Responsiveness of the Traumatic Brain Injury-Quality of Life (TBI-QOL) Measurement System

Arch Phys Med Rehabil. 2020 Jan;101(1):54-61. doi: 10.1016/j.apmr.2017.11.018. Epub 2018 Jan 31.


Objective: To assess the responsiveness of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system.

Design: Participants completed the 20 TBI-QOL item banks and the Participation Assessment with Recombined Tools-Objective (PART-O) Productivity Subscale at baseline and 6-month follow-up assessments. Participants were categorized into 4 groups (increased productivity, unchanged productivity, and decreased productivity) based on PART-O Productivity scores. Paired sample t tests were used to compare TBI-QOL scores at baseline and 6 months, and standardized response means and Cohen's d were computed to estimate effect sizes.

Setting: Three traumatic brain injury (TBI) Model Systems rehabilitation centers in the United States.

Participants: Two hundred one community-dwelling adults with TBI.

Interventions: Not applicable.

Main outcome measures: 20 TBI-QOL item banks.

Results: As expected, given that there was no intervention, group mean TBI-QOL subdomain scores for the entire sample showed no change or small improvement over the 6-month study period. At the follow-up assessment, 72 participants reported increased productivity, 71 reported decreased productivity, and 58 reported the same level of productivity as they had 6 months prior. When compared with participants who reported unchanged or decreased productivity, participants who reported increased productivity on the PART-O subscale had clinically meaningful (d≥0.30) improvements on 7 TBI-QOL measures. The largest improvement was in the Independence subdomain (mean change, 7.06; df=0.84), with differences also observed in the Mobility, Positive Affect and Well-Being, Resilience, Grief/Loss, Ability to Participate, and Satisfaction with Participation subdomains.

Conclusions: The 20 TBI-QOL item banks demonstrate responsiveness to change and measurement stability in a community-dwelling sample. Researchers may use the TBI-QOL to detect changes in HRQOL after a clinical intervention and clinicians may use it in their daily practices to monitor patient recovery.

Keywords: Health-related quality of life; Patient-reported outcome measure; Traumatic brain injury.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / psychology*
  • Disability Evaluation*
  • Efficiency*
  • Female
  • Humans
  • Independent Living / psychology*
  • Male
  • Middle Aged
  • Psychometrics
  • Quality of Life / psychology*
  • United States