The Development of a New Computer Adaptive Test to Evaluate Anxiety in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Caregiver-Specific Anxiety

Arch Phys Med Rehabil. 2019 Apr;100(4S):S22-S30. doi: 10.1016/j.apmr.2018.05.027. Epub 2018 Jun 26.


Objective: To design a new measure of caregiver-specific anxiety for use in caregivers of individuals with traumatic brain injury (TBI), the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver-Specific Anxiety item bank.

Design: Cross-sectional survey study.

Setting: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.

Participants: Three hundred forty-four caregivers of civilians with TBI and 216 caregivers of service members/veterans with TBI (N=560).

Interventions: Not applicable.

Main outcome measures: TBI-CareQOL Caregiver-Specific Anxiety item bank.

Results: The retention of 40 Caregiver-Specific Anxiety items was supported by exploratory and confirmatory factor analyses. Graded response model (GRM) and differential item functioning analyses supported the retention of 33 items in the final measure. Expert review and GRM calibration data was used to select a 6-item static short form, and GRM calibration data was used to program the TBI-CareQOL Caregiver-Specific Anxiety computer adaptive test (CAT).

Conclusions: Established, rigorous measurement development standards were used to develop the new TBI-CareQOL Caregiver-Specific Anxiety CAT and corresponding 6-item short form. This measure is the first patient-reported outcome measure designed to assess caregiver-specific anxiety in caregivers of individuals with TBI. The measure exhibits strong psychometric properties.

Keywords: Anxiety; Caregiver; Families of Veterans; Health-related quality of life; Patient reported outcome; Rehabilitation; Traumatic brain injury; Veterans.

Publication types

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

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Anxiety / diagnosis*
  • Brain Injuries, Traumatic / psychology*
  • Brain Injuries, Traumatic / rehabilitation
  • Caregivers / psychology*
  • Computer Simulation
  • Cross-Sectional Studies
  • Diagnosis, Computer-Assisted / standards*
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Male
  • Middle Aged
  • Military Personnel / psychology
  • Psychometrics
  • Qualitative Research
  • Quality of Life / psychology*
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Veterans / psychology