Psychometric Properties of Two Participation Measures in Veterans with Mild Traumatic Brain Injury

Abstract Objective To compare the psychometric properties of two commonly used participation measures: the Community Reintegration of Service Members (CRIS) and the Participation Assessment with Recombined Tools-Objective (PART-O) in Veterans with mild traumatic brain injury (mTBI). Design The data were collected from two cross-sectional observation studies conducted in two Veterans Affairs medical centers. Setting Questionnaires were completed in-person or by mail. Participants Veterans with mild TBI were recruited from the Michael E. DeBakey Veterans Affairs Medical Center in Houston (N=94) and the Malcom Randall North Florida/South Georgia Veterans Health System (N=107). Interventions Not applicable. Main Outcome Measures: CRIS and PART-O. Results We conducted Rasch analysis on the PART-O and on three subscales of the CRIS (Extent of Participation, Perceived Limitation, and Satisfaction). For PART-O, results showed PART-O has questionable unidimensionality. For both instruments, some rating categories were under used and rating scales did not advance accordingly. Compared with PART-O, the CRIS was able to distinguish more categories of a person’s ability (>5 vs 2 by PART-O ) and had better internal consistency as indicated by higher Cronbach’s Alpha (0.96-0.98vs 0.65 for PART-O). Conclusions To capture participation unique to Veterans with mTBI, CRIS has greater potential to detect a change in participation and is therefore recommended over PART-O. Rating scales of both instruments, however, need further refinement. We suggest future studies examine collapsed rating categories and use qualitative methods to redefine categories.