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Agreement between persons with traumatic brain injury and their relatives regarding psychosocial outcome using the
A M Sander1, R T Seel, J S Kreutzer
1Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond 23298-0542, USA.
Objective:
To extend psychometric research on the Community Integration Questionnaire (CIQ) by comparing patients' reports with those of family members.
Design:
Reports on community integration were obtained from family members and patients 1 year after brain injury. Kappa reliability coefficients were used to examine agreement for individual items on the questionnaire. Total scores for the three CIQ scales were compared between groups using independent samples t tests.
Setting:
Outpatient clinics affiliated with the four NIDRR traumatic brain injury Model System rehabilitation centers.
Participants:
CIQ data were obtained for 259 adult patients with traumatic brain injury. For 122 cases, patients and family members provided corresponding data. In 101 cases, only self-reported data were available. In 36 cases, information was provided solely by family members. All patients received inpatient rehabilitation and were at least 16 years of age. The full range of brain injury severity was represented.
Main Outcome Measure:
The 15-item CIQ, comprised of three scales, Home Integration, Productive Activity, and Social Integration.
Results:
Analysis of kappa values found "moderate" to "almost perfect" agreement levels for all 15 items. Almost-perfect ratings were found for three of the four items on the Productive Activity Scale. Comparisons were made between scale scores derived from patients and families. The Home Integration scale showed differences, with patient scores higher than those reported by family members (t = 3.51, p < .01). However, the difference in scores was attributable to small discrepancies on two items and was not considered clinically meaningful. The Total CIQ score also showed a difference, with patients reporting significantly higher levels of integration relative to family members (t = 2.30, p < .05). This difference was also attributable to discrepancies on two items of the Home Integration Scale.
Conclusions:
The results have important implications for researchers who may be limited to one source of data. The hypothesis that patients and family members have very different perspectives of patients' community activities was not supported. Rather, similar ratings of individual activities were given with two exceptions, meal preparation and housekeeping. More research is needed to delineate relationships between agreement ratings and outcome categories.