Carlozzi NE, Kallen MA, Ianni PA, Sander AM, Hahn EA, Lange RT, Brickell TA, French LM, Miner JA, Hanks R. Arch. Phys. Med. Rehabil. 2019; 100(4S): S31-S42.
Affiliation
Rehabilitation Institute of Michigan, Department of Psychology and Neuropsychology, Detroit, Michigan, USA; Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan, USA.
OBJECTIVE: To develop new patient-reported outcome (PRO) measures to better understand feelings of loss in caregivers of individuals with traumatic brain injury (TBI).
DESIGN: Cross-sectional survey study. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS: Five-hundred-sixty caregivers of civilians with TBI (n=344) or service members/veterans (SMVs) with TBI (n=216) INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: TBI-CareQOL Feelings of Loss-Self and TBI-CareQOL Feelings of Loss-Person with Traumatic Brain Injury Item banks RESULTS: While the initial exploratory and confirmatory factor analyses of the Feelings of Loss item pool (98 items) potentially supported a unidimensional set of items, further analysis indicated two different factors: Feelings of Loss-Self (43 items) and Feelings of Loss-Person with TBI (20 items). For Feelings of Loss-Self, an additional 13 items were deleted due to item-response theory based item misfit; the remaining 30 items had good overall model fit (Confirmatory Fit Index [CFI]=0.96, Tucker Lewis Index [TLI]=.96, Root Mean Squared Error [RMSEA]=.10). For Feelings of Loss-Other, 1 additional item was deleted due to an associated high correlated error modification index value; the final 19 items evidenced good overall model fit (CFI=0.97, TLI=.97, RMSEA=.095). The final item banks were developed to be administered as either a CAT or a short-form. Clinical experts approved the content of the 6-item short forms of the two measures (three-week test-retest was r=.87 for Feelings of Loss-Self and r=.85 for Feelings of Loss-Person with TBI).
CONCLUSIONS: The findings from this study resulted in the development of two new PROs to assess feelings of loss in caregivers of individuals with TBI; TBI-CareQOL Feelings of Loss-Self and TBI-CareQOL Feelings of Loss-Person with TBI. Good psychometric properties were established and a short-form was developed for ease of use in clinical situations. Additional research is needed to determine concurrent and predictive validity of these measures in the psychological treatment of those caring for persons with TBI.