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Rasch Analysis of Postconcussive Symptoms: Development of Crosswalks and the Brain Injury Symptom Scale
Leia Vos1, Gale G Whiteneck2, Esther Ngan3
1TIRR Memorial Hermann, Brain Injury Research Center, Houston, TX; Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, TX; Zabolocki VA Medical Center, Milwaukee, WI.
Objective:
The first aim of this study was to develop a Rasch-based crosswalk between 2 postconcussive symptom measures, the Neurobehavioral Symptom Inventory (NSI) and the Rivermead Postconcussive Symptom Questionnaire (RPQ). The second goal was to utilize Rasch analysis to formulate a new proposed scale containing the best theoretical and psychometric items.
Design:
Prospective cohort observational study.
Setting:
Three acute inpatient rehabilitation hospitals in the United States.
Participants:
Community-dwelling persons (N=497) who were previously hospitalized and were diagnosed with mild to severe traumatic brain injury. Participants were (1) 18-64 years old; (2) could give informed consent; (3) able to complete study measures in English; (4) did not have an interfering medical or psychiatric condition.
Interventions:
Not applicable.
Main Outcome Measures:
NSI, RPQ.
Results:
Rasch analysis revealed 4 subdimensions across the 2 scales: cognitive, affective, physical, and visual. Crosswalk tables were generated for the first 3. Visual items were too few to generate a crosswalk. Iterative Rasch analysis produced a new scale with items rated from none to severe including the best items in each of these dimensions.
Conclusions:
The NSI and RPQ have considerable overlap and measure the same overarching constructs. Crosswalk tables may be helpful for clinicians and researchers to convert scores from 1 measure to the other. A more psychometrically sound scale, the Brain Injury Symptom Scale, composed of items from the NSI and RPQ, is proposed and will need further validation.
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