The Development of a New Computer-Adaptive Test to Evaluate Strain in Caregivers of Individuals With TBI: TBI-CareQOL Caregiver Strain

Arch Phys Med Rehabil. 2019 Apr;100(4S):S13-S21. doi: 10.1016/j.apmr.2018.05.033. Epub 2018 Aug 25.


Objective: To develop a new measure of caregiver strain for use in caregivers of individuals with traumatic brain injury (TBI), Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver Strain.

Design: Qualitative data, literature reviews, and cross-sectional survey study.

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

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

Interventions: Not applicable.

Main outcome measure: TBI-CareQOL Caregiver Strain Item Bank.

Results: Exploratory and confirmatory factor analyses, a graded response model (GRM) and differential item functioning supported the retention of 33 items in the final measure. GRM calibration data was used to inform the selection of a 6-item static short form, and to program the TBI-CareQOL Caregiver Strain computer-adaptive test (CAT). CAT simulation analyses indicated a 0.97 correlation between the CAT scores and the full item-bank. Three-week test-retest reliability was strong (r=0.83).

Conclusions: The new TBI-CareQOL Caregiver Strain CAT and corresponding 6-item short form were developed using established rigorous measurement development standards; this is the first self-reported measure developed to evaluate caregiver strain in caregivers of individuals with TBI.

Keywords: Caregiver; Health-related quality of life; Military family; 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
  • 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
  • Stress, Psychological / diagnosis*
  • Surveys and Questionnaires
  • Veterans / psychology