Brain injury functional outcome measure (BI-FOM): A single instrument capturing the range of recovery in moderate-severe traumatic brain injury

Model System:

TBI

Reference Type:

Journal article

Accession No.:

J85524

Journal:

Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

2021 , 102, 1, 87-96

Publication Website:

Abstract:

Study developed a measure of global functioning after moderate-to-severe traumatic brain injury (TBI) with similar measurement precision but a longer measurement range than the Functional Independence Measure (FIM). The study was conducted in 2 phases by 6 centers participating in the TBI Model Systems program. Phase 1 involved retrospective analysis of 5 data sets containing the FIM, Disability Rating Scale, and other assessment items to identify candidate items for extending the measurement range of the FIM. Phase 2 involved prospective administration of 49 candidate items from phase 1, with Rasch analysis to identify a unidimensional scale with an extended range. Participants were administered the 49 assessment items in person or via telephone. Data were obtained from 184 individuals with moderate-severe injury who were recruited during inpatient rehabilitation or at 1-year telephone follow-up. Item response theory parameters (item monotonicity, infit/outfit statistics, and Factor 1 variance) were applied to the data. After collapsing misordered rating categories and removing misfitting items, we derived the Brain Injury Functional Outcome Measure (BI-FOM), a 31-item assessment instrument with high reliability, greatly extended measurement range, and improved unidimensionality compared with the FIM. The BI-FOM improves global measurement of function after moderate-severe brain injury. Its high precision, relative lack of floor and ceiling effects, and feasibility for telephone follow-up, if replicated in an independent sample, are substantial advantages.

Author(s):