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

Pamela A. Kisala, David S. Tulsky*, Aaron J. Boulton, Allen W. Heinemann, David Victorson, Mark Sherer, Angelle M. Sander, Nancy Chiaravalloti, Noelle E. Carlozzi, Robin Hanks

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)33-42
Number of pages10
JournalArchives of physical medicine and rehabilitation
Issue number1
StatePublished - Jan 2020


  • Brain injuries
  • Help-seeking behavior
  • Independent living
  • Patient outcome assessment
  • Personal autonomy
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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