Development of Quality of Life Tool for TBI

Specific short-term objectives for this study include:

O1: Identify a parsimonious set of domains that capture HRQOL in deployment-related TBI.

O2: Construct and refine clinically-relevant HRQOL of life item banks for deployment-related TBI, in order to supplement the TBI-QOL and generic Neuro-QOL banks and extend the TBI/Neuro-QOL projects to address the unique issues facing wounded warriors with TBI.

O3:Utilize Item Response Theory methodology to refine and calibrate targeted and generic item banks for use with deployment-related TBI.

O4:Develop a short form, refining item sets and developing algorithms for future development of a computerized adaptive test.

Research Design: The proposed three-year prospective study will employ a mixed methods research design in three stages. Combining qualitative and quantitative methods maximizes the ability of the study team to design and validate a clinically sensitive HRQOL measure for wounded warriors with deployment-related TBI. Furthermore, this approach is consistent with the FDA's draft guidance on patient reported outcome (PRO) measures development.

Phase 1: Qualitative data obtained from focus groups of veterans and VA providers will be used to (a) evaluate the generic Neuro-QOL domains and items for relevance and appropriateness for use in deployment-related TBI and (b) identify new HRQOL domains and items specific to deployment-related TBI. [Objective #1] Phase 2: The generic and specific item banks will be field tested in a large sample of veterans with deployment-related TBI recruited from all 4 VA Polytrauma Rehabilitation Centers (PRCs). [Objective #2] Phase 3: Psychometric analyses, including item response theory (IRT) of field test data will be completed. The psychometric properties of the scale will be evaluated empirically. A short form will be developed, refining item sets and developing algorithms for future development of a computerized adaptive test (CAT). [Objectives #3 & 4]

Inclusion criteria

• enrolled in VA and diagnosed with a deployment-related TBI documented in computerized patient record system (CPRS)
• at least one year post injury
• greater than 18 years of age
• able to follow two step commands and
• English speaking

Clinicians Inclusion Criteria:

• Clinicians, including:

• physicians
• psychologists
• nurses
• social workers
• therapists who have provided care to wounded warriors with deployment-related TBI for at least three years

Exclusion criteria

Veterans Exclusion criteria include:

• those veterans who are not yet discharged from initial rehabilitation (want patients to experience community based living environment)
• living in the community less than three months post initial rehabilitation, including residential care or long term care living environments

No exclusion criteria for the clinicians