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J Head Trauma Rehabil. 2019 Sep/Oct;34(5):289-297. doi: 10.1097/HTR.0000000000000530.

Measuring Fatigue in TBI: Development of the TBI-QOL Fatigue Item Bank and Short Form.

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Center for Health Assessment Research and Translation, University of Delaware, Newark, DE (Ms Kisala and Drs Boulton and Tulsky); Rusk Rehabilitation, New York University Langone Medical Center, New York, NY (Dr Bushnik); Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan (Dr Hanks); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Kolakowsky-Hayner); and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE (Dr Tulsky).



To develop a traumatic brain injury (TBI)-specific, item response theory (IRT)-calibrated Fatigue item bank, short form, and computer adaptive test (CAT) as part of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system.


Five TBI Model Systems rehabilitation centers in the US PARTICIPANTS:: Adults with complicated mild, moderate, or severe TBI confirmed by medical record review.


Cross-sectional field testing via phone or in-person interview.


TBI-QOL Fatigue item bank, short form, and CAT.


A total of 590 adults with TBI completed 95 preliminary fatigue items, including 86 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) and 9 items from the Quality of Life in Neurological Disorders (Neuro-QOL) system. Through 4 iterations of factor analysis, 22 items were deleted for reasons such as local item dependence, misfit, and low item-total correlations. Graded response model IRT analyses were conducted on the 73-item set, and Stocking-Lord equating was used to transform the item parameters to the PROMIS (general population) metric. A short form and CAT, which demonstrate similar reliability to the full item bank, were developed. Test-retest reliability of the CAT was established in an independent sample (Pearson's r and intraclass correlation coefficient = 0.82 [95% confidence interval: 0.72-0.88]).


The TBI-QOL Fatigue item bank, short form, and CAT provide rehabilitation researchers and clinicians with TBI-optimized tools for assessment of the patient-reported experience and impact of fatigue on individuals with TBI.

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