Understanding Health-Related Quality of Life in Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury: Establishing the Reliability and Validity of PROMIS Fatigue and Sleep Disturbance Item Banks

Arch Phys Med Rehabil. 2019 Apr;100(4S):S102-S109. doi: 10.1016/j.apmr.2018.05.020. Epub 2018 Jun 20.


Objective: To examine the reliability and validity of Patient-Reported Outcomes Measurement Information System (PROMIS) measures of sleep disturbance and fatigue in traumatic brain injury (TBI) caregivers and to determine the severity of fatigue and sleep disturbance in these caregivers.

Design: Cross-sectional survey data collected through an online data capture platform.

Setting: A total of 4 rehabilitation hospitals and Walter Reed National Military Medical Center.

Participants: Caregivers (N=560) of civilians (n=344) and service member/veterans (SMVs) (n=216) with TBI.

Intervention: Not applicable.

Main outcome measures: PROMIS sleep and fatigue measures administered as both computerized adaptive tests (CATs) and 4-item short forms (SFs).

Results: For both samples, floor and ceiling effects for the PROMIS measures were low (<11%), internal consistency was very good (all α≥0.80), and test-retest reliability was acceptable (all r≥0.70 except for the fatigue CAT in the SMV sample r=0.63). Convergent validity was supported by moderate correlations between the PROMIS and related measures. Discriminant validity was supported by low correlations between PROMIS measures and measures of dissimilar constructs. PROMIS scores indicated significantly worse sleep and fatigue for those caring for someone with high levels versus low levels of impairment.

Conclusions: Findings support the reliability and validity of the PROMIS CAT and SF measures of sleep disturbance and fatigue in caregivers of civilians and SMVs with TBI.

Keywords: Caregiver; Fatigue; Patient reported outcome measures; Psychometrics; Rehabilitation; Sleep; Traumatic brain injury.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Validation Study

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Brain Injuries, Traumatic / psychology*
  • Brain Injuries, Traumatic / rehabilitation
  • Caregivers / psychology*
  • Cross-Sectional Studies
  • Fatigue / diagnosis*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Military Personnel / psychology
  • Patient Reported Outcome Measures
  • Psychometrics
  • Quality of Life / psychology*
  • Reproducibility of Results
  • Sleep Wake Disorders / diagnosis*
  • Surveys and Questionnaires / standards*
  • Veterans / psychology