Another Look at Two Participation Measures for Civilians With Traumatic Brain Injury

Abstract

Date Presented 04/07/19

Promoting participation is the core practice of OT. As ideal participation is so individualized and affected by personal and environmental factors, to date we still have not reached consensus on what the gold standard is for measuring participation outcome. This study compared construct validity of two participation measures commonly used in traumatic brain injury. We aimed to help clinicians select a psychometric sound instrument to identify those with participation challenges.

Primary Author and Speaker: Pey-Shan Wen

Contributing Authors: Julia Waid-Ebbs

Promoting participation is the core practice of occupational therapy. The International Classification of Functioning, Disability and Health (ICF) defines participation as “engagement in life situations” and it is also operationalized to the degree to which social roles are fulfilled.¹ As ideal participation is so individualized and affected by personal and environmental factors,² to date we still have not reached consensus on what the gold standard is for measuring participation outcome. Currently, two participation measures are commonly used in traumatic brain injury (TBI): the Participation Assessment with Recombined Tools-Objective (PART-O),¹ and the Community Reintegration for Injured Service Members (CRIS).³ The PART-O is recommended as a common data element by National Institute of Neurological Disorders and Stroke (NINDS), used in the National TBI Model Systems and recently adopted by VA TBI Model Systems. The CRIS was specifically developed for service members using the 9 activity and participation chapters of the ICF. Wen and Colleague (2018) compared the psychometric properties of the PART-O and the CRIS in veterans with mild TBI and found that the CRIS showed superior psychometric properties than the PART-O in veterans.⁴ However, no study has assessed the psychometric properties of the CRIS against the PART-O in civilians. The purposes of this study was to evaluate the convergent and discriminate validity of these two instruments in civilians with TBI. The findings can help clinicians select a psychometric sound instrument to identify those with reintegration challenges.

DESIGN: This is an observational, cross-sectional quantitative study. Participants: We recruited civilians with TBI (n=54) through a local hospital and several local support groups. A control sample, people without TBI (n=46), based on matched design (matching age, gender and education) was recruited via word of mouth. Inclusion criteria for civilians with TBI were: diagnosed with TBI for > 6 months, 18 – 89 years old, able to speak and read English, no other neurological diseases and able to consent. Inclusion criteria for control sample were the same expect for no medical history of TBI.

METHOD: The PART-O contains 17 items and 3 domains: productivity, social relations and out and about. The CRIS measures 3 aspects of participation: extent of participation, perceived limitation and satisfaction with about 50 items per aspect. The 36-Item Short Form Health Survey (SF-36) consists of physical and mental domains and 8 scales. Analysis: We compared discriminate validity using the independent t-tests. The Pearson correlation coefficients were used for convergent validity.

RESULTS: Discriminant validity: Two groups were significantly different on only the productivity domain and the average total scores of the PART-O (p<0.01). In contrast, two groups were significantly different on all three domains of the CRIS (p<0.01). Convergent validity: productivity domain scores and average total scores of the PART-O significantly correlated with the physical and mental component of SF-36 (0.24-0.44). All 3 domains of the CRIS significantly correlated with the physical and mental component of SF-36 (0.60-0.70).

CONCLUSION: We found that the convergent and discriminant validity of the PART-O were not optimal. The CRIS, although not developed for civilians, showed superior construct validity. As more occupational therapists work with people with chronic diseases in community settings, occupational therapists need to know which assessment can better identify those with reintegration challenges and capture the outcome in participation. This study provided the critical information for instrument selection when measuring participation in civilians with TBI.

References

1. Whiteneck, G., Dijkers, M., Heinemann, A., Bogner, J., Bushnik, T., Cicerone, K., . . . Millis, S. (2011). Development of the Participation Assessment With Recombined Tools–Objective for Use After Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation., 92(4), 542-551.

2. Bogner, J., Whiteneck, G., Corrigan, J., Lai, J., Dijkers, M., & Heinemann, A. (2011). Comparison of Scoring Methods for the Participation Assessment With Recombined Tools–Objective. Archives of Physical Medicine and Rehabilitation., 92(4), 552-563.

3. Resnik L., Gray M., Borgia M.L. (2011) Measurement of community reintegration in sample of severely wounded servicemembers. Journal of Rehabilitation Research and Development., 48(2),89-101.

4. Wen, P., Waid-Ebbs, J., Graham, D., & Helmer, D. (2018). Psychometric Properties of 2 Participation Measures in Veterans With Mild Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation., 99(2), S86-S93.