Development and Psychometric Characteristics of the TBI-QOL Independence Item Bank and Short Form and the TBI-QOL Asking for Help Scale

Measurement properties of the Traumatic Brain Injury Quality of Life (TBI-QoL) and Spinal Cord Injury Quality of Life (SCI-QoL) measurement systems: a systematic review

PURPOSE

Traumatic brain injury and spinal cord injury impact all areas of individuals' quality of life. A synthesis of available evidence for the Traumatic Brain Injury Quality of Life (TBI-QoL) and Spinal Cord Injury Quality of Life (SCI-QoL) measurement systems could inform evidence-based clinical practice and research. Thus, we aimed to systematically review the literature of existing evidence on the measurement properties of SCI-QoL and TBI-QoL among rehabilitation populations.

METHODS

We used the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) framework for evaluating measures to guide this systematic review. We searched nine electronic databases and registries, and hand-searched reference lists of included articles. Two independent reviewers screened selected articles and extracted the data. We used COSMIN's thresholds to synthesize measurement properties evidence (insufficient, sufficient), and the modified GRADE approach to synthesize evidence quality (very-low, low, moderate, high).

RESULTS

We included 16 studies for SCI-QoL and 14 studies for TBI-QoL. Both measurement systems have sufficient content validity, structural validity, internal consistency and construct validity across nearly all domains (GRADE: high). Most SCI-QoL domains and some TBI-QoL domains have sufficient evidence of cross-cultural validity and test-retest reliability (GRADE: moderate-high). Besides the cognition domains of TBI-QoL, which have indeterminate evidence for measurement error and sufficient evidence for responsiveness (GRADE: high), there is no additional evidence available for these measurement properties.

CONCLUSION

Rehabilitation researchers and clinicians can use SCI-QoL and TBI-QoL to describe and evaluate patients. Further evidence of measurement error, responsiveness, and predictive validity would advance the use and interpretation of SCI-QoL and TBI-QoL in rehabilitation.

Assessment of quality of life after upper extremity transplantation: Framework for patient-reported outcome scale domains

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.

Responsiveness of the Traumatic Brain Injury Quality of Life Cognition Banks in Recent Brain Injury

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.