores are transformed to the PROMIS metric.
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Affiliation(s)
- Matthew L. Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware, USA,Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA,Center on Assessment Research and Translation, University of Delaware, Newark, Delaware, USA,Correspondence to: Matthew L. Cohen, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Center on Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Trevor A. Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David S. Tulsky
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA,Center on Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
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Mulcahey MJ, Slavin MD, Pengsheng N, Kratz A, Kisala PA, Tulsky DS, Jette AM. Examination of psychometric properties of PROMIS®: Pediatric upper limb measures in youth with cerebral palsy. Br J Occup Ther 2018. [DOI: 10.1177/0308022618757961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction This study examines the validity and distribution characteristics of the PROMIS® pediatric upper limb measures in a sample of young people with cerebral palsy. Method Data are a cross-sectional subset of a larger prospective study of the responsiveness to change of PROMIS® pediatric measures following surgery to improve functioning in young people with cerebral palsy. Ninety-three participants between the ages of eight and 21 years completed the PROMIS® pediatric mobility and upper limb computer adaptive tests and short forms in conjunction with a set of static “legacy” measures of physical functioning, including a parent-report of upper limb function. Results The PROMIS® Pediatric upper limb short form demonstrated acceptable internal consistency (Cronbach’s alpha = 0.85). PROMIS® pediatric upper limb computer adaptive tests and short form mean values (42.1(11) and 43(10.4), respectively) were nearly 1 SD below normal, which is appropriate when a generic measure is used in a sample of young persons with cerebral palsy. The PROMIS® pediatric upper limb computer adaptive tests had a higher frequency of ceiling effects (29.50%) compared to the short form (18.30%). Conclusion Results of this study suggest that the PROMIS® pediatric upper limb computer adaptive tests and the short form are valid indicators of upper limb function in young people with cerebral palsy. The item bank can be replenished to address ceiling effects.
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Affiliation(s)
- Mary Jane Mulcahey
- Professor of Occupational Therapy, Jefferson College of Health Professions, Thomas Jefferson University, USA
| | - Mary D Slavin
- Research Scientist, Law, Policy and Management, Boston University School of Public Health, USA
| | - Ni Pengsheng
- Statistician, Law, Policy and Management, Boston University School of Public Health, USA
| | - Anna Kratz
- Assistant Professor, Institute for Health Care Policy and Innovation, University of Michigan, USA
| | - Pamela A Kisala
- Associate Scientist, Center on Assessment Research and Translation, University of Delaware, USA
| | - David S Tulsky
- Professor, Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, USA
| | - Alan M Jette
- Professor, Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
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21
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Bertisch H, Rivara FP, Kisala PA, Wang J, Yeates KO, Durbin D, Zonfrillo MR, Bell MJ, Temkin N, Tulsky DS. Psychometric evaluation of the pediatric and parent-proxy Patient-Reported Outcomes Measurement Information System and the Neurology and Traumatic Brain Injury Quality of Life measurement item banks in pediatric traumatic brain injury. Qual Life Res 2017; 26:1887-1899. [PMID: 28271316 DOI: 10.1007/s11136-017-1524-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The primary objective is to provide evidence of convergent and discriminant validity for the pediatric and parent-proxy versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, Anger, Peer Relations, Mobility, Pain Interference, and Fatigue item banks, the Neurology Quality of Life measurement system (Neuro-QOL) Cognition-General Concerns and Stigma item banks, and the Traumatic Brain Injury Quality of Life (TBI-QOL) Executive Function and Headache item banks in a pediatric traumatic brain injury (TBI) sample. METHODS Participants were 134 parent-child (ages 8-18 years) days. Children all sustained TBI and the dyads completed outcome ratings 6 months after injury at one of six medical centers across the United States. Ratings included PROMIS, Neuro-QOL, and TBI-QOL item banks, as well as the Pediatric Quality of Life inventory (PedsQL), the Health Behavior Inventory (HBI), and the Strengths and Difficulties Questionnaire (SDQ) as legacy criterion measures against which these item banks were validated. RESULTS The PROMIS, Neuro-QOL, and TBI-QOL item banks demonstrated good convergent validity, as evidenced by moderate to strong correlations with comparable scales on the legacy measures. PROMIS, Neuro-QOL, and TBI-QOL item banks showed weaker correlations with ratings of unrelated constructs on legacy measures, providing evidence of discriminant validity. CONCLUSION Our results indicate that the constructs measured by the PROMIS, Neuro-QOL, and TBI-QOL item banks are valid in our pediatric TBI sample and that it is appropriate to use these standardized scores for our primary study analyses.
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Affiliation(s)
- Hilary Bertisch
- NYU Rusk Rehabilitation, New York University School of Medicine, 240 East 38th Street, Suite 17-72, New York, NY, 10016, USA.
| | - Frederick P Rivara
- Departments of Pediatrics and Epidemiology, Harborview Injury Prevention and Research Center, University of Washington, Seattle Children's Research Institute, Seattle, WA, USA
| | - Pamela A Kisala
- Center on Assessment Research and Translation, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, USA
| | - Dennis Durbin
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael J Bell
- Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, WA, USA
| | - David S Tulsky
- Center on Assessment Research and Translation, Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA.,Kessler Foundation, West Orange, NJ, USA
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Coster WJ, Ni P, Slavin MD, Kisala PA, Nandakumar R, Mulcahey MJ, Tulsky DS, Jette AM. Differential item functioning in the Patient Reported Outcomes Measurement Information System Pediatric Short Forms in a sample of children and adolescents with cerebral palsy. Dev Med Child Neurol 2016; 58:1132-1138. [PMID: 27098277 PMCID: PMC5052096 DOI: 10.1111/dmcn.13138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
AIM The present study examined the Patient Reported Outcomes Measurement Information System (PROMIS) Mobility, Fatigue, and Pain Interference Short Forms (SFs) in children and adolescents with cerebral palsy (CP) for the presence of differential item functioning (DIF) relative to the original calibration sample. METHOD Using the Graded Response Model we compared item parameter estimates generated from a sample of 303 children and adolescents with CP (175 males, 128 females; mean age 15y 5mo) to parameter estimates from the PROMIS calibration sample, which served as the reference group. DIF was assessed in a two-step process using the item response theory-likelihood ratio-differential item functioning detection procedure. RESULTS Significant DIF was identified for four of eight items in the PROMIS Mobility SF, for two of eight items in the Pain Interference Scale, and for one item out of 10 on the Fatigue Scale. Impact of DIF on total score estimation was notable for Mobility and Pain Interference, but not for Fatigue. INTERPRETATION Results suggest differences in the responses of adolescents with CP to some items on the PROMIS Mobility and Pain Interference SFs. Cognitive interviews about the PROMIS items with adolescents with varying degrees of mobility limitations would provide better understanding of how they are interpreting and selecting responses to the PROMIS items and thus help guide selection of the most appropriate way to address this issue.
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Affiliation(s)
- Wendy J Coster
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA.
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Mary D Slavin
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Pamela A Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Ratna Nandakumar
- College of Education and Human Development, University of Delaware, Newark, DE
| | - Mary Jane Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - David S Tulsky
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE,Kessler Foundation Research Center, West Orange, NJ, USA
| | - Alan M Jette
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
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Slavin MD, Ni P, Tulsky DS, Kisala PA, Heinemann AW, Charlifue S, Fyffe DC, Graves DE, Marino RJ, Morse LR, Rosenblum D, Tate D, Worobey LA, Dawson MB, Jette AM. Spinal Cord Injury–Functional Index/Assistive Technology Short Forms. Arch Phys Med Rehabil 2016; 97:1745-1752.e7. [DOI: 10.1016/j.apmr.2016.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 10/21/2022]
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Keeney T, Slavin MD, Ni P, Tulsky DS, Kisala PA, Heinemann AW, Charlifue S, Fyffe DC, Graves DE, Marino RJ, Morse LR, Rosenbaum D, Tate D, Worobey LA, Dawson MB, Jette AM. Spinal Cord Injury Functional Index: Ability to Detect Change. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mulcahey MJ, Haley SM, Slavin MD, Kisala PA, Ni P, Tulsky DS, Jette AM. Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery. J Pediatr Orthop 2016; 36:749-56. [PMID: 26057065 PMCID: PMC4670604 DOI: 10.1097/bpo.0000000000000533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Patient Reported Outcomes Measurement Information System (PROMIS) was developed to provide patient-reported outcome measures that are designed as being universally relevant across health conditions, low burden, and precise. A major problem for research and clinical practice in cerebral palsy (CP) is the void of outcomes instruments that are capable of evaluating the wide range of abilities and broad age spectrum inherent in this clinical population. Given the tremendous potential of PROMIS, the research questions for this study were "How do PROMIS pediatric computer adaptive tests and short forms detect change in children with CP following elective musculoskeletal surgery?" and "How do PROMIS instruments compare to the Pediatric Quality of Life Inventory Cerebral Palsy Module Version 3.0 (PedsQL CP), Pediatric Outcomes Data Collection Instrument (PODCI), the Timed Up and Go (TUG), and the Gross Motor Functional Measure (GMFM)." METHODS PROMIS Pediatric computer adaptive tests and short forms and the PedsQL, PODCI, TUG, and GMFM were administered before and after surgery. Effect size (ES) and standardized response mean (SRM) were calculated. Floor and ceiling effects were evaluated and, exposure rates for the PROMIS item banks were examined. RESULTS ES and SRM for all PROMIS Pediatric Measures were nonsignificant. PedsQL CP detected significant, positive change in mobility at 6 (ES=0.26; SRM=0.31) and 12 (ES=0.36; SRM=0.36) months; pain at 12 months (ES=0.29; SRM=0.34); and fatigue at 6 (ES=0.24; SRM=0.22) and 12 (ES=0.36; SRM=0.41) months. Significant negative changes were detected by the PODCI (ES=-0.20; SRM=-0.26), GMFM (ES=-0.13; SRM=-0.24), and TUG (ES=-0.29; SRM=-0.25). Ceiling effects were high. Exposure to an appropriate range of the PROMIS Mobility item bank was limited. CONCLUSIONS PROMIS measures were less able to detect change than other measures. PROMIS measures may be improved by tailoring start/stop rules or by adding items to include content appropriate for children with mobility impairments. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- MJ Mulcahey
- Department of Occupational Therapy, School of Health Professions, Thomas Jefferson University, Philadelphia, PA
| | - Stephen M. Haley
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
- Deceased
| | - Mary D. Slavin
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Pengsheng Ni
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - David S. Tulsky
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
- Kessler Foundation Research Center, West Orange, NJ
| | - Alan M. Jette
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
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Cohen M, Kisala PA, Holdnack J, Tulsky D. Construct Validity of the SCI-QOL Trauma Item Bank. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Holdnack J, Cohen M, Tulsky D, Kisala PA, Heinemann A. Anger Issues in Individuals with TBI: Prevalence and Cognitive Risk Factors. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sinha R, Slavin MD, Kisala PA, Ni P, Tulsky DS, Jette AM. Functional Ability Level Development and Validation: Providing Clinical Meaning for Spinal Cord Injury Functional Index Scores. Arch Phys Med Rehabil 2015; 96:1448-57. [DOI: 10.1016/j.apmr.2014.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/25/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Department of Physical Therapy, University of Delaware, College of Health Sciences, 540 S. College Ave., Newark, DE 19713.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
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Abstract
OBJECTIVE To develop a self-reported measure of the subjective impact of pressure ulcers on health-related quality of life (HRQOL) in individuals with spinal cord injury (SCI) as part of the SCI quality of life (SCI-QOL) measurement system. DESIGN Grounded-theory based qualitative item development methods, large-scale item calibration testing, confirmatory factor analysis (CFA), and item response theory-based psychometric analysis. SETTING Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. MAIN OUTCOME MEASURES SCI-QOL Pressure Ulcers scale. RESULTS 189 individuals with traumatic SCI who experienced a pressure ulcer within the past 7 days completed 30 items related to pressure ulcers. CFA confirmed a unidimensional pool of items. IRT analyses were conducted. A constrained Graded Response Model with a constant slope parameter was used to estimate item thresholds for the 12 retained items. CONCLUSIONS The 12-item SCI-QOL Pressure Ulcers scale is unique in that it is specifically targeted to individuals with spinal cord injury and at every stage of development has included input from individuals with SCI. Furthermore, use of CFA and IRT methods provide flexibility and precision of measurement. The scale may be administered in its entirety or as a 7-item "short form" and is available for both research and clinical practice.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Kisala PA, Tulsky DS, Pace N, Victorson D, Choi SW, Heinemann AW. Measuring stigma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Stigma item bank and short form. J Spinal Cord Med 2015; 38:386-96. [PMID: 26010973 PMCID: PMC4445029 DOI: 10.1179/1079026815z.000000000410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated item bank and computer adaptive test (CAT) to assess the effects of stigma on health-related quality of life in individuals with spinal cord injury (SCI). DESIGN Grounded-theory based qualitative item development methods, large-scale item calibration field testing, confirmatory factor analysis, and item response theory (IRT)-based psychometric analyses. SETTING Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. MAIN OUTCOME MEASURES SCI-QOL Stigma Item Bank RESULTS A sample of 611 individuals with traumatic SCI completed 30 items assessing SCI-related stigma. After 7 items were iteratively removed, factor analyses confirmed a unidimensional pool of items. Graded Response Model IRT analyses were used to estimate slopes and thresholds for the final 23 items. CONCLUSIONS The SCI-QOL Stigma item bank is unique not only in the assessment of SCI-related stigma but also in the inclusion of individuals with SCI in all phases of its development. Use of confirmatory factor analytic and IRT methods provide flexibility and precision of measurement. The item bank may be administered as a CAT or as a 10-item fixed-length short form and can be used for research and clinical applications.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Natalie Pace
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kalpakjian CZ, Tulsky DS, Kisala PA, Bombardier CH. Measuring grief and loss after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Grief and Loss item bank and short form. J Spinal Cord Med 2015; 38:347-55. [PMID: 26010969 PMCID: PMC4445025 DOI: 10.1179/2045772315y.0000000015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop an item response theory (IRT) calibrated Grief and Loss item bank as part of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. DESIGN A literature review guided framework development of grief/loss. New items were created from focus groups. Items were revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis (CFA), graded response IRT modeling and evaluation of differential item functioning (DIF). SETTING We tested a 20-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI answered the grief and loss questions. RESULTS The final calibrated item bank resulted in 17 retained items. A unidimensional model was observed (CFI=0.976; RMSEA=0.078) and measurement precision was good (theta range between -1.48 to 2.48). Ten items were flagged for DIF, however, after examination of effect sizes found this to be negligible with little practical impact on score estimates. CONCLUSIONS This study indicates that the SCI-QOL Grief and Loss item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Bertisch H, Kalpakjian CZ, Kisala PA, Tulsky DS. Measuring positive affect and well-being after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Positive Affect and Well-being bank and short form. J Spinal Cord Med 2015; 38:356-65. [PMID: 26010970 PMCID: PMC4445026 DOI: 10.1179/2045772315y.0000000024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To develop an item response theory (IRT)-calibrated spinal cord injury (SCI)-specific Positive Affect and Well-being (PAWB) item bank with flexible options for administration. DESIGN Qualitative feedback from patient and provider focus groups was used to expand on the Neurological Disorders and Quality of Life (Neuro-QOL) positive affect & well-being item bank for use in SCI. New items were created and revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis, graded response IRT modeling and evaluation of differential item functioning (DIF). SETTING We tested a 32-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI answered the PAWB questions. RESULTS A unidimensional model was observed (Confirmatory Fit Index=0.947; Root Mean Square Error of Approximation=0.094) and measurement precision was good (reliability in theta of -2.9 to 1.2 is roughly equivalent to classical reliability of 0.95 or above). Twelve items were flagged for DIF, however, after examination of effect sizes, the DIF was determined to be negligible and would have little practical impact on score estimates. The final calibrated item bank resulted in 28 retained items CONCLUSIONS This study indicates that the Spinal Cord Injury--Quality of Life PAWB bank represents a psychometrically robust measurement tool. Short form items are also suggested and a computer adaptive test is available.
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Affiliation(s)
- Hilary Bertisch
- Rusk Rehabilitation, New York University Langone Medical Center, New York, NY, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Tulsky DS, Kisala PA, Tate DG, Spungen AM, Kirshblum SC. Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale. J Spinal Cord Med 2015; 38:288-302. [PMID: 26010964 PMCID: PMC4445020 DOI: 10.1179/2045772315y.0000000030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Bladder Management Difficulties and Bowel Management Difficulties item banks and Bladder Complications scale. DESIGN Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using focus groups with individuals with spinal cord injury (SCI) and SCI clinicians, cognitive interviews, and item response theory (IRT) analytic approaches, including tests of model fit and differential item functioning. SETTING Thirty-eight bladder items and 52 bowel items were tested at the University of Michigan, Kessler Foundation Research Center, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters VA Medical Center, Bronx, NY. PARTICIPANTS Seven hundred fifty-seven adults with traumatic SCI. RESULTS The final item banks demonstrated unidimensionality (Bladder Management Difficulties CFI=0.965; RMSEA=0.093; Bowel Management Difficulties CFI=0.955; RMSEA=0.078) and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently (CFI=0.992, RMSEA=0.050) and were thus retained as a separate scale. CONCLUSION The SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
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Heinemann AW, Kisala PA, Hahn EA, Tulsky DS. Development and psychometric characteristics of the SCI-QOL Ability to Participate and Satisfaction with Social Roles and Activities item banks and short forms. J Spinal Cord Med 2015; 38:397-408. [PMID: 26010974 PMCID: PMC4445030 DOI: 10.1179/2045772315y.0000000028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To develop a spinal cord injury (SCI)-focused version of PROMIS and Neuro-QOL social domain item banks; evaluate the psychometric properties of items developed for adults with SCI; and report information to facilitate clinical and research use. DESIGN We used a mixed-methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups helped define the constructs; cognitive interviews helped revise items; 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 Five SCI Model System sites and one Veterans Administration medical center. PARTICIPANTS The calibration sample consisted of 641 individuals; a reliability sample consisted of 245 individuals residing in the community. RESULTS A subset of 27 Ability to Participate and 35 Satisfaction items demonstrated good measurement properties and negligible differential item functioning related to demographic and injury characteristics. The SCI-specific measures correlate strongly with the PROMIS and Neuro-QOL versions. Ten item short forms correlate >0.96 with the full banks. Variable-length CATs with a minimum of 4 items, variable-length CATs with a minimum of 8 items, fixed-length CATs of 10 items, and the 10-item short forms demonstrate construct coverage and measurement error that is comparable to the full item bank. CONCLUSION The Ability to Participate and Satisfaction with Social Roles and Activities CATs and short forms demonstrate excellent psychometric properties and are suitable for clinical and research applications.
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Affiliation(s)
- Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 345 E. Superior St. Chicago, IL 60611, USA
| | - Pamela A. Kisala
- Center on Assessment Research and Translation, College of Health Sciences and the Department of Physical Therapy, University of Delaware, STAR Health Sciences Complex, 540 South College Avenue, Newark, DE 19713 USA
| | - Elizabeth A. Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Kalpakjian CZ, Tate DG, Kisala PA, Tulsky DS. Measuring self-esteem after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Self-esteem item bank and short form. J Spinal Cord Med 2015; 38:377-85. [PMID: 26010972 PMCID: PMC4445028 DOI: 10.1179/2045772315y.0000000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Self-esteem item bank. DESIGN Using a mixed-methods design, we developed and tested a self-esteem item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory-(IRT) based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. SETTING We tested a pool of 30 items at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI completed the self-esteem items. RESULTS A unidimensional model was observed (CFI=0.946; RMSEA=0.087) and measurement precision was good (theta range between -2.7 and 0.7). Eleven items were flagged for DIF; however, effect sizes were negligible with little practical impact on score estimates. The final calibrated item bank resulted in 23 retained items. CONCLUSION This study indicates that the SCI-QOL Self-esteem item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Victorson D, Tulsky DS, Kisala PA, Kalpakjian CZ, Weiland B, Choi SW. Measuring resilience after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Resilience item bank and short form. J Spinal Cord Med 2015; 38:366-76. [PMID: 26010971 PMCID: PMC4445027 DOI: 10.1179/2045772315y.0000000016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Resilience item bank and short form. DESIGN Using a mixed-methods design, we developed and tested a resilience item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory based analytic approaches, including tests of model fit and differential item functioning (DIF). SETTING We tested a 32-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs medical center. PARTICIPANTS A total of 717 individuals with SCI completed the Resilience items. RESULTS A unidimensional model was observed (CFI=0.968; RMSEA=0.074) and measurement precision was good (theta range between -3.1 and 0.9). Ten items were flagged for DIF, however, after examination of effect sizes we found this to be negligible with little practical impact on score estimates. The final calibrated item bank resulted in 21 retained items. CONCLUSION This study indicates that the SCI-QOL Resilience item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Brian Weiland
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, Kirshblum SC, Fyffe D, Gershon R, Spungen AM, Bombardier CH, Dyson-Hudson TA, Amtmann D, Z. Kalpakjian C, W. Choi S, Jette AM, Forchheimer M, Cella D. Overview of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. J Spinal Cord Med 2015; 38:257-69. [PMID: 26010962 PMCID: PMC4445018 DOI: 10.1179/2045772315y.0000000023] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
CONTEXT/OBJECTIVE The Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system was developed to address the shortage of relevant and psychometrically sound patient reported outcome (PRO) measures available for clinical care and research in spinal cord injury (SCI) rehabilitation. Using a computer adaptive testing (CAT) approach, the SCI-QOL builds on the Patient Reported Outcomes Measurement Information System (PROMIS) and the Quality of Life in Neurological Disorders (Neuro-QOL) initiative. This initial manuscript introduces the background and development of the SCI-QOL measurement system. Greater detail is presented in the additional manuscripts of this special issue. DESIGN Classical and contemporary test development methodologies were employed. Qualitative input was obtained from individuals with SCI and clinicians through interviews, focus groups, and cognitive debriefing. Item pools were field tested in a multi-site sample (n=877) and calibrated using item response theory methods. Initial reliability and validity testing was performed in a new sample of individuals with traumatic SCI (n=245). SETTING Five Model SCI System centers and one Department of Veterans Affairs Medical Center across the United States. PARTICIPANTS Adults with traumatic SCI. INTERVENTIONS n/a OUTCOME MEASURES n/a RESULTS The SCI-QOL consists of 19 item banks, including the SCI-Functional Index banks, and 3 fixed-length scales measuring physical, emotional, and social aspects of health-related QOL (HRQOL). CONCLUSION The SCI-QOL measurement system consists of psychometrically sound measures for individuals with SCI. The manuscripts in this special issue provide evidence of the reliability and initial validity of this measurement system. The SCI-QOL also links to other measures designed for a general medical population.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise G. Tate
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | | | - Richard Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | | | | | - Alan M. Jette
- Boston University School of Public Health, Boston, MA, USA
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Jette AM, Slavin MD, Ni P, Kisala PA, Tulsky DS, Heinemann AW, Charlifue S, Tate DG, Fyffe D, Morse L, Marino R, Smith I, Williams S. Development and initial evaluation of the SCI-FI/AT. J Spinal Cord Med 2015; 38:409-18. [PMID: 26010975 PMCID: PMC4445031 DOI: 10.1179/2045772315y.0000000003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe the domain structure and calibration of the Spinal Cord Injury Functional Index for samples using Assistive Technology (SCI-FI/AT) and report the initial psychometric properties of each domain. DESIGN Cross sectional survey followed by computerized adaptive test (CAT) simulations. SETTING Inpatient and community settings. PARTICIPANTS A sample of 460 adults with traumatic spinal cord injury (SCI) stratified by level of injury, completeness of injury, and time since injury. INTERVENTIONS None MAIN OUTCOME MEASURE SCI-FI/AT RESULTS: Confirmatory factor analysis (CFA) and Item response theory (IRT) analyses identified 4 unidimensional SCI-FI/AT domains: Basic Mobility (41 items) Self-care (71 items), Fine Motor Function (35 items), and Ambulation (29 items). High correlations of full item banks with 10-item simulated CATs indicated high accuracy of each CAT in estimating a person's function, and there was high measurement reliability for the simulated CAT scales compared with the full item bank. SCI-FI/AT item difficulties in the domains of Self-care, Fine Motor Function, and Ambulation were less difficult than the same items in the original SCI-FI item banks. CONCLUSION With the development of the SCI-FI/AT, clinicians and investigators have available multidimensional assessment scales that evaluate function for users of AT to complement the scales available in the original SCI-FI.
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Affiliation(s)
- Alan M. Jette
- New England Regional Spinal Cord Injury Center, Boston, MA, USA,Correspondence to: Alan M. Jette, Health and Disability Research Institute, Boston University School of Public Health, 715 Albany Street T5 W, Boston, MA 02118, USA. Reprints are available from David S. Tulsky at
| | - Mary D. Slavin
- New England Regional Spinal Cord Injury Center, Boston, MA, USA
| | - Pengsheng Ni
- New England Regional Spinal Cord Injury Center, Boston, MA, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | | | | | - Susie Charlifue
- The Rocky Mountain Regional Spinal Injury System, Englewood, CO, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | | | - Leslie Morse
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Ralph Marino
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ian Smith
- University of Pittsburgh Medical Centers, Pittsburgh, PA, USA
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Abstract
OBJECTIVE To develop a comprehensive, psychometrically sound, and conceptually grounded patient reported outcomes (PRO) measurement system for individuals with spinal cord injury (SCI). METHODS Individual interviews (n=44) and focus groups (n=65 individuals with SCI and n=42 SCI clinicians) were used to select key domains for inclusion and to develop PRO items. Verbatim items from other cutting-edge measurement systems (i.e. PROMIS, Neuro-QOL) were included to facilitate linkage and cross-population comparison. Items were field tested in a large sample of individuals with traumatic SCI (n=877). Dimensionality was assessed with confirmatory factor analysis. Local item dependence and differential item functioning were assessed, and items were calibrated using the item response theory (IRT) graded response model. Finally, computer adaptive tests (CATs) and short forms were administered in a new sample (n=245) to assess test-retest reliability and stability. PARTICIPANTS AND PROCEDURES A calibration sample of 877 individuals with traumatic SCI across five SCI Model Systems sites and one Department of Veterans Affairs medical center completed SCI-QOL items in interview format. RESULTS We developed 14 unidimensional calibrated item banks and 3 calibrated scales across physical, emotional, and social health domains. When combined with the five Spinal Cord Injury--Functional Index physical function banks, the final SCI-QOL system consists of 22 IRT-calibrated item banks/scales. Item banks may be administered as CATs or short forms. Scales may be administered in a fixed-length format only. CONCLUSIONS The SCI-QOL measurement system provides SCI researchers and clinicians with a comprehensive, relevant and psychometrically robust system for measurement of physical-medical, physical-functional, emotional, and social outcomes. All SCI-QOL instruments are freely available on Assessment CenterSM.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Richard Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kisala PA, Tulsky DS, Kalpakjian CZ, Heinemann AW, Pohlig RT, Carle A, Choi SW. Measuring anxiety after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Anxiety item bank and linkage with GAD-7. J Spinal Cord Med 2015; 38:315-25. [PMID: 26010966 PMCID: PMC4445022 DOI: 10.1179/2045772315y.0000000029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated item bank and computer adaptive test to assess anxiety symptoms in individuals with spinal cord injury (SCI), transform scores to the Patient Reported Outcomes Measurement Information System (PROMIS) metric, and create a statistical linkage with the Generalized Anxiety Disorder (GAD)-7, a widely used anxiety measure. DESIGN Grounded-theory based qualitative item development methods; large-scale item calibration field testing; confirmatory factor analysis; graded response model item response theory analyses; statistical linking techniques to transform scores to a PROMIS metric; and linkage with the GAD-7. Setting Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. Participants Adults with traumatic SCI. MAIN OUTCOME MEASURES Spinal Cord Injury-Quality of Life (SCI-QOL) Anxiety Item Bank RESULTS Seven hundred sixteen individuals with traumatic SCI completed 38 items assessing anxiety, 17 of which were PROMIS items. After 13 items (including 2 PROMIS items) were removed, factor analyses confirmed unidimensionality. Item response theory analyses were used to estimate slopes and thresholds for the final 25 items (15 from PROMIS). The observed Pearson correlation between the SCI-QOL Anxiety and GAD-7 scores was 0.67. CONCLUSIONS The SCI-QOL Anxiety item bank demonstrates excellent psychometric properties and is available as a computer adaptive test or short form for research and clinical applications. SCI-QOL Anxiety scores have been transformed to the PROMIS metric and we provide a method to link SCI-QOL Anxiety scores with those of the GAD-7.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Allen W. Heinemann
- Rehabilitation Institute of Chicago, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan T. Pohlig
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - Adam Carle
- Cincinnati Children's Hospital, Cincinnati, OH, USA
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Tulsky DS, Kisala PA, Kalpakjian CZ, Bombardier CH, Pohlig RT, Heinemann AW, Carle A, Choi SW. Measuring depression after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Depression item bank and linkage with PHQ-9. J Spinal Cord Med 2015; 38:335-46. [PMID: 26010968 PMCID: PMC4445024 DOI: 10.1179/2045772315y.0000000020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated spinal cord injury-quality of life (SCI-QOL) item bank, computer adaptive test (CAT), and short form to assess depressive symptoms experienced by individuals with SCI, transform scores to the Patient Reported Outcomes Measurement Information System (PROMIS) metric, and create a crosswalk to the Patient Health Questionnaire (PHQ)-9. DESIGN We used grounded-theory based qualitative item development methods, large-scale item calibration field testing, confirmatory factor analysis, item response theory (IRT) analyses, and statistical linking techniques to transform scores to a PROMIS metric and to provide a crosswalk with the PHQ-9. SETTING Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. MAIN OUTCOME MEASURES Spinal Cord Injury--Quality of Life (SCI-QOL) Depression Item Bank RESULTS Individuals with SCI were involved in all phases of SCI-QOL development. A sample of 716 individuals with traumatic SCI completed 35 items assessing depression, 18 of which were PROMIS items. After removing 7 non-PROMIS items, factor analyses confirmed a unidimensional pool of items. We used a graded response IRT model to estimate slopes and thresholds for the 28 retained items. The SCI-QOL Depression measure correlated 0.76 with the PHQ-9. CONCLUSIONS The SCI-QOL Depression item bank provides a reliable and sensitive measure of depressive symptoms with scores reported in terms of general population norms. We provide a crosswalk to the PHQ-9 to facilitate comparisons between measures. The item bank may be administered as a CAT or as a short form and is suitable for research and clinical applications.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ryan T. Pohlig
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE, USA
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University and Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Adam Carle
- Cincinnati Children's Hospital, Cincinnati, OH, USA
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Kisala PA, Victorson D, Pace N, Heinemann AW, Choi SW, Tulsky DS. Measuring psychological trauma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Psychological Trauma item bank and short form. J Spinal Cord Med 2015; 38:326-34. [PMID: 26010967 PMCID: PMC4445023 DOI: 10.1179/2045772315y.0000000022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the SCI-QOL Psychological Trauma item bank and short form. DESIGN Using a mixed-methods design, we developed and tested a Psychological Trauma item bank with patient and provider focus groups, cognitive interviews, and item response theory based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. SETTING We tested a 31-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Veterans Administration hospital. PARTICIPANTS A total of 716 individuals with SCI completed the trauma items RESULTS The 31 items fit a unidimensional model (CFI=0.952; RMSEA=0.061) and demonstrated good precision (theta range between 0.6 and 2.5). Nine items demonstrated negligible DIF with little impact on score estimates. The final calibrated item bank contains 19 items CONCLUSION The SCI-QOL Psychological Trauma item bank is a psychometrically robust measurement tool from which a short form and a computer adaptive test (CAT) version are available.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Natalie Pace
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - David S. Tulsky
- Correspondence to: David Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Carlozzi NE, Kirsch NL, Kisala PA, Tulsky DS. An examination of the Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate and Severe traumatic brain injury (TBI). Clin Neuropsychol 2015; 29:21-37. [PMID: 25646823 DOI: 10.1080/13854046.2015.1005677] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined the clinical utility of the Wechsler Adult Intelligence Scales-Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate or severe TBI. One hundred individuals with TBI (n = 35 complicated mild or moderate TBI; n = 65 severe TBI) and 100 control participants matched on key demographic variables from the WAIS-IV normative dataset completed the WAIS-IV. Univariate analyses indicated that participants with severe TBI had poorer performance than matched controls on all index scores and subtests (except Matrix Reasoning). Individuals with complicated mild/moderate TBI performed more poorly than controls on the Working Memory Index (WMI), Processing Speed Index (PSI), and Full Scale IQ (FSIQ), and on four subtests: the two processing speed subtests (SS, CD), two working memory subtests (AR, LN), and a perceptual reasoning subtest (BD). Participants with severe TBI had significantly lower scores than the complicated mild/moderate TBI on PSI, and on three subtests: the two processing speed subtests (SS and CD), and the new visual puzzles test. Effect sizes for index and subtest scores were generally small-to-moderate for the group with complicated mild/moderate and moderate-to-large for the group with severe TBI. PSI also showed good sensitivity and specificity for classifying individuals with severe TBI versus controls. Findings provide support for the clinical utility of the WAIS-IV in individuals with complicated mild, moderate, and severe TBI.
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Affiliation(s)
- Noelle E Carlozzi
- a Department of Physical Medicine and Rehabilitation , University of Michigan , Ann Arbor , Michigan 48109-2800 , USA
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Tulsky DS, Carlozzi N, Chiaravalloti ND, Beaumont JL, Kisala PA, Mungas D, Conway K, Gershon R. NIH Toolbox Cognition Battery (NIHTB-CB): list sorting test to measure working memory. J Int Neuropsychol Soc 2014; 20:599-610. [PMID: 24959983 PMCID: PMC4426848 DOI: 10.1017/s135561771400040x] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The List Sorting Working Memory Test was designed to assess working memory (WM) as part of the NIH Toolbox Cognition Battery. List Sorting is a sequencing task requiring children and adults to sort and sequence stimuli that are presented visually and auditorily. Validation data are presented for 268 participants ages 20 to 85 years. A subset of participants (N=89) was retested 7 to 21 days later. As expected, the List Sorting Test had moderately high correlations with other measures of working memory and executive functioning (convergent validity) but a low correlation with a test of receptive vocabulary (discriminant validity). Furthermore, List Sorting demonstrates expected changes over the age span and has excellent test-retest reliability. Collectively, these results provide initial support for the construct validity of the List Sorting Working Memory Measure as a measure of working memory. However, the relationship between the List Sorting Test and general executive function has yet to be determined.
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Affiliation(s)
- David S. Tulsky
- Departments of Rehabilitation Medicine, Orthopedic Surgery, and General Medicine, New York University Langone Medical Center, New York, New York
- Kessler Foundation Research Center, West Orange, New Jersey
| | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | | | - Jennifer L. Beaumont
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Pamela A. Kisala
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, New York
| | - Dan Mungas
- Department of Neurology, University of California, Davis, California
| | - Kevin Conway
- National Institute on Drug Abuse, Rockville, Maryland
| | - Richard Gershon
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
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Jette AM, Tulsky DS, Ni P, Kisala PA, Slavin MD, Dijkers MP, Heinemann AW, Tate DG, Whiteneck G, Charlifue S, Houlihan B, Williams S, Kirshblum S, Dyson-Hudson T, Zanca J, Fyffe D. Development and Initial Evaluation of the Spinal Cord Injury-Functional Index. Arch Phys Med Rehabil 2012; 93:1733-50. [DOI: 10.1016/j.apmr.2012.05.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/04/2012] [Accepted: 05/09/2012] [Indexed: 11/26/2022]
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Tulsky DS, Kisala PA, Victorson D, Tate D, Heinemann AW, Amtmann D, Cella D. Developing a contemporary patient-reported outcomes measure for spinal cord injury. Arch Phys Med Rehabil 2011; 92:S44-51. [PMID: 21958922 DOI: 10.1016/j.apmr.2011.04.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 04/27/2011] [Accepted: 04/28/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop a spinal cord injury (SCI)-specific patient-reported outcome (PRO) measure of health-related quality of life (QOL) covering multiple domains of functioning, including physical, emotional, and social health. DESIGN Focus groups. SETTING Four SCI Model Systems rehabilitation hospitals. PARTICIPANTS Individuals with SCI (n=65) and clinicians (n=42). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Spinal Cord Injury Quality of Life Measurement System (SCI-QOL). RESULTS Qualitative analysis yielded 3 domains of primary importance: physical-medical health, emotional health, and social participation. Results were used to guide domain and item decisions in the development of the SCI-QOL PRO measurement system. Qualitative data were used to develop item pools with item content specific to individuals with SCI across a wide spectrum of functioning. When possible, items from other major measurement initiatives were included verbatim in the item pools to link the measurement systems and facilitate cross-study and cross-population comparisons. CONCLUSIONS Issues that affect individuals' QOL after SCI are varied and several issues are unique to individuals who have had a traumatic injury. From these qualitative data, 3 major domains and 18 subdomains of functioning were identified. Item pools were developed in each of these 18 areas to measure functioning related to physical-medical issues, emotional status, and social participation.
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Affiliation(s)
- David S Tulsky
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI 48109-2800, USA.
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Carlozzi NE, Tulsky DS, Kisala PA. Traumatic Brain Injury Patient-Reported Outcome Measure: Identification of Health-Related Quality-of-Life Issues Relevant to Individuals With Traumatic Brain Injury. Arch Phys Med Rehabil 2011; 92:S52-60. [DOI: 10.1016/j.apmr.2010.12.046] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 12/20/2010] [Accepted: 12/21/2010] [Indexed: 10/17/2022]
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Kisala PA, Tulsky DS. Opportunities for CAT applications in medical rehabilitation: development of targeted item banks. J Appl Meas 2010; 11:315-330. [PMID: 20847478 PMCID: PMC6445378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Researchers in the field of rehabilitation medicine have increasingly turned to qualitative data collection methods to better understand the experience of living with a disability. In rehabilitation psychology, these techniques are embodied by participatory action research (PAR; Hall 1981; White, Suchowierska, and Campbell 2004), whereby researchers garner qualitative feedback from key stakeholders such as patients and physicians. Glaser and Strauss (1967) and, later, Strauss and Corbin (1998) have outlined a systematic method of gathering and analyzing qualitative data to ensure that results are conceptually grounded to the population of interest. This type of analysis yields a set of interrelated concepts ("codes") to describe the phenomenon of interest. Using this data, however, becomes somewhat of a methodological problem. While this data is often used to describe phenomena of interest, it is challenging to transform the knowledge gained into practical data to inform research and clinical practice. In the case of developing patient-reported outcomes (PRO) measures for use in a rehabilitation population, it is difficult to make sense of the qualitative analysis results. Qualitative feedback tends to be open-ended and free-flowing, not conforming to any traditional data analysis methodology. Researchers involved in measure development need a practical way to quantify the qualitative feedback. This manuscript will focus on a detailed methodology of empiricizing qualitative data for practical application, in the context of developing targeted, rehabilitation-specific PRO measures within a larger, more generic PRO measurement system.
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Affiliation(s)
- Pamela A Kisala
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI 48103, USA.
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