Real-time measurement of daily participation in adults with TBI using EMA

Traumatic brain injury (TBI) reduces productivity, social participation, and life satisfaction. Ecological Momentary Assessment (EMA), which captures real-time experiences, may have advantages over traditional retrospective self-report measures.

Thirty-four adults with moderate-to-severe TBI completed smartphone-based EMA surveys (5x/day for 4 weeks). EMA-derived variables indexed the proportion of prompts participants were home, alone, or engaged in productive or social activities. Retrospective measures (Participation Assessment with Recombined Tools-Objective [PART-O] and Satisfaction With Life Scale [SWLS]) were collected at baseline and 4 weeks later. We used Linear Mixed Effects Models to examine associations between EMA indicators and outcomes.

We did not observe a significant linear change in PART-O and SWLS scores; however, EMA-derived participation indicators demonstrated marked day-to-day variability, and were associated with PART-O scores-greater EMA-reported time engaged in productive activities with higher PART-O Summary, Productivity, and Social; greater EMA-reported time at home with lower PART-O Productivity; and greater EMA-reported time alone with lower PART-O Summary. No EMA indicators were significantly associated with SWLS.

EMA-derived measures revealed substantial within and between-person variability, the latter of which was associated with scores on traditional participation measures, supporting the potential of EMA as a measure of participation patterns after TBI.