Rasch analysis of the community integration measure in persons with traumatic brain injury.

OBJECTIVE: To examine the measurement properties of the Community Integration Measure (CIM) in persons with traumatic brain injury (TBI). DESIGN: Rasch analysis was used to retrospectively evaluate the CIM. SETTING: Rehabilitation hospital. PARTICIPANTS: Persons (N=279) 1 to 15 years after a TBI. INTERVENTIONS: None. MAIN OUTCOME MEASURE: CIM RESULTS: The CIM met Rasch expectations of unidimensionality and reliability (person separation ratio=2.01, item separation ratio=4.52). However, item endorsibility was poorly targeted to the participants' level of community integration. A ceiling effect was found with this sample. CONCLUSIONS: The CIM is a relatively reliable and unidimensional scale. Future iterations might benefit from the addition of items that are more difficult to endorse (ie, improved targeting).

The reliability and validity of the brief symptom inventory-18 in persons with traumatic brain injury.

OBJECTIVE: To investigate the psychometric properties of the Brief Symptom Inventory-18 (BSI-18) among persons with traumatic brain injury (TBI). DESIGN: Inception cohort design with cross-sectional follow-up of 6 months to 15 years. SETTING: Rehabilitation hospital. PARTICIPANTS: Adults (N=257) with moderate to severe TBI (81 inpatients and 176 follow-up participants, analyzed separately). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The BSI-18 is a brief screen of psychologic distress with a Global Severity Index (GSI), and 3 clinical subscales: somatization, anxiety, and depression. RESULTS: Internal consistency of the GSI was high in both follow-up participants (alpha=.91) and inpatients (alpha=.84), whereas estimates for the somatization, anxiety, and depression subscales were more variable (alpha range, .61-.84). As would be expected for a measure of affective state, retest reliability estimates were only moderate. The BSI-18 GSI correlated with multiple measures of psychosocial adjustment. After accounting for demographics, injury severity, inpatient functional status, years since injury, and various psychosocial factors, the BSI-18 showed incremental validity in predicting concurrent functional, psychosocial, and psychologic status. CONCLUSIONS: The BSI-18 GSI had excellent reliability and validity among inpatients and follow-up participants. Modest reliability estimates may place an upper bound on the validity of the BSI-18 clinical subscales in inpatient TBI populations.

Behavioral inhibition and activation systems in traumatic brain injury.

PURPOSE/OBJECTIVE: Personality has been linked to cognitive appraisal and health outcomes; however, research specific to traumatic brain injury (TBI) has been sparse. Gray's theory of behavioral inhibition system and behavioral activation system (BIS/BAS) offers a neurobiologic view of personality that may be especially relevant to neurobehavioral change associated with TBI. The present study examined theoretical and psychometric issues of using the BIS/BAS scale among adults with TBI as well as BIS/BAS personality correlates of TBI. Research Method/Design: Eighty-one adults with complicated-mild to severe TBI and 76 of their significant others (SOs) participated. Measures included the BIS/BAS scale, Positive and Negative Affect Schedule, and Awareness Questionnaire. RESULTS: Among adults with TBI, BIS/BAS internal consistency reliabilities were similar to those found in normative samples of adults without TBI. The TBI group endorsed significantly higher BAS than did the SO group, and injury severity was positively correlated to BAS. The SO group showed expected patterns of correlation between personality and affect; positive affect was associated with BAS, and negative affect with BIS. In contrast, in the TBI group, BAS was positively correlated to both positive and negative affect. Impaired awareness of abilities moderated the intensity of relationships between BIS/BAS and affect. CONCLUSIONS/IMPLICATIONS: TBI was associated with relatively intensified BAS (approach behavior) but not BIS (avoidance behavior). The observed pattern is consistent with the neurobiology of TBI-related personality change and with theory regarding the independence of the BIS and BAS systems. The BIS/BAS scale shows promise as a personality measure in TBI. (PsycINFO Database Record

Religion and spirituality in rehabilitation outcomes among individuals with traumatic brain injury.

OBJECTIVE: The long-term consequences of traumatic brain injury affect millions of Americans, many of whom report using religion and spirituality to cope. Little research, however, has investigated how various elements of the religious and spiritual belief systems affect rehabilitation outcomes. The present study sought to assess the use of specifically defined elements of religion and spirituality as psychosocial resources in a sample of traumatically brain injured adults. PARTICIPANTS: The sample included 88 adults with brain injury from 1 to 20 years post injury and their knowledgeable significant others (SOs). The majority of the participants with brain injury were male (76%), African American (75%) and Christian (76%). MEASURES: Participants subjectively reported on their religious/spiritual beliefs and psychosocial resources as well as their current physical and psychological status. Significant others reported objective rehabilitation outcomes. ANALYSES: Hierarchical multiple regression analyses were used to determine the proportion of variance in outcomes accounted for by demographic, injury related, psychosocial and religious/spiritual variables. RESULTS: The results indicate that religious well-being (a sense of connection to a higher power) was a unique predictor for life satisfaction, distress and functional ability whereas public religious practice and existential well-being were not. CONCLUSIONS: The findings of this project indicate that specific facets of religious and spiritual belief systems do play direct and unique roles in predicting rehabilitation outcomes whereas religious activity does not. Notably, a self-reported individual connection to a higher power was an extremely robust predictor of both subjective and objective outcome.

The reliability and validity of the Community Integration Measure in persons with traumatic brain injury.

OBJECTIVE: To investigate the psychometric properties of the Community Integration Measure (CIM), a scale that assesses self-perceived quality of community integration, among persons with traumatic brain injury (TBI). METHOD: Persons (N = 279) with TBI completed the CIM, as well as other measures of community integration and quality of life, and were followed up to 15 years postinjury. RESULTS: The CIM was found to be a reliable instrument with adequate internal consistency. Validity was demonstrated in its relationship to other measures of community integration and life satisfaction. Utility was evident in its prediction of perceived social support. CONCLUSION: Results suggest that the CIM is an adequate measure of community integration for persons with histories of TBI of up to 15 years.