Environmental Factors Item Development for Persons With Stroke, Traumatic Brain Injury, and Spinal Cord Injury

Abstract

Objectives To describe methods used in operationalizing environmental factors; to describe the results of a research project to develop measures of environmental factors that affect participation; and to define an initial item set of facilitators and barriers to participation after stroke, traumatic brain injury, and spinal cord injury. Design Instrument development included an extensive literature review, item classification and selection, item writing, and cognitive testing following the approach of the Patient-Reported Outcomes Measurement Information System. Setting Community. Participants Content area and outcome measurement experts (n=10) contributed to instrument development; individuals (n=200) with the target conditions participated in focus groups and in cognitive testing (n=15). Interventions None. Main Outcome Measures Environmental factor items were categorized in 6 domains: assistive technology; built and natural environment; social environment; services, systems, and policies; access to information and technology; and economic quality of life. Results We binned 2273 items across the 6 domains, winnowed this pool to 291 items for cognitive testing, and recommended 274 items for pilot data collection. Conclusions Five of the 6 domains correspond closely to the International Classification of Functioning, Disability and Health taxonomy of environmental factors; the sixth domain, economic quality of life, reflects an important construct that reflects financial resources that affect participation. Testing with a new and larger sample is underway to evaluate reliability, validity, and sensitivity.

Development of Self-Report Measures of Social Attitudes That Act As Environmental Barriers and Facilitators for People With Disabilities

“…The parent project 15 developed an overarching EF conceptual framework that includes six domains: assistive technology; built and natural environment; social environment; services, systems, and policies; access to information and technology; and economic quality of life. The efforts of the Social Environment Workgroup, including a multi-step qualitative item review process and field test, are described below.…”

“…15,21 An interdisciplinary expert panel then completed domain identification so that all candidate items were assigned to domains within the conceptual framework. 15 The Social Environment Workgroup—consisting of psychologists, occupational therapists, and disability and health outcomes researchers—assigned items to conceptual groups informed by both theory and item content. The Workgroup then examined the items for redundancy, content coverage and representativeness; doing so allowed for both the writing of new items to fill content gaps and winnowing down the pool to a representative set of items.…”

“…12,14,15 For example, the Craig Hospital Inventory of Environmental Factors (CHIEF) includes only 3 attitude items as part of a 25-item global assessment of environmental factors. 16 …”

“…This work was accomplished as part of a larger study aimed at developing a comprehensive set of self-report EF measures, including item banks, for use with people with spinal cord injury (SCI), traumatic brain injury (TBI) or stroke. 15 An item bank is a set of items that are representative of the spectrum of a common trait (e.g., social attitudes) and are calibrated on the same measurement scale using item response theory or Rasch model approaches, thus simplifying scoring and interpretation. 17-20 An advantage of item banking is that it allows for brief-but-comprehensive assessment.…”

Measuring Environmental Factors: Unique and Overlapping International Classification of Functioning, Disability and Health Coverage of 5 Instruments

“…18 We used 83 qualitative methods including focus groups and cognitive interviews to develop a conceptual framework 84 and to verify item meaning from the perspectives of people with disabilities. EFIB's item banks assess (1) 85…”