17. Assessment of Outcomes Following Acquired Brain Injury
|ABI||Acquired Brain Injury|
|ABS||Agitated Behavior Scale|
|ADL||Activities of Daily Living|
|BBS||Berg Balance Scale|
|BDI||Beck Depression Inventory|
|CBMS||Community Balance and Mobility Scale|
|CHART||Craig Handicap Assessment and Reporting Technique|
|CIQ||Community Integration Questionnaire|
|DRS||Disability Rating Scale|
|FAM||Functional Assessment Measure|
|FIM||Functional Independence Measure|
|FSS||Fatigue Severity Scale|
|GCS||Glasgow Coma Scale|
|GOS||Glasgow Outcome Scale|
|GOSE||Glasgow Outcome Scale – Extended|
|GOAT||Galveston Orientation and Amnesia Test|
|HADS||Hospital Anxiety and Depression Scale|
|HRQoL||Health-Related Quality of Life|
|ICC||Intra-Class Correlation Coefficient|
|LCFS||Rancho Los Amigos Levels of Cognitive Functioning Scale|
|LHS||London Handicap Scale|
|MADRS||Montgomery-Asberg Depression Rating Scale|
|MCS||Mental Component Scale of the Medical Outcomes Survey SF-36|
|MFIS||Modified Fatigue Impact Scale|
|MMSE||Mini Mental State Examination|
|MOS SF-36||Medical Outcome Survey Short Form 36|
|3MS||Modified Mini Mental State Examination|
|MPAI||Mayo Portland Adaptability Inventory|
|NFI||Neurobehavioural Functioning Inventory|
|OPCS||The Office of Population Consensus and Survey|
|PCS||Physical Component Scale|
|PTA||Post Traumatic Amnesia|
|QOLIBRI||Quality of Life After Brain Injury|
|SWLS||Satisfaction With Life Scale|
|TBI||Traumatic Brain Injury|
|WAIS||Wechsler Adult Intelligence Scale|
No Key Points in this Module
The following chapter is a review of measurement tools used to assess individuals after a brain injury. The list of tools appearing here was derived by a consensus of experts working on the Evidence-Based Review of Acquired Brain Injury (ABI) literature.
The tools were chosen based on a 3-step process. The first was the development of an inventory of current outcome measures based on both the literature and discussions held with rehabilitation team members who actually use the tools. The second was a consensus agreement among a panel of experts as to which tools are most important. Finally, there had to be sufficient research on the outcome measure in ABI populations to allow a meaningful analysis of the psychometric qualities of the tools. Those outcome measures that made it through this process were selected for review. An exhaustive list of outcome tools is not listed here as there are over 700 measures related to function following TBI (Tate et al., 2013).
17.1.1 Evaluation Criteria for Outcome Measures
It is necessary to have a set of criteria to guide the selection of outcomes measures. Reliability, validity and responsiveness have widespread use and are discussed as being essential to the evaluation of outcome measures (Duncan et al., 2002; Law, 2002; Roberts & Counsell, 1998; van der Putten et al., 1999). Finch et al. (2002) provide a good tutorial on issues for outcome measure selection.
The Health Technology Assessment programme (Fitzpatrick et al., 1998) examined 413 articles focusing on methodological aspects of the use and development of patient-based outcome measures. In their report, they recommend the use of eight evaluation criteria (Table 17.2). These criteria, including some additional considerations described below, were applied to each of the outcome measures reviewed in this chapter.
17.2 Agitated Behavior Scale
This scale was designed to be used specifically with those who had sustained a TBI (Corrigan, 1989). The ABS has also been tested with a group of individuals living in a long term care facility and has demonstrated strong internal consistency and inter-rater reliability (Bogner et al., 1999). Bogner et al. (2001) found that there was a strong relationship between cognition and agitation. Higher scores on the MMSE and the Functional Independence Measure (FIM) cognitive subscales were significantly related to lower scores on the ABS (Bogner et al., 2001; Corrigan & Bogner, 1994). Administering the scale requires little time and can be completed in less than 30 minutes. Agitation is considered to be present if the score is >21 (Corrigan & Bogner, 1995). The scale is free of cost and readily available at www.tbims.org/combi/abs/abs.pdf.
The ABS has yet to be validated throughout a wider range of rehabilitation facilities (Corrigan & Bogner, 1995). As well, one of the more significant limitations of the ABI is the risk of over-diagnosing agitation (Corrigan & Mysiw, 1988).
- Interpretability: Scores on the ABS are easy to interpret: severely agitated ≥36, moderately agitated 29-35, mildly agitated 22-28, and not agitated <22 (Bogner et al., 2000).
- Acceptability: The scale is available free of charge and requires little time for training and administration.
- Feasibility: The ABS requires little time to complete and can be completed by all health professionals working with the patient.
17.3 Berg Balance Scale
The scale consists of 14 items requiring subjects to maintain positions or complete movement tasks of varying levels of difficulty. All items on the test are common to everyday life. Administration of the scale requires a ruler, stopwatch, chair, step or stool, space to turn 360° and 10-15 minutes. It is administered via direct observation of task completion and items are scored 0-4 based on the ability of the individual to meet the specific time and distance requirements of the test (Berg et al., 1995; Juneja et al., 1998). A score of zero represents the inability to complete the item and a score of 4 represents the ability to complete the task independently. It is generally accepted that total scores below 45 indicate balance impairment (Berg et al., 1992b; Zwick et al., 2000). Despite the use of this scale, all but one study (Feld et al., 2001) examined psychometric properties among a stroke or older adult population. Therefore, caution is advised when making generalizations to an ABI population.
The BBS has been thoroughly evaluated for use among populations of individuals who have experienced stroke. At present, information regarding the reliability and validity of the BBS when used among patients with TBI/ABI is severely limited.
No common interpretation exists for BBS scores, their relationship to mobility status, and the use of mobility aides (Wee et al., 2003). The rating scales associated with each item, while numerically identical, have different operational definitions for each number or score. A score of 2, for example, is defined differently and has a different associated level of difficulty from item to item (Kornetti et al., 2004). There is also no common score associated with successful item completion (Kornetti et al., 2004). Use of an overall score that adds ratings with different meanings having no common reference point may not be appropriate as interpretation is difficult and very little functional information is provided about the individual patient (Kornetti et al., 2004). The BBS requires a minimal detectable change of 6 points at a 90% confidence interval (Stevenson, 2001).
A recent Rasch analysis of the BBS revealed that some item ratings were not used at all or were underutilized, and others were unable to distinguish between individuals with different levels of ability (Kornetti et al., 2004). Collapsing rating scales to eliminate infrequently endorsed categories and creating a common pass/fail point for each item resulted in changes to the ordering of item difficulty, reduced tendencies for ceiling effects and an improved functional definition of the 45/56 cut-off point (Kornetti et al., 2004).
Summary-Berg Balance Scale
- Interpretability: There are no common standards for the interpretation of BBS scores, though there is an accepted cut-off point for the presence of balance impairment.
- Acceptability: This direct observation test would not be suited for severely affected patients as it assesses only one item relative to balance while sitting. Active individuals would find it too simple. The scale is not suited for use by proxy.
Feasibility: The BBS requires no specialized training to administer and relatively little equipment or space.
17.4 Community Balance and Mobility Scale
The CBMS is a measure developed specifically for use in assessment of individuals who have sustained mild to moderate TBI. It may have increased sensitivity to change when used within this population when compared to more established measures such as the Berg Balance Scale (Inness et al., 2011).
The scale may be assessing a construct more similar to “dynamic mobility” rather than balance per se (Inness et al., 2011). The information available in the literature with regard to the reliability, validity or practical application of this scale is extremely limited and arises from the original authors only. Additional evaluation of the CBMS’ psychometric properties is required. The CBMS is not appropriate for use on individuals with severe ABIs in which ambulation is affected because the CBMS was developed for people who are ambulatory (Innes et al. 1999).
Summary-Community Balance and Mobility Scale
- Interpretability: Not enough information available.
- Acceptability: Not enough information available.
- Feasibility: Not enough information available.
17.5 Community Integration Questionnaire
The CIQ assesses handicap, which is viewed by the scale authors as the opposite of integration in three domains: home Integration (i.e. active participation in the operation of the home or household), social Integration (i.e. participation in social activities outside the home) and productivity (i.e. regular performance of work, school and/or volunteer activities) (Willer et al., 1993). The scale is comprised of 15 items in three corresponding subscales each of which has a different number of items and sub-scores (Sander et al., 1999; Willer et al., 1994). The Home Integration subscale consists of 5 items each scored on a scale from 0-2, where 2 represents the greatest degree of integration. The Social Integration subscale is comprised of 6 items rated in the same manner as Home Integration whereas the Productivity subscale consists of 4 questions with responses weighted to provide a total of 7 points. Scores from each of the subscales are summed to provide an overall CIQ score. The maximum possible score is 29, which reflects complete community integration (K. Hall et al., 1996a).
The CIQ may be completed individually, face-to-face, or through telephone interviews (K. Hall et al., 1996a). If the individual with TBI is unable to complete the assessment, the questionnaire may be completed by proxy (Willer et al., 1994). There are two versions of the questionnaire available, one for completion by the person with TBI and one for completion by a suitable proxy (family member, close friend, significant other) (Sander et al., 1999). The CIQ requires approximately 15 minutes to complete (K. Hall et al., 1996a; Zhang et al., 2002).
The CIQ has become one of the most widely used tools in the assessment of community integration for people who have experienced TBI. The scale was originally developed via an expert panel that included individuals with TBI, suggesting that items have face validity (Willer et al., 1994; Willer et al., 1993). The scale can be completed quickly and easily by most individuals with TBI or by an appropriate proxy. The scale focuses more on behaviour than emotional states, which promotes better agreement between patient and proxy ratings (Cusick et al., 2000; Dijkers, 1997).
While the CIQ was developed to assess handicap (as defined by WHO under the International Classification of Impairments, Disabilities and Handicaps), the CIQ does not appear to assess all of the domains included in the definition (Dijkers, 1997). Under the current definitions provided by the International Classification of Functioning, Disability and Health (WHO, 2001), CIQ items may reflect activities more than participation (Kuipers et al., 2004). The reduction of items from 47 to 15 based on factor analysis excluded items not loading onto one of the three predetermined factors that might have provided a more comprehensive assessment of handicap and/or participation. It should be noted that the factor analysis used to eliminate scale items was based on scale scores from an extremely small sample (n=49) of individuals with severe TBI (Dijkers, 1997; Willer et al., 1993). Lequerica et al. (2013) discovered that the CIQ is most effective when used to assess Caucasians in comparison to Black and Hispanic populations.
The CIQ does not measure integration skills, the success of integration activities from the point of view of the individual with TBI, nor the feelings or meaning associated with integration activities (Willer et al., 1993; Zhang et al., 2002). What the CIQ measures appears to be somewhat inconsistent. Some items measure the frequency with which activities are performed, while others measure the assistance or supervision required in order to perform an activity (Dijkers, 1997; Zhang et al., 2002). In addition, the CIQ social integration subscale does not relate to other measures of social integration in the expected way. The CIQ social integration subscale appears inconsistently related to the CHART social interaction subscale (Willer et al., 1993; Zhang et al., 2002) and only weakly related to the FIM social interaction item (Sander et al., 1999). It has been suggested that all three may be measuring slightly different constructs. The FIM examines appropriateness of interaction while CHART assesses the size and composition of social networks. The CIQ does not assess either of these aspects of social integration (Sander et al., 1999).
Age, gender and level of education have all been reported to have an effect on CIQ scores. Dijkers (1997) reviewed four studies that reported the effects of age and it generally appeared as though scores for women indicated greater integration into the home, while male scores typically suggested more integration into the productivity domain. Kaplan (2001) demonstrated similar effects of gender around home integration in a sample of individuals with malignant brain tumours. It has been suggested that a lack of more traditional, male household tasks may account for some of the reported differences in home integration (Dijkers 1997). The CIQ separates the activities of running a household from other productive activity. Therefore it may penalize individuals who were and continue to be homemakers. It may also penalize those individuals with family members who have always shared in home-making activities (Kaplan, 2001). It has been suggested that this bias could be ameliorated by conducting a retrospective, pre-morbid assessment to provide a basis for comparison (Sander et al. 1999).
In his 1997 review, (Dijkers) reported a tendency for younger age to be associated with greater integration on the CIQ. Kaplan (2001) reported that older age was significantly related to poorer community integration both for the total CIQ and for each subscale. In addition to age and gender, amount of education appears to have an effect on community integration as assessed by the CIQ. More education is associated with better integration in all three dimensions ((Heinemann & Whiteneck, 1995; Kaplan, 2001). Gender roles, age and education differences all impact the CIQ differently. These differences need to be reflected in the scale through the development of age-appropriate norms stratified by education, gender and marital status (Dijkers, 1997; Kaplan, 2001; Sander et al., 1999).
In an assessment of the factor structure and validity of the CIQ, Sander et al. (1999)Sander et al. (1999) identified two items that appeared problematic. It was recommended that the childcare item and the frequency of shopping item both be removed. The childcare item is frequently not applicable and appears to penalize people who have no children in the home while the shopping item loaded significantly on two of the three identified factors and did not contribute any unique information to the sale (Sander et al. 1999).
Summary-Community Integration Questionnaire
- Interpretability: The CIQ is widely used. However, no norms are currently available. There is no basis for determining that an individual’s level of integration on the CIQ is or is not normal (Dijkers, 1997).
- Acceptability: The scale is short and simple and represents little patient burden. It has been used successfully with proxy respondents.
- Feasibility: No special training is required to administer the CIQ. The scale is free, but should be requested from the scale author. It has been used in longitudinal studies to show change over time.
17.6 Disability Rating Scale
The DRS is comprised of eight items in four categories: i) level of consciousness; ii) cognitive abilities; iii) dependence on others; and iv) employability (Rappaport et al., 1982). Each item has its own rating scale ranging from 0-3 to 0-5 and are either in ½-point or 1-point increments. Rating forms are available for download at http://tbims.org/combi/drs/drsrat.htm. The total or composite score is calculated by summing the ratings for all 8 items, so that lower scores are associated with less disability. The overall score can be used to assign the individual to one of 10 disability outcome categories ranging from no disability (DRS score=0) to extreme vegetative state (DRS score=29) and death (DRS=30) ((Fleming & Maas, 1994; K. M. Hall et al., 1996)
The DRS is available at no cost and is free to copy. It may be downloaded from http://tbims.org/combi. Training materials are also provided on the same website and a training video is available for a modest fee. Administration of the scale may be via direct observation or interview(Hall et al., 1993) (Hall et al., 1993). When necessary, collateral sources of information may be used to complete the ratings (Rappaport et al., 1982). The DRS is simple to administer and requires approximately 5 minutes to complete (Hall et al., 1993; Hall, 1997).
The DRS is a single assessment comprised of items spanning all major dimensions of impairment, disability and handicap (K. Hall et al., 1996b; Rappaport et al., 1982). It is a brief and simple tool that allows for the ongoing assessment of recovery from injury to community re-integration. In addition, the ability to assign scores to outcome category with relatively little loss of information (Gouvier et al., 1987) provides a quick snapshot of the individual’s overall disability status (Hall et al., 1993). The DRS appears to be more reliable and valid than the Level of Cognitive Functioning Scale (LCFS) and may be more sensitive to change than categorical rankings such as the Glasgow Outcome Scale (GOS) (Hall et al., 1985). In addition, Glasgow Coma scores can be obtained from the DRS (Hall, 1997).
Descriptions of what corresponds to successful item performance at each rating level are not precise and subscales do not clearly identify areas for intervention (Brazil, 1992). The sequelae of head injury that are included for assessment are limited and do not include formal cognitive assessment (Brazil, 1992). The DRS assesses only general rather than specific function or functional change (Hall & Johnston, 1994). It may be most useful as a means to characterize sample severity and provide the means for comparison to other groups, but it is not particularly sensitive to the effects of treatments designed to ameliorate specific functional limitations or social participation (Hall et al., 1993). In inpatient rehabilitation settings, the FIM is a more sensitive instrument with which to monitor change (Hall & Johnston, 1994).
The DRS is not well suited to patients with mild TBI or very severe impairments (Hall et al., 1993; K. Hall et al., 1996b; Wilson et al., 2000). It has been recommended that ½ point scoring increments rather than whole points should be employed in order to increase the precision and sensitivity of the instrument when assessing higher functioning individuals (Hall et al., 1993). When subjects do not fit whole-point definitions for cognitive ability for self-care items, dependence on others and employability, ½ points can be awarded; total scores with ½ points are rounded down for the purposes of assignment to outcome category (Hammond et al., 2001). The rating form available for download has included the ½ point scoring option. When using the ½ point scoring option, the DRS does appear to be sensitive to change between discharge and one-year and even 5-year follow-ups. However, year-by-year change is not captured by DRS ratings more than one year post-injury (Hammond et al., 2001).
- Interpretability: The DRS is widely used and is part of the TBI Model Systems Database. It provides a quick, accessible snapshot of outcomes of disability in terms of general function.
- Acceptability: The simplicity and brevity associated with the DRS would suggest little to no patient burden associated with its administration. Ratings provided by family members are strongly correlated with those completed by healthcare team members.
- Feasibility: The DRS is free to use and copy. Training materials are also provided free of charge and a training video is available for a modest fee. The DRS seems to be able to detect significant change over time and may be well suited for group comparisons.
17.7 Fatigue Severity Scale
Fatigue Severity Scale (FSS) is a self-report questionnaire designed to assess disabling fatigue in all individuals (Krupp et al., 1989). The scale was designed to investigate fatigue/function measures, that is, the connection between fatigue intensity and functional disability (Dittner et al., 2004; Taylor et al., 2000).The FSS, which consists of nine questions, uses a 7-point Likert scale ranging from strongly disagrees to strongly agree (see below). The scores from each question are totalled with lower scores indicating less fatigue in everyday life. The total score for the FSS is calculated as the average of the individual item responses. Although the FSS was originally designed to assess fatigue in individuals with multiple sclerosis, it has been found to be sensitive to fatigue in those with a TBI (Ziino & Ponsford, 2005).
The FSS scale is a self-report scale that is easy to administer and can be completed quickly with minimal effort (Burger et al., 2010; LaChapelle & Finlayson, 1998). The scale can be accessed and downloaded for free from www.saintalphonsus.org/documents/boise/sleep-Fatigue-Severity-Scale.pdf.
Although the overall score of the FSS is beneficial in comparing between groups, the individual questions are not able to do so (LaChapelle & Finlayson, 1998). Because no two fatigue scales measure the same construct, it is strongly recommended that the user understand what aspect of fatigue they want to assess and why, whether or not a unidimensional or multidimensional scale should be used, and whether the scale would be beneficial to the population of interest (Dittner et al., 2004). Another major concern with the scale is the use of a 7-point Likert scale (completely disagree to completely agree). It is believed that ≥6 categories on any rating scale obscures the distinction between the categories. The collapsing of the options to three (i.e., disagree, neutral, agree) may improve the measure (Burger et al., 2010). The FSS has not been found to be a good instrument for measuring cognitive levels of fatigue (Amtmann et al., 2012).
- Interpretability: The FSS has been shown to be a valid and reliable scale for several populations including the ABI population (Ziino & Ponsford, 2005). Regardless, the scores on the FSS are easy to interpret and are used to assess patients for fatigue post injury. Items on the scale can be open to interpretation as the word fatigue may mean something different to each individual (Burger et al., 2010).
- Acceptability: The scale has been shown to be both valid and reliable with a variety of populations. It has been shown to have good internal consistency and is sensitive to change in fatigue levels over time.
- Feasibility: The FSS is a self-administered scale that does not require any training to use and is available in several languages.
17.8 Functional Independence Measure
The FIM is a composite measure consisting of 18 items assessing six areas of function (i.e. self-care, sphincter control, mobility, locomotion, communication and social cognition). These fall into two basic domains: 1) physical (13 items) and 2) cognitive (5 items). The 13 physical items are based on those found on the Barthel Index (BI), while the cognitive items are intended to assess social interaction, problem-solving and memory. The physical items are collectively referred to as the motor-FIM while the remaining 5 items are referred to as the cognitive-FIM. The scale has not been found to fit with the Rasch model with MS patients (Mills et al., 2009).
Each item is scored on a 7-point Likert scale indicative of the amount of assistance required to perform each item (1=total assistance, 7=total independence). A simple summed score of 18-126 is obtained where 18 represents complete dependence/total assistance and 126 represents complete independence. Subscale scores for the physical and cognitive domains may also be used and may yield more useful information than combining them into a single FIM score (Linacre et al., 1994).
Administration of the FIM requires training and certification. The most common approach to administration is direct observation and the FIM takes approximately 30 minutes to administer and score. The developers of the FIM further recommend that the rating be derived by consensus opinion of a multi-disciplinary team after a period of observation.
The FIM is a widely used, well-accepted, generic measure of burden of care used in inpatient rehabilitation settings. In clinical assessment, the greater number of items and wider choice of responses per item may yield more detailed information on an individual basis than assessments, such as the Barthel Index, with fewer items and response options (Hobart et al., 2001).
The reliability of the FIM is dependent upon the individual conducting the assessment. Training and education in administration of the test is a pre-requisite for good levels of inter-rater reliability (Cavanagh et al., 2000) (stroke). Length of time and amount of training required to arrive at a consensus score, as recommended by the developers of the FIM, may have significant implications for the practical application of the FIM in clinical practice.
The use of a single summed raw score may be misleading as it gives the appearance of a continuous scale. Steps between scores, however, are not equal in terms of level of difficulty and cannot provide more than ordinal level information (Linacre et al., 1994). Kidd et al. (1995) (varying etiologies) suggested that one may use the summed scores as though on an interval level scale while the individual items remain ordinal.
Kidd et al. (1995) suggest that the inclusion of items related to communication and cognition as well as the ranking of 7 levels of severity for each item make the FIM more sensitive and inclusive. However, the contribution of the cognitive subscale to the scale as a whole is questionable. It has been shown to have less reliability and responsiveness than either the motor FIM or the total FIM (Hobart et al., 2001; Ottenbacher et al., 1996; van der Putten et al., 1999).
In an evaluation of responsiveness, FIM, motor FIM and the BI were all found to have similar effect sizes. The total-FIM was reported to exhibit no ceiling effect, 0% as compared to the BI’s 7% (van der Putten et al., 1999). This would suggest that the FIM might have no real advantage in terms of responsiveness to change despite having more items and a more precise scoring range for each item.
The FIM includes only five items to assess cognition. This limited cognitive assessment may be inadequate for the assessment of individuals who have experienced TBI (Hall & Johnston, 1994). In addition, the FIM is intended to be used in an inpatient rehabilitation setting and is not well suited to ongoing, long-term assessment in community-based settings ((Gurka et al., 1999); TBI).
Summary-Functional Independence Measure
- Interpretability: The FIM has been well studied for its validity and reliability. It is widely used and has one scoring system, increasing the opportunity for comparison. It is important to remember when interpreting FIM scores that it is an ordinal level scale, not continuous.
- Acceptability: Multiple modes in which this measure could be administration have been assessed, including through telephone interviews. The FIM has also been studied for use by proxy respondent.
- Feasibility: Training and education of persons to administer the FIM, in addition to the price of the scale itself, may represent significant cost. Use of interview formats may make the FIM more feasible for longitudinal assessment.
17.9 Functional Assessment Measure
The 12 FAM items include swallowing, car transfer, community access, reading, writing, speech intelligibility, emotional status, adjustment to limitations, employability, orientation, attention, and safety judgement. Each item is rated using the same 7-point scale used on the FIM. Like the FIM, the FIM+FAM also consists of two subscales, one representing physical or motor functioning and one representing cognitive/psychosocial function. The total score for the FIM+FAM is 210, 112 for the motor FIM+FAM and 98 for the cognitive subscale (Gurka et al., 1999). Higher scores signify greater independence.
The FIM must be purchased from UDS and use of the FIM requires training and certification. The FAM items are in the public domain and can be downloaded from http://tbims.org/combi. A FIM+FAM rating form is available along with decision trees, training and testing vignettes specific to the FAM items from the website. The FIM+FAM requires approximately 35 minutes to administer (Hall & Johnston, 1994).
The FIM was intended specifically for assessment during inpatient rehabilitation. The FAM items are better suited to evaluation post discharge from inpatient rehabilitation and may extend the applicability of the scale beyond the timeframe of the original FIM (Gurka et al., 1999). Addition of the FAM items to the FIM appeared to expand the range of abilities assessed (Hall et al., 1993).
Use of the FIM+FAM still requires the use of trained raters who ideally complete ratings after a period of observation and contribute to a team consensus process (Hobart et al., 2001). The use of untrained raters may result in lower scale reliability (Hall et al., 1993).
Many of the FAM items have been identified as difficult to score (adjustment to limitations, emotion, employability, community mobility, safety judgement, attention and speech intelligibility) (Turner-Stokes et al., 1999). Items in the expanded psychosocial/cognitive subscale seem to include more abstract concepts requiring raters to make more subjective assessments than was necessary for the more objective and observable behavioural items included on the original FIM (Hall et al., 1993; McPherson et al., 1996). The abstract nature of items could have a deleterious effect on the reliability of those items (Alcott et al., 1997). Additional training together with more explicit definitions and/or content modification of the most abstract items could assist raters in the provision of reliable evaluations (Alcott et al., 1997; McPherson et al., 1996).
While the FAM items were intended to provide additional assessment of the psychosocial aspects of disability following brain injury (Hall et al., 1993), the validity of the assessment has not been clearly established (Hobart et al., 2001). The psychosocial/cognitive FIM+FAM does not correlate well with measures of handicap, such as the LHS or as strongly as one might expect with the mental component summary of the MOS SF36 (Hobart et al., 2001). Overall, the added length and increased training requirements associated with the FIM+FAM do not seem to offer any substantial advantage over the FIM (Hobart et al., 2001; McPherson & Pentland, 1997). While the FIM+FAM appears to evaluate a somewhat broader range of abilities (Hall et al., 1993), reports of ceiling effects associated with the FIM+FAM are varied and reported effect sizes are approximately the same as those reported for the FIM (Hobart et al., 2001).
- Interpretability: The 18-FIM items are widely used and recognized. However, the FAM items are more difficult to rate reliably and the validity of FAM is not well established.
- Acceptability: Alternate modes of administration have not been examined and FAM items have not been evaluated for use in assessment by proxy.
- Feasibility: The addition of FAM items to the FIM creates a longer assessment requiring the involvement of additional raters in team consensus and more training for these raters. While the FAM items are freely available, use of the FIM items requires purchase of the scale, training and certification.
17.10 Galveston Orientation and Amnesia Test
Assessment consists of 10 items regarding orientation to person (name, address, and birthdate), place (city/town and building they are in) and time (current time, date, month, year & date of hospital admission) as well as memory of events both after and prior to the injury (Bode et al., 2000). Oral questions are posed directly to the patient who may respond either orally or in writing (Jain et al., 2000; Levin et al., 1979). Error points are awarded for each incorrect response, summed and deducted from 100 to arrive at the total score. Both the scale and instructions for assigning error points are available in Levin et al. (1979).
The duration of post traumatic amnesia (PTA) is defined as the period following coma in which the GOAT score is<75 (Levin et al., 1979). PTA is considered to have ended if a score ≥75 is achieved on three consecutive administrations (Novack et al., 2000; Wade, 1992; Zafonte et al., 1997). In the initial standardization study of Levin et al. (1979) using patients with mild head injury as a reference group, it was determined that a score of 75 represented a level achieved by 92% of the standardization group. No patients with mild head injury scored less than 65 on the GOAT. Scores between 66 and 75 are considered borderline-abnormal while scores above 75 fall into the range considered normal within the reference group (Levin et al., 1979; van Baalen et al., 2003).
The GOAT provides an objective rating of early cognitive recovery eliminating the need for sometimes ambiguous terminology used to describe mental status, such as “confused” (Levin et al., 1979). Rasch analysis demonstrated that items on the GOAT represent a wide range of difficulty suggesting that the scale is useful for assessing patients with a wide range of cognitive impairments (Bode et al., 2000).
The standard GOAT response format makes administration difficult with nonverbal patients (Novack et al., 2000). The requirement for oral or written expression may result in penalizing patients who are experiencing deficits of expression but not in orientation or in the retrieval or consolidation of memory (Jain et al., 2000). An aphasia-specific version of the GOAT has been created, although it requires further evaluation.
For items in which partial credit is used, Rasch analysis revealed step disorder (Bode et al., 2000). Collapsing these response categories to a simple dichotomy (right versus wrong) eliminated the disorder and allowed the construction of an equal interval measure from the GOAT (Bode et al., 2000). While the GOAT does contain items intended to provide an assessment of memory, it is primarily a measure of disorientation. Eight of the 10 GOAT items evaluate orientation while only two examine memory (Forrester et al., 1994).
- Interpretability: The GOAT provides an objective assessment with a standardized cut-off for the presence of PTA.
- Acceptability: In its original form, the GOAT is not well suited to the assessment of patients with aphasia.
- Feasibility: The GOAT may be too lengthy for a simple, repeated bedside assessment of mental status. However, it is freely available and can be used by any healthcare professional.
17.11 Glasgow Coma Scale
The GCS is an observer rating scale consisting of 15 items in three basic categories: 1) motor response (6 items), 2) verbal response (5 items), and 3) eye opening (4 items). Points are awarded for the best response in each category and category scores are summed to provide a global GCS score (Sternbach, 2000; Wade, 1992). Total summed scores range from 3 (totally un-responsiveness) to 15 (alert, fully responsive). A total of ≤8 is used to separate coma from non-coma (Wade, 1992).
Additional categorical divisions are used to differentiate patients in terms of initial severity of head injury such that GCS scores 13-15 represent mild injury, scores 9-12 represent moderate injury, and scores ≤8 represent severe injury (Sternbach, 2000). The GCS is freely available, takes approximately 1 minute to administer and can be performed by all medical personnel (Oppenheim & Camins, 1992). The test can be obtained at no cost at ww.trauma.org/archive/scores/gcs.html.
The Glasgow Coma Scale is a simple, straightforward and very brief bedside assessment. It is the most widely used instrument in the assessment of level of consciousness. GCS scores are a significant predictor of outcome following head injury. However, the prognostic value of the GCS is increased by taking other variables into account as well, such as mechanism of injury, age, CT findings, papillary abnormalities and episodes of hypoxia and hypotension (Balestreri et al., 2004; Demetriades et al., 2004; Zafonte et al., 1996).
The GCS is based on the assumption that evaluation of eye opening is sufficient to represent brainstem arousal systems activity. While other assessments have been developed to provide a more comprehensive evaluation of brainstem responses, the resulting tools are substantially more complex than the GCS (Sternbach, 2000).
The GCS has been reported to be reliable when used by various groups of healthcare professionals regardless of the level of education or intensive care unit experience (Juarez & Lyons, 1995). Nurses and general surgeons have been reported to be as consistent in their ratings as neurosurgeons (Teasdale et al., 1978). However, it has also been demonstrated that consistent ratings among inexperienced raters may also be inaccurate. Rowley and Fielding (1991)reported that the percentage agreement between inexperienced individuals and expert raters ranged from 58.3% to 83.3%. Lower levels of accuracy were most notable in the middle ranges of the scale. Training and the implementation of standard assessment procedures are important to maintain both high levels of reliability and accuracy of evaluation. The administration of a painful stimulus appears to be somewhat controversial and there is a great deal of variability in the means and location of its application (Edwards, 2001; Lowry, 1999).
The GCS is most often reported as a single overall score, although the scale authors did not recommend the summary score for use in clinical practice. While the single, global score may be a convenient way to summarize data, the use of a global score may result in a loss of information that adversely affects the predictive accuracy of the GCS (Healey et al., 2003; Teasdale et al., 1983; Teoh et al., 2000). The use of a global summary score assumes that each category is equally weighted (Teasdale et al., 1983). However, it has been reported that motor response has the greatest influence on the summary score and results are skewed toward this component (Bhatty & Kapoor, 1993). Healey et al. (2003) demonstrated that the ability of the GCS score to predict survival was derived mostly from the motor response category. In addition, the summary score represents a potential 120 combinations of scores from the three GCS components collapsed into only 13 possibilities. Different combinations of motor responsiveness, verbal responsiveness and eye-opening may have different associated outcomes. Teoh et al. (2000)reported significant differences in mortality outcomes between 4 of 11 scores with multiple permutations demonstrating that individuals with the same GCS scores in varying permutations can have significantly different risks for mortality.
Perhaps the most frequently encountered limitation of the GCS is untestable components in various patient groups. Pastorek et al. (2004) reported that the ability of the patient to be evaluated on the entire GCS contributed to the prediction of global outcome measures at 6 months (Pastorek et al., 2004). Unfortunately, patients who have been intubated or sedated, those with paralysis or facial swelling, patients with hypotension, hypoxia, alcohol or illicit drug intoxication may not be able to provide responses to all categories of GCS items for reasons unrelated to head trauma (Demetriades et al., 2004; Oppenheim & Camins, 1992; Rutledge et al., 1996). Murray et al. (1999), as cited in Teasdale and Murray (2000)) reported that in a study of head injury patients in European centres, total assessment was possible in 61% of patients before hospital, in 77% on arrival at hospital and in 56% of patients arriving at a neurosurgical unit. It has been suggested that inability to assess using the GCS may reflect the increased and more aggressive use of intubation, ventilation and sedation (Balestreri et al., 2004; Teasdale & Murray, 2000). When the GCS was developed, the initial assessment was to be undertaken approximately 6 hours after injury to allow time for stabilization of systemic problems, but prior to the initiation of interventions such as neuromuscular paralyzing agents or sedatives (Bakay & Ward, 1983; Marion & Carlier, 1994). Increasingly, GCS assessment is performed upon arrival at the Emergency Department and some patients may be already intubated and/or sedated by that time (Marion & Carlier, 1994; Waxman et al., 1991).
- Interpretability: The GCS is the most familiar, most widely-used early assessment of level of consciousness. It has established categories related to the presence of coma and severity of injury.
- Acceptability: A very brief, simple observer rater scale. The application of painful stimulus is controversial. Assessment of all components is compromised by aggressive, early interventions such as intubation and sedation.
- Feasibility: The scale is simple to administer and designed for use by any health profession. Lack of experience and variability in assessment may result in inaccurate assessment. Training and standardized procedures are recommended.
17.12 Glasgow Outcome Scale/Extended Glasgow Coma Scale
Patients are assigned to one of five possible outcome categories: 1) death, 2) persistent vegetative state, 3) severe disability, 4) moderate disability, and 5) good recovery (Jennett & Bond, 1975). In 1981, a revision to the scale was proposed to better classify patients who had regained consciousness (Jennett et al., 1981). In the Extended Glasgow Outcome Scale (GOSE), each of the three categories applicable to conscious patients are subdivided into an upper and lower band resulting in eight possible categories. GOS ratings can be derived from the GOSE by collapsing these subdivisions (Wilson et al., 2000).
The assignment of an individual to an outcome category should be based on the results of a structured interview focused on social and personal functional ability (Jennett et al., 1981). The final rating is based on the lowest category of outcome indication in the interview (Wilson et al., 2000). The GOS and GOSE can be accessed for no cost at
The GOS is the most widely used and accepted measure of outcome following head injury (Wade, 1992). It has been adopted widely for use in clinical trials (Hellawell et al., 2000; Wade, 1992; Wilson et al., 2000). It is a simple, reliable means of describing recovery (Jennett et al., 1981) that is quick to administer, broadly applicable and has clinically relevant categories (Wilson et al., 2000).
Structured interviews and guidelines for their administration are available for the GOS and GOSE (Wilson et al., 1998). Each interview incorporates a way to include information regarding pre-injury status, thereby providing a means for determining the effect of the sequelae of head injury on outcome, separate from the effects of pre-existing conditions or circumstances (Pettigrew et al., 1998; Wilson et al., 1998). While use of the structured interview has increased the reliability of postal and telephone administration, face-to face interview remain the preferred method to determine a GOS rating (Wilson et al., 2002).
The GOS provides an overall assessment of outcome and does not provide detailed information with regard to specific disabilities or handicaps. Categories are broad and the scale does not reflect subtle improvements in functional status of an individual (Pettigrew et al., 1998). Individuals may achieve considerable improvement in ability, but not change outcome category (Brooks et al., 1986). The GOS rating was intended primarily to provide an overall summary of outcome and facilitate comparison not to describe specific areas of dysfunction (Pettigrew et al., 1998). In addition, GOS outcome categories are often expressed as a dichotomy: poor or unfavourable outcome versus independence or favourable outcome. This results in a loss of information and low sensitivity (Teasdale et al., 1998).
Originally, GOS categories were described according to a range of features, but specific criteria were not defined for each of the different outcomes. This lack of clarity may have had a negative impact on scale reliability by introducing an element of subjectivity on the part of the rater (Maas et al., 1983; Teasdale et al., 1998). In addition, attempts to increase the sensitivity of the GOS by subdividing the upper three categories in an upper and lower band was associated with decreased consistency in category assignments (Maas et al., 1983). However, the structured interview and guidelines created by Wilson et al. (1998) have alleviated much of the difficulty surrounding ambiguous assignment criteria.
Summary-Glasgow Outcome Scale
- Interpretability: The GOS is widely used and accepted. The GOS provides an overall assessment suitable for the comparison of outcomes at the group level.
- Acceptability: The brevity and simplicity of the GOS facilitates patient compliance. The GOS has been studied for use by telephone and mail administration. Structured interviews improve the reliability of administration by these methods.
- Feasibility: The GOS can be used by professionals from various backgrounds and does not require any physical, psychiatric or neurologic examination. It is well-suited to busy clinical settings and large scale research trials.
17.13 Hospital Anxiety and Depression Scale
While many measures are used in the TBI population to assess depression and anxiety post injury, unfortunately none of these measures have been evaluated for use with this population (Schonberger & Ponsford, 2010; Whelan-Goodinson et al., 2009). Recently the HADS has been tested with those who have sustained an ABI. However, due to the mixed aetiology problems were found with some of the questions which could be related to the injury itself, the level of cognitive impairment or the decreased speed at which information is processed (Dawkins et al., 2006; Johnston et al., 2000).
The HADS is brief and simple to use and although it was originally designed to be used with hospital populations it has been found to perform well with non-hospital groups (McDowell, 2006). It takes on average 2-5 minutes to complete and is completed by the patients themselves (Snaith, 2003). The HADS requires the individual to respond to the question in relation to how they felt in the past week, so it is reasonable to re-administer the test again but only at weekly intervals. It has been found to perform as well as the Beck Depression Inventory (BDI) and the General Health Questionnaire instruments. Overall, Mykletun et al. (2001)found the HADS scale possessed good “psychometric properties in terms of factor structure, intercorrelation, homogeneity and internal consistency” (p 543).
When using the HADS to diagnosis depression or depressive symptoms post ABI, the sequelae of TBI may confound the test scores (Whelan-Goodinson et al., 2009). Caution is recommended when interpreting the results of these scales. Even though the HADS has been shown to be a reliable measure of emotional distress post ABI, the cut-off scores and categories have not been shown to be useful in predicting probable presence or “caseness” of depression or anxiety (Whelan-Goodinson et al., 2009).
- Interpretability: The results are easy to interpret with higher scores on each individual scale or the entire scale indicating greater anxiety, depression or mood disorders.
- Acceptability: The HADS is widely accepted and used with most patient populations including those with a TBI.
- Feasibility: It takes only a few minutes to complete, no specialized training is need to administer the test and may be completed by the patients themselves.
17.14 Mayo-Portland Adaptability Inventory
The original version of the MPAI consisted of six subscales: physical/medical, cognition, emotion, everyday activities, social behaviours and behaviours (Bohac et al., 1997). Items were rated to reflect distinctions between impairment, disability and handicap as defined by the World Health Organization’s (International Classification of Impairments Disabilities and Handicaps) (Malec & Lezak, 2003; Malec et al., 2000b). The MPAI has undergone successive revisions based on ongoing Rasch and multivariate analyses. The most current version is the MPAI-4, which evaluates the general dimension of sequelae of ABI in 3 sub-dimensions: ability, adjustment and participation (Malec, 2004b).
The MPAI-4 consists of 29 items in 3 subscales (the Ability Index, the Adjustment Index and the Participation Index) plus an additional 6 items that are not included in the MPAI-4 score. The first 29 scale items are intended to reflect the current status of the individual with brain injury without attempting to determine whether their status might be influenced by factors other than ABI. The additional six, unscored items are intended to identify the presence of other factors that may be contributing to the individual’s current status (Malec & Lezak, 2003).
In general, items are rated on a 5-point scale from 0 to 4 where 0 represents the most favourable outcome, no problem or independence, and 4 represents the presence of severe problems. A worksheet is provided that guides the user through the scoring and re-scoring of items. Following any necessary re-scoring, item scores are summed for each subscale to provide a raw score for that index. After making adjustment for items appearing in more than one index, subscale raw scores are summed to provide an overall adaptability index score. Raw scores for the indices and total scale may be converted to T-scores with a mean of 50 and a standard deviation of 10 using the tables provided in the manual (Malec & Lezak, 2003). T-scores provided are based on data sets from two populations of individuals with ABI. They have not been referenced to non-ABI samples. In general, when compared to the reference populations with ABI, total T-scores less than 30 are indicative of good outcome, 30-40 of mild limitations, 40-50 of mild to moderate limitations, 50-60 of moderate to severe difficulties, and>60 of severe limitations (Malec & Lezak, 2003).
The MPAI-4 was designed to be completed by professional staff, individuals who have experienced brain injury and/or their significant others. Ratings provided by any two or more of these groups can be combined to provide a more comprehensive composite score (Malec & Lezak, 2003).When administered by professional staff, the ratings should be completed by team consensus. The MPAI-4 is free of charge. The manual and rating forms may be downloaded from the COMBI website (http://tbims.org/combi/mpai). A French translation of the rating form is also available from the website.
The MPAI is a readily available assessment of the post-acute sequelae of ABI. The Participation Index may be administered independently to provide a quick evaluation of participation outcomes. Differences in ratings between staff member consensus and individual with ABI or between SO and individual with ABI may provide a measure of impaired self-awareness (Malec, 2004a; Malec & Degiorgio, 2002).
The authors do not recommend the MPAI-4 for use in the assessment of individuals with very severe ABI (Malec et al., 2003).
The authors reported that the placement of items in the 3 scale indices is based on a rational process in keeping with clinical observation and the results of ongoing analyses (Malec et al., 2003). However, the placement of some items appears odd. Self-care, for instance, is part of the participation index. In an earlier analysis, it was stated that it was more conceptually sound to place the self-care items with other basic skills such as use of hands, mobility and speech (Bohac et al., 1997). These basic items are currently part of the MPAI-4 abilities index. Other items, such as initiation, social contact and leisure skills/recreation were assigned to more than one index suggesting significant overlap between the subscales of adjustment and participation.
There are no published validation or reliability studies of the Mayo-Portland Adaptability that did not originate from the group responsible for the development of the scale.
- Interpretability: Tables are provided and raw scores are converted to standardized T-scores based on a national sample (n=386) or regional sample (n=134). No truly normative data is available for the purpose of comparison.
- Acceptability: May be completed by patients and significant others with trained professionals available to provide assistance.
- Feasibility: The MPAI-4 is free to download and copy. Administration, scoring and interpretation should be undertaken by trained professionals. The manual also contains a recommendation that a person capable in advanced psychometrics should be available. To maintain high levels of reliability, assessment should be completed by team consensus.
17.15 Medical Outcomes Study Short Form 36
Items are organized into eight dimensions or subscales which include physical functioning, role limitations: physical, emotional, bodily pain, social functioning, general mental health, and general health perceptions. It also includes two questions intended to estimate change in health status over the past year. These two questions remain separate from the eight subscales and are not scored. With the exception of the general change in health status questions, subjects are asked to respond with reference to the past four weeks. An acute version of the SF-36 refers to problems in the past week only (McDowell & Newell, 1996).
The recommended scoring system uses a weighted Likert system for each item. Items within subscales are summed to provide a total score for each subscale or dimension. Each of the eight summed scores is linearly transformed onto a scale from 0 to 100 to provide a score for each scale. In addition, a physical component and mental component score can be derived from the scale items. Standardized population data for several countries are available for the SF-36 (McDowell & Newell, 1996). The component scores have also been standardized with a mean of 50 and standard deviation of 10 (Finch et al., 2002)
The SF-36 questionnaire can be self-completed or administered in person or over the telephone by a trained interviewer. It is considered simple to administer and takes less than 10 minutes to complete (Andresen & Meyers, 2000). Permission to use the instrument should be obtained from the Medical Outcomes Trust who oversee the standardized administration of the SF-36 and will provide updates on administration and scoring (McDowell & Newell, 1996). Various computer applications are available to assist in scoring the SF-36 including free Excel templates that can be downloaded from the internet (Callahan et al., 2005).
The SF-36 is simple to administer. Both forms (i.e., self-completed or interview) take less than 10 minutes to complete (Hartley et al., 1995). As a self-completed, mailed questionnaire, it has been shown to have reasonably high response rates: 83% has been reported by Brazier et al. (1992); O’Mahony and Rodgers H (1998), 75%-83% reported by Dorman et al. (1998). Dorman et al. (1999) reported a response rate of 85% and Walters et al. (2001) reported 82% overall and 69% for those over age 85.
Callahan et al. (2005)found that the SF-36 was appropriate for longitudinal serial assessment of recovery in a mixed group of patients suffering from a cerebrovascular accident, TBI, or spinal cord dysfunction. The instrument has been shown to be valid and reliable in the adult TBI population and appears to be sensitive to the wide spectrum of health issues faced by this group (Emanuelson et al., 2003; Findler et al., 2001).
Higher rates of missing data have been reported among older patients when using a self-completed form of administration (Brazier et al., 1992; Brazier et al., 1996; Hayes et al., 1995). O’Mahony et al. (1998) found item completion rates to range from 66% to 96%. At the scale level, complete data collection (amount required to compute a scale score) ranged from 67% (role limitations-emotional) to 97% (social functioning). Walters et al. (2001) reported scale completion rates among community dwelling older adults ranging from 86.4% to 97.7% with all eight scales being calculable for 72% of respondents. Dorman et al. (1999) reported a proportion of missing data on the scale level ranging from 2% (social functioning) to 16% (role functioning-emotional). Given the lack of data completeness found, postal administration of the SF-36 may not be appropriate for use among older adults. However, low completion rates may not be limited to self-completion or postal administration. Andresen et al. (1999) administered the SF-36 to nursing home residents by face-to-face interview and reported that only 1 in 5 residents were able to complete it.
It has been suggested that data completeness may be indicative of respondent acceptance and understanding of the survey as relevant to them (Andresen et al., 1999; O’Mahony & Rodgers H, 1998). Hayes et al. (1995) noted that the most common items missing on the self-completed questionnaire referred to work or vigorous activity. Older respondents identified these questions as pertinent for much younger people and not relevant to their own situation. The authors suggested modifications to some of the questions, which may increase acceptability to older populations. In a qualitative assessment of the physical functioning and general health perceptions dimensions of the SF-36, Mallinson (2002) noted that the participants, who were all over the age of 65, tended to display signs of disengagement from the interview process and some participants expressed concern relating to the relevance of the questions. There was also considerable variation noted in subjective interpretation of items and most subjects used qualifying, contextual information to clarify their responses to the interviewer. As Mallinson (2002) pointed out, individual issues of subjective meaning and context are lost when the questionnaire is scored.
The SF-36 does not lend itself to the generation of an overall summary score. In scales using summed Likert scales, information contained within individual responses is lost in the total scale score , in that any given total score can be achieved in a variety of ways from individual item responses (Dorman et al., 1999). Hobart et al. (2002) examined the use of the 2-dimensional model, which consists of a mental health component (MCS) and physical health component (PCS). These two scales can account for only 60% of the variance in SF-36 scores suggesting a significant loss of information when the 2-component model is used.
It has been suggested that the SF-36 may be more sensitive to the health difficulties of mild TBI than of moderate/severe TBI patients as it was unable to differentiate between the severity levels (Emanuelson et al., 2003). One study found initial differences between these groups, but once depression was controlled for, these differences were less visible, suggesting that depression may account for the differences between TBI groups on the SF-36 (Findler et al., 2001). MacKenzie et al. (2002) suggest that adding a cognitive component to the SF-36 would make the instrument a more useful outcome measure in a head trauma population, as the tool is likely to underestimate the extent of disability in this group.
The level of test re-test reliability reported in stroke populations indicate that the SF-36 may not be adequate for serial comparisons of individual patients, but rather should be used for large group comparisons only (Dorman et al., 1998). Weinberger et al. (1996) also questioned the usefulness of the SF-36 in serial evaluation of individuals given large reported absolute differences in SF-36 scores obtained via common modes of administration (face-to-face interview, self-administration and telephone interview) over short testing intervals.
Dikmen et al. (2001) emphasized that the SF-36 was designed to be self-administered, thus its disadvantage is the inability to use the SF-36 to assess patients who are too impaired to complete the questionnaire on their own. While the use of a proxy may be the only means by which to include data from more severely affected TBI patients, reported disagreement between patient and proxy assessments has been considerable. In an adolescent TBI population, moderate rates of agreement were reported between proxy and patient respondent ratings for items related to physical health. However, on more subjective items, agreement was very low (Ocampo et al., 1997). It has been suggested that clinicians do not substitute proxy data for patient responses due to the subjective nature of many SF-36 items (Ocampo et al., 1997).
- Interpretability: Use of scale scores and summary component scores represents a loss of information and decreases potential clinical interpretability. Standardized norms for several countries are available for the SF-36.
- Acceptability: Completion times are approximately 10 minutes for either self-completed or interview administered questionnaires. Some items have been questioned for their relevance to elderly populations. The SF-36 has been studied for use by proxy, but agreement rates are low and reliability of the test decreased when proxy respondents completed assessments.
- Feasibility: The SF-36 questionnaire can be administered through a self-completion questionnaire or by interview (either on the telephone or in-person). It has been used as a mail survey with reasonably high completion rates reported. However, data obtained is more complete when interview administration is used. Permission to use the instrument and additional information regarding its administration and scoring should be obtained from the Medical Outcomes Trust.
17.16 Mini Mental Status Examination
The MMSE consists of 11 simple questions or tasks. Typically, these are grouped into seven cognitive domains including orientation to time, orientation to place, registration of three words, attention and calculation, recall of three words, language, and visual construction. Administration by a trained interviewer takes approximately 10 minutes. The test yields a total score of 30 and provides a picture of a subject’s present cognitive performance based on direct observation of completion of test items/tasks. A score of 23 out of 24 is the generally accepted cut-off point indicating the presence of cognitive impairment (Dick et al., 1984). Levels of impairment have also been classified as none (24-30), mild (18-24), and severe (0-17) (Tombaugh & McIntyre, 1992).
An expanded version of the MMSE, the modified mini-mental state examination (3MS) was developed by Teng & Chui (1987) increasing the content, number, and difficulty of items included in the assessment. The score of the 3MS ranges from 0 to 100 with a standardized cut-off point of 79/80 for the presence of cognitive impairment. This expanded assessment takes approximately 5 minutes more to administer than the original MMSE. The MMSE is available for purchase at http://www4.parinc.com/Products/Product.aspx?ProductID=MMSE#Items.
The Mini-mental State Examination is brief, inexpensive, and simple to administer. Its widespread use and accepted cut-off scores increase its interpretability.
It has been suggested that the MMSE may attempt to assess too many functions in one brief test. An individual’s performance on individual items or within a single domain may be more useful than interpretation of a single score (Tombaugh & McIntyre, 1992; Wade, 1992). However, an acceptable cut-off for the identification of the presence of an impairment may be possible only when the test is used as a measure of “cognitive impairment” (Blake et al., 2002). Blake et al. (2002) reported that when the test is used to screen for problems of visual or verbal memory, orientation or attention acceptable cut-off scores could not be identified.
MMSE scores have been shown to be affected by age, level of education and sociocultural background (Bleecker et al., 1988; Lorentz et al., 2002; Tombaugh & McIntyre, 1992). These variables may introduce bias leading to the misclassification of individuals, and such biases have not always been reported. For instance, Agrell & Dehlin (2000) found neither age nor education to influence scores. Lorentz et al. (2002) expressed concern that adjustments made for these biases may limit the general utility of the MMSE.
Perhaps the greatest limitation of the MMSE is its low reported levels of sensitivity, particularly among individuals with mild cognitive impairment (de Koning et al., 1998; Tombaugh & McIntyre, 1992), in patients with focal lesions (particularly those in the right hemisphere) (Tombaugh & McIntyre, 1992), within a general neurological patient population (Dick et al., 1984) and within a stroke population (Blake et al., 2002; Suhr & Grace, 1999). It has been suggested that its low level of sensitivity derives from the emphasis placed on language items and a paucity of visual-spatial items (de Koning et al., 2000; de Koning et al., 1998; Grace et al., 1995; Suhr & Grace, 1999; Tombaugh & McIntyre, 1992). Various solutions have been proposed to the problem of the MMSE’s poor sensitivity including the use of age-specific norms (Bleecker et al., 1988) and the addition of a clock-drawing task to the test (Suhr & Grace, 1999). Clock-drawing tests themselves have been assessed as acceptable to patients, easily scored and less affected by education, age and other non-dementia variables than other very brief measures of cognitive impairment (Lorentz et al., 2002) and would have little effect on the simplicity and accessibility of the test. The MMSE has been evaluated for use among a variety of neurological populations.
At present, information regarding the reliability and validity of the MMSE when used among patients with TBI/ABI is extremely limited.
- Interpretability: The MMSE is widely used and has generally accepted cut-off scores indicative of the presence of cognitive impairment. Documented age and education effects have led to the development of stratified norms (Ruchinskas & Curyto, 2003).
- Acceptability: The test is brief, requiring approximately 10 minutes to complete. It may be affected by patient variables such as age, level of education and sociocultural background. As it is administered via direct observation of task completion, it is not suitable for use with a proxy respondent.
- Feasibility: The test requires no specialized equipment and little time, making it inexpensive and portable. A survey conducted by Lorentz et al. (2002) revealed participant physicians found the MMSE too lengthy and unable to contribute much useful information.
17.17 Neurobehavioral Functioning Inventory
The NFI consists of 70 items representing behaviours or symptoms. These are grouped into six functional domains or subscales derived from principal components and factor analytic methodologies (Hart et al., 2003; Seel et al., 1997). The six domains include depression (13 items), somatic (11 items), memory/attention (19 items), communication (10 items), aggression (9 items) and motor (8 items) (Hart et al., 2003; Kreutzer et al., 1996). Six additional, critical items relating to patient safety and community integration have been added to the scale (Kreutzer et al., 1999) to be used in the identification of areas requiring immediate attention (Awad, 2002).
Items are rated for frequency of occurrence on a 5-point Likert scale from 1 (never) to 5 (always). While the NFI is a self-rating inventory, it provides for the inclusion of information obtained from suitable proxy sources. The test contains forms for ratings by self and by a significant other. The test takes approximately 20 minutes to complete (Awad, 2002).
The NFI is a proprietary scale that must be purchased from The Psychological Corporation (Harcourt Assessment, Inc.).
The NFI allows information from collateral sources to be collected, allowing for a more comprehensive picture of both the difficulties experienced by the patient and the impact of problems on the home environment (Witol et al., 1999). Multiple sources of information can improve reliability of information provided through self-report from individuals with TBI who, due to impaired self-awareness, may supply unreliable information (Hart et al., 2003).
Awad (2002) was unable to establish construct validity for the NFI. The author cited poor fit indices, a large number of items with poor/weak relation to their latent construct (20 items with squared multiple correlations <0.40), strong correlations between subscales and an inability to distinguish a group of individuals with TBI from non-clinical controls as the basis for this assertion. It is suggested that the NFI may be measuring aspects of a single large construct rather than six discrete constructs.
Weinfurt et al. (1999) reported very low endorsement rates for many of the items resulting in skewed distributions. Low rates of endorsement might indicate that these items are not meaningful discriminators for the head injury population.
While the authors do provide data for comparison, it is not truly normative. The data set used for standardization was derived from a population of individuals with TBI. There is no normative data available based on non-clinical populations (Awad, 2002; Witol et al., 1999).
Although the NFI is widely used, there is relatively little information available in the literature with regard to its reliability, validity and responsiveness. The information that is available pertains to older versions of the NFI and, at present, there are no validity or reliability data available for the 76-item version (Awad, 2002).
- Interpretability: Comparative data is provided in the manual stratified by patient age and injury severity. The NFI has been translated into Spanish, German and French.
- Acceptability: The NFI is a lengthy self-report inventory requiring approximately 20 minutes to complete. Forms are provided for assessment by self or by proxy.
- Feasibility: The NFI is a proprietary scale and must be purchased.
17.18 Rancho Los Amigos Levels of Cognitive Functioning Scale
The LCFS is a quick and simple way to present an individual’s level of recovery. It is also useful for making quick comparisons between groups (Johnston et al., 1991). Its simplicity and utility have contributed to its widespread use within the United States (Hall, 1997; Hall & Johnston, 1994).
At present there is no standardized method to derive an LCFS rating. Variable interobserver agreement has been reported suggesting that standardized rating methods might serve to improve reliability (Beauchamp et al., 2001).
The LCFS provides a quick and simple description of global behaviour from which level of cognitive functioning is inferred. It focuses on the impact of cognitive dysfunction on arousal and overall behaviour, but does not provide information regarding specific domains of cognitive impairment (Labi et al., 1998). There is relatively little published evidence to support the reliability or validity of the LCFS.
- Interpretability: The LCFS is used widely in the United States and provides a quick, global presentation of level of recovery.
- Acceptability: Ratings are derived from observation and represent little or no patient burden. Use of collateral information to derive ratings has not been evaluated.
- Feasibility: The LCFS is short and simple. It is available free of charge. The LCFS has been evaluated for use in longitudinal assessments.
17.19 Satisfaction with Life Scale (SWLS)
Diener et al. (1985) generated 48 self-report items related to satisfaction with life including items assessing positive and negative affect. Factor analyses were used to identify three factors including life satisfaction, negative affect and positive affect. All affect items were eliminated as were items with factor loadings of less than 0.60. The remaining 10 items were reduced to five on the basis of “semantic similarity” (Diener et al., 1985).
Respondents are instructed to rate each item using a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree). Item ratings are summed to provide a total score ranging from 5 to 35 where higher scores are indicative of greater life satisfaction. The SWLS takes a global approach to assessment. Because no specific domains are named within the scale and items are not specific in nature, the respondent is free to consider the life domains or affective components that he or she believes to contribute the most to their subjective experience of happiness (Arrindell et al., 1999; Diener et al., 1985; W. Pavot & E. Diener, 1993).
The scale is short and simple to administer and score. It can easily be added to assessments using multiple measures with no significant increase in time (Pavot et al., 1991). The Satisfaction with Life Scale can be accessed for no cost at www.ppc.sas.upenn.edu/lifesatisfactionscale.pdf.
The scale is available freely and is simple to administer and score. With only five items, it takes very little time to complete. The scale has been evaluated for use in populations of varying ages (e.g., adolescent, young adult and senior). The original scale was tested in both college students and geriatric populations (Diener et al., 1985). Scale items are at the 6th to 10th grade reading level, which makes it comprehensible to most adults (W. Pavot & E. Diener, 1993) The scale has been evaluated in several cultures and has been translated into several languages including Dutch, Taiwanese, Spanish, French, Russian, Korean, Hebrew, Mandarin Chinese, Spanish, and Portuguese.
It has been suggested that social desirability may account for a large proportion of variance in the assessment of subjective well-being and may, in fact be an important component of well-being (W. Pavot & E. Diener, 1993). However, Diener et al. (1985) reported a very weak association between SWLS scores and the Marlowe-Crowne scale of social desirability (r=0.02).
While the SWLS is a simple scale, interpretation of scores is not clear. The SWLS was not intended to provide an assessment of subjective well-being (SWB), only a single aspect of well-being. One cannot assume that SWLS scores provide a direct assessment of emotional well-being. In order to assess the broader construct of subjective well-being, assessment of negative and positive affect should be included (W. Pavot & E. Diener, 1993). Furthermore, no published normative data for the SWLS could be located. Pavot and Diener (1993) identified numerous studies providing means and standard deviations for SWLS scores in a variety of populations and note considerable variation within different population subsets. However, scores may be interpreted in absolute rather than relative terms. In this case, it has been suggested that a score of 20 is regarded as neutral, while scores in excess of 20 represent satisfaction (21-25=slightly satisfied and 26-30= satisfied), and scores of less than 20 represent dissatisfaction (15-19=slightly dissatisfied and 5-9=extremely dissatisfied) (W. Pavot & E. Diener, 1993).
The SWLS does not appear to be affected by gender or age (W. Pavot & E. Diener, 1993). Factor analyses focusing on factorial invariance across gender have demonstrated that the structure and measurement of life satisfaction are equivalent across groups. That is, the strength of relationships between items and the underlying construct is the same for men and women (Shevlin et al., 1998; Wu & Yao, 2006). However, factorial invariance was not demonstrated on evaluation of the Spanish version of the SWLS (Atienza et al., 2003; Pons et al., 2000). Westaway et al. (2003) reported that SWLS scores were not related to either gender or age, but rather to employment status and level of education. Similarly, Neto (1993) identified significant main effects associated with both gender and socioeconomic status such that higher status and male gender were associated with greater satisfaction with life as assessed on the SWLS.
Although the SWLS is used to evaluate satisfaction with life in populations of adults with ABI, no studies have specifically evaluated the use of this scale within the ABI population.
- Interpretability: Guidelines for absolute interpretation of scores are available. To our knowledge, no normative data is presently available for the SWLS.
- Acceptability: Scale items are at a suitable reading level for most adults and it takes a minimal amount of time for the subject to complete the measure in its entirety.
- Feasibility: This scale is brief, simple, and has a low-cost of administration.
17.20 Quality of Life after Traumatic Brain Injury
The final QOLIBRI consists of 37 items in six subscales including cognition (7 items), self (7 items), daily life and autonomy (7 items) and social relationships (6 items), emotions (5items) and physical problems (5 items). The first four subscales are coded on a 1 to 5 scale where 1 is not at all satisfied and 5 is very satisfied. The responses to the last two subscales (emotion and physical problems) are reverse scored to correspond with the satisfaction items. Here 1 is very bothered and 5 is not at all bothered. Responses for each subscale are summed to give a total, which is then divided by the number of responses to give the scale a mean score. The scale means have a maximum possible range of 1 to 5. The mean can be computed when there are some missing responses, but should not be calculated if more than one third of responses on the scale are missing. In a similar manner the QOLIBRI total score is calculated by summing all the responses, and then dividing by the actual number of responses. Again, a total score should not be calculated if more than one third of responses are missing (www.qolibrinet.com). The scales have also been translated into seven languages and have been tested with each language cohort. The test is available for no cost at http://www.qolibrinet.com/registration.htm.
This scale was designed specifically for the ABI population and has been translated into six other languages. To date, this is the only scale designed specifically for those who have sustained either an ABI or a TBI. The composite measure has the advantage of covering both functional outcomes post ABI and Health-Related QoL (HRQoL) post ABI.
Like so many other scales measuring quality of life, the important limitation is the complexity of HRQoL, as it remains virtually impossible to capture and define an individual’s view of the future, the concept of individuality, and the experience of intimacy (Truelle et al., 2010). The conclusions of the study are based on the approach to recruitment. Subjects where subjects were chosen at various times across a multitude of settings (convenience sampling), and therefore the sample was scale orientated, not patient focused (Truelle et al., 2010).
- Interpretability: Results are easy to interpret, with lower scores indicating a better QoL.
- Acceptability: The scale, available in seven languages, is a self-report based on each individual’s perception of how he or she is doing.
- Feasibility: The scale is now available and ready for more regular use. It is easy to use, available in a variety of languages and there is no fee for its use.
No Summary in this Module
Alcott, D., Dixon, K., & Swann, R. (1997). The reliability of the items of the Functional Assessment Measure (FAM): differences in abstractness between FAM items. Disabil Rehabil, 19(9), 355-358.
Amato, S., Resan, M., & Mion, L. (2012). The feasibility, reliability, and clinical utility of the agitated behavior scale in brain-injured rehabilitation patients. Rehabil Nurs, 37(1), 19-24.
Amtmann, D., Bamer, A. M., Noonan, V., Lang, N., Kim, J., & Cook, K. F. (2012). Comparison of the psychometric properties of two fatigue scales in multiple sclerosis. Rehabil Psychol, 57(2), 159-166.
Anderson, C., Laubscher, S., & Burns, R. (1996). Validation of the Short Form 36 (SF-36) health survey questionnaire among stroke patients. Stroke, 27(10), 1812-1816.
Anderson, S. I., Housley, A. M., Jones, P. A., Slattery, J., & Miller, J. D. (1993). Glasgow Outcome Scale: an inter-rater reliability study. Brain Inj, 7(4), 309-317.
Andresen, E. M. (2000). Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil, 81(12 Suppl 2), S15-20.
Andresen, E. M., Gravitt, G. W., Aydelotte, M. E., & Podgorski, C. A. (1999). Limitations of the SF-36 in a sample of nursing home residents. Age Ageing, 28(6), 562-566.
Andresen, E. M., & Meyers, A. R. (2000). Health-related quality of life outcomes measures. Arch Phys Med Rehabil, 81(12 Suppl 2), S30-45.
Armutlu, K., Korkmaz, N. C., Keser, I., Sumbuloglu, V., Akbiyik, D. I., Guney, Z., & Karabudak, R. (2007). The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J Rehabil Res, 30(1), 81-85.
Arrindell, W. A., Heesink, J., & Feij, J. A. (1999). The Satisfaction With Life Scale (SWLS): appraisal with 1700 healthy young adults in The Netherlands. Personality and Individual Differences, 26(5), 815-826.
Atienza, F. L., Balaguer, I., & Garcı́a-Merita, M. a. L. (2003). Satisfaction with Life Scale: analysis of factorial invariance across sexes. Personality and Individual Differences, 35(6), 1255-1260.
Au-Yeung, S. S., Ng, J. T., & Lo, S. K. (2003). Does balance or motor impairment of limbs discriminate the ambulatory status of stroke survivors? Am J Phys Med Rehabil, 82(4), 279-283.
Awad, C. P. (2002). Establishing the validity of the neurobehavioral functioning inventory. (University of Missouri-Columbia).
Aylard, P. R., Gooding, J. H., McKenna, P. J., & Snaith, R. P. (1987). A validation study of three anxiety and depression self-assessment scales. J Psychosom Res, 31(2), 261-268.
Bakay, R. A., & Ward, A. A., Jr. (1983). Enzymatic changes in serum and cerebrospinal fluid in neurological injury. J Neurosurg, 58(1), 27-37.
Balestreri, M., Czosnyka, M., Chatfield, D. A., Steiner, L. A., Schmidt, E. A., Smielewski, P., Matta, B., & Pickard, J. D. (2004). Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry, 75(1), 161-162.
Beauchamp, K., Baker, S., McDaniel, C., Moser, W., Zalman, D. C., Balinghoff, J., Cheung, A. T., & Stecker, M. (2001). Reliability of nurses’ neurological assessments in the cardiothoracic surgical intensive care unit. Am J Crit Care, 10(5), 298-305.
Beck, A. T., Guth, D., Steer, R. A., & Ball, R. (1997). Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Behav Res Ther, 35(8), 785-791.
Belmont, A., Agar, N., Hugeron, C., Gallais, B., & Azouvi, P. (2006). Fatigue and traumatic brain injury. Ann Readapt Med Phys, 49(6), 283-288, 370-284.
Berg, K., Wood-Dauphinee, S., & Williams, J. I. (1995). The balance scale: Reliability assessment with elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine, 27(1), 27-36.
Berg, K., Wood-Dauphinee, S., Williams, J. I., & Gayton, D. (1989). Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41(6), 304-311.
Berg, K. O., Maki, B. E., Williams, J. I., Holliday, P. J., & Wood-Dauphinee, S. L. (1992a). Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil, 73(11), 1073-1080.
Berg, K. O., Wood-Dauphinee, S. L., Williams, J. I., & Maki, B. (1992b). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health, 83(SUPPL. 2), S7-S11.
Bhatty, G. B., & Kapoor, N. (1993). The Glasgow Coma Scale: a mathematical critique. Acta Neurochir (Wien), 120(3-4), 132-135.
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res, 52(2), 69-77.
Blake, H., McKinney, M., Treece, K., Lee, E., & Lincoln, N. B. (2002). An evaluation of screening measures for cognitive impairment after stroke. Age Ageing, 31(6), 451-456.
Bleecker, M. L., Bolla-Wilson, K., Kawas, C., & Agnew, J. (1988). Age-specific norms for the Mini-Mental State Exam. Neurology, 38(10), 1565-1568.
Bode, R. K., Heinemann, A. W., & Semik, P. (2000). Measurement properties of the Galveston Orientation and Amnesia Test (GOAT) and improvement patterns during inpatient rehabilitation. J Head Trauma Rehabil, 15(1), 637-655.
Bogle Thorbahn, L. D., & Newton, R. A. (1996). Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther, 76(6), 576-583; discussion 584-575.
Bogner, J. A., Corrigan, J. D., Bode, R. K., & Heinemann, A. W. (2000). Rating scale analysis of the Agitated Behavior Scale. J Head Trauma Rehabil, 15(1), 656-669.
Bogner, J. A., Corrigan, J. D., Fugate, L., Mysiw, W. J., & Clinchot, D. (2001). Role of agitation in prediction of outcomes after traumatic brain injury. Am J Phys Med Rehabil, 80(9), 636-644.
Bogner, J. A., Corrigan, J. D., Stange, M., & Rabold, D. (1999). Reliability of the Agitated Behavior Scale. J Head Trauma Rehabil, 14(1), 91-96.
Bohac, D. L., Malec, J. F., & Moessner, A. M. (1997). Factor analysis of the Mayo-Portland Adaptability Inventory: structure and validity. Brain Inj, 11(7), 469-482.
Borgaro, S. R., Baker, J., Wethe, J. V., Prigatano, G. P., & Kwasnica, C. (2005). Subjective reports of fatigue during early recovery from traumatic brain injury. J Head Trauma Rehabil, 20(5), 416-425.
Brazier, J. E., Harper, R., Jones, N. M., O’Cathain, A., Thomas, K. J., Usherwood, T., & Westlake, L. (1992). Validating the SF-36 health survey questionnaire: new outcome measure for primary care. Bmj, 305(6846), 160-164.
Brazier, J. E., Walters, S. J., Nicholl, J. P., & Kohler, B. (1996). Using the SF-36 and Euroqol on an elderly population. Qual Life Res, 5(2), 195-204.
Brazil, K. (1992). Assessing the consequences of traumatic brain injury. Int J Rehabil Res, 15(2), 93-101.
Brock, K. A., Goldie, P. A., & Greenwood, K. M. (2002). Evaluating the effectiveness of stroke rehabilitation: choosing a discriminative measure. Arch Phys Med Rehabil, 83(1), 92-99.
Brooks, D. N., Hosie, J., Bond, M. R., Jennett, B., & Aughton, M. (1986). Cognitive sequelae of severe head injury in relation to the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry, 49(5), 549-553.
Brown, S. A., McCauley, S. R., Levin, H. S., Contant, C., & Boake, C. (2004). Perception of health and quality of life in minorities after mild-to-moderate traumatic brain injury. Appl Neuropsychol, 11(1), 54-64.
Burger, H., Franchignoni, F., Puzic, N., & Giordano, A. (2010). Psychometric properties of the Fatigue Severity Scale in polio survivors. Int J Rehabil Res, 33(4), 290-297.
Butcher, S. J., Meshke, J. M., & Sheppard, M. S. (2004). Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil, 24(4), 274-280.
Callahan, C. D., Young, P. L., & Barisa, M. T. (2005). Using the SF-36 for longitudinal outcomes measurement in rehabilitation. Rehabil Psychol, 50(1), 65-70.
Cavanagh, S. J., Hogan, K., Gordon, V., & Fairfax, J. (2000). Stroke-specific FIM models in an urban population. J Neurosci Nurs, 32(1), 17-21.
Cifu, D. X., Keyser-Marcus, L., Lopez, E., Wehman, P., Kreutzer, J. S., Englander, J., & High, W. (1997). Acute predictors of successful return to work 1 year after traumatic brain injury: a multicenter analysis. Arch Phys Med Rehabil, 78(2), 125-131.
Corrigan, J. (1989). Development of a scale for assessment of agitation following traumatic brain injury. J Clin Exp Neuropsychol, 11(2), 261-277.
Corrigan, J. D., & Bogner, J. A. (1994). Factor structure of the Agitated Behavior Scale. J Clin Exp Neuropsychol, 16(3), 386-392.
Corrigan, J. D., & Bogner, J. A. (1995). Assessment of agitation following brain injury. NeuroRehabilitation, 5(3), 205-210.
Corrigan, J. D., Bogner, J. A., & Tabloski, P. A. (1996). Comparisons of agitation associated with Alzheimer’s disease and acquired brain in jury. American Journal of Alzheimer’s Disease and Other Dementias, 11(6), 20-24.
Corrigan, J. D., & Deming, R. (1995). Psychometric characteristics of the Community Integration Questionnaire: Replication and extension. J Head Trauma Rehabil, 10(4), 41-53.
Corrigan, J. D., & Mysiw, W. J. (1988). Agitation following traumatic head injury: equivocal evidence for a discrete stage of cognitive recovery. Arch Phys Med Rehabil, 69(7), 487-492.
Corrigan, J. D., Smith-Knapp, K., & Granger, C. V. (1997). Validity of the functional independence measure for persons with traumatic brain injury. Arch Phys Med Rehabil, 78(8), 828-834.
Corrigan, J. D., Smith-Knapp, K., & Granger, C. V. (1998). Outcomes in the first 5 years after traumatic brain injury. Arch Phys Med Rehabil, 79(3), 298-305.
Cusick, C. P., Gerhart, K. A., & Mellick, D. C. (2000). Participant-proxy reliability in traumatic brain injury outcome research. J Head Trauma Rehabil, 15(1), 739-749.
Daving, Y., Andren, E., Nordholm, L., & Grimby, G. (2001). Reliability of an interview approach to the Functional Independence Measure. Clin Rehabil, 15(3), 301-310.
Dawkins, N., Cloherty, M. E., Gracey, F., & Evans, J. J. (2006). The factor structure of the Hospital Anxiety and Depression Scale in acquired brain injury. Brain Inj, 20(12), 1235-1239.
de Koning, I., Dippel, D. W., van Kooten, F., & Koudstaal, P. J. (2000). A short screening instrument for poststroke dementia : the R-CAMCOG. Stroke, 31(7), 1502-1508.
de Koning, I., van Kooten, F., & Koudstaal, P. J. (1998). Value of screening instruments in the diagnosis of post-stroke dementia. Haemostasis, 28(3-4), 158-166.
Demetriades, D., Kuncir, E., Murray, J., Velmahos, G. C., Rhee, P., & Chan, L. (2004). Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries. J Am Coll Surg, 199(2), 216-222.
Desrosiers, J., Noreau, L., Rochette, A., Bravo, G., & Boutin, C. (2002). Predictors of handicap situations following post-stroke rehabilitation. Disabil Rehabil, 24(15), 774-785.
Dick, J. P., Guiloff, R. J., Stewart, A., Blackstock, J., Bielawska, C., Paul, E. A., & Marsden, C. D. (1984). Mini-mental state examination in neurological patients. J Neurol Neurosurg Psychiatry, 47(5), 496-499.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale. J Pers Assess, 49(1), 71-75.
Dijkers, M. (1997). Measuring the Long-Term Outcomes of Traumatic Brain Injury: A Review of the Community Integration Questionnaire. J Head Trauma Rehabil, 12(6), 74-91.
Dikmen, S., Machamer, J., Miller, B., Doctor, J., & Temkin, N. (2001). Functional status examination: a new instrument for assessing outcome in traumatic brain injury. J Neurotrauma, 18(2), 127-140.
Dittner, A. J., Wessely, S. C., & Brown, R. G. (2004). The assessment of fatigue: a practical guide for clinicians and researchers. J Psychosom Res, 56(2), 157-170.
Dodds, T. A., Martin, D. P., Stolov, W. C., & Deyo, R. A. (1993). A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil, 74(5), 531-536.
Donaghy, S., & Wass, P. J. (1998). Interrater reliability of the functional assessment measure in a brain injury rehabilitation program. Arch Phys Med Rehabil, 79(10), 1231-1236.
Doninger, N. A., Heinemann, A. W., Bode, R. K., Sokol, K., Corrigan, J. D., & Moore, D. (2003). Predicting community integration following traumatic brain injury with health and cognitive status measures. Rehabil Psychol, 48(2), 67-76.
Dorman, P., Slattery, J., Farrell, B., Dennis, M., & Sandercock, P. (1998). Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. Stroke, 29(1), 63-68.
Dorman, P. J., Dennis, M., & Sandercock, P. (1999). How do scores on the EuroQol relate to scores on the SF-36 after stroke? Stroke, 30(10), 2146-2151.
Dromerick, A. W., Edwards, D. F., & Diringer, M. N. (2003). Sensitivity to changes in disability after stroke: a comparison of four scales useful in clinical trials. J Rehabil Res Dev, 40(1), 1-8.
Duncan, P. W., Lai, S. M., Tyler, D., Perera, S., Reker, D. M., & Studenski, S. (2002). Evaluation of proxy responses to the Stroke Impact Scale. Stroke, 33(11), 2593-2599.
Edwards, S. L. (2001). Using the Glasgow Coma Scale: analysis and limitations. Br J Nurs, 10(2), 92-101.
Eliason, M. R., & Topp, B. W. (1984). Predictive validity of Rappaport’s Disability Rating Scale in subjects with acute brain dysfunction. Phys Ther, 64(9), 1357-1360.
Emanuelson, I., Andersson Holmkvist, E., Bjorklund, R., & Stalhammar, D. (2003). Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: a population-based study in western Sweden. Acta Neurol Scand, 108(5), 332-338.
Essink-Bot, M. L., Krabbe, P. F., Bonsel, G. J., & Aaronson, N. K. (1997). An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the EuroQol instrument. Med Care, 35(5), 522-537.
Feld, J. A., Rabadi, M. H., Blau, A. D., & Jordan, B. D. (2001). Berg balance scale and outcome measures in acquired brain injury. Neurorehabil Neural Repair, 15(3), 239-244.
Fielding, K., & Rowley, G. (1990). Reliability of assessments by skilled observers using the Glasgow Coma Scale. Aust J Adv Nurs, 7(4), 13-17.
Finch, E., Brooks, D., Stratford, P. W., & Mayo, N. E. (2002). Physical Rehabilitations Outcome Measures A Guide to Enhanced Clinical Decision-Making., 2nd ed. Toronto, Ontario: Canadian Physiotherapy Association.
Findler, M., Cantor, J., Haddad, L., Gordon, W., & Ashman, T. (2001). The reliability and validity of the SF-36 health survey questionnaire for use with individuals with traumatic brain injury. Brain Inj, 15(8), 715-723.
Fitzpatrick, R., Davey, C., Buxton, M. J., & Jones, D. R. (1998). Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess, 2(14), i-iv, 1-74.
Fleming, J. M., & Maas, F. (1994). Prognosis of rehabilitation outcome in head injury using the Disability Rating Scale. Arch Phys Med Rehabil, 75(2), 156-163.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12(3), 189-198.
Forrester, G., Encel, J., & Geffen, G. (1994). Measuring post-traumatic amnesia (PTA): an historical review. Brain Inj, 8(2), 175-184.
Foundation, B. T. (2000). The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Indications for intracranial pressure monitoring. J Neurotrauma, 17(6-7), 479-491.
Friedman, J. H., Alves, G., Hagell, P., Marinus, J., Marsh, L., Martinez-Martin, P., Goetz, C. G., Poewe, W., Rascol, O., Sampaio, C., Stebbins, G., & Schrag, A. (2010). Fatigue rating scales critique and recommendations by the Movement Disorders Society task force on rating scales for Parkinson’s disease. Mov Disord, 25(7), 805-822.
Fryer, L. J., & Haffey, W. J. (1987). Cognitive rehabilitation and community readaptation: Outcomes from two program models. J Head Trauma Rehabil, 2(3), 51-63.
Gill, M. R., Reiley, D. G., & Green, S. M. (2004). Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med, 43(2), 215-223.
Gouvier, W. D., Blanton, P. D., LaPorte, K. K., & Nepomuceno, C. (1987). Reliability and validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in monitoring recovery from severe head injury. Arch Phys Med Rehabil, 68(2), 94-97.
Grace, J., Nadler, J. D., White, D. A., Guilmette, T. J., Giuliano, A. J., Monsch, A. U., & Snow, M. G. (1995). Folstein vs modified Mini-Mental State Examination in geriatric stroke. Stability, validity, and screening utility. Arch Neurol, 52(5), 477-484.
Granger, C. V., Cotter, A. C., Hamilton, B. B., & Fiedler, R. C. (1993). Functional assessment scales: a study of persons after stroke. Arch Phys Med Rehabil, 74(2), 133-138.
Gujjar, A. R., Jacob, P. C., Nandhagopal, R., Ganguly, S. S., Obaidy, A., & Al-Asmi, A. R. (2013). Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium: Interrater reliability and relation to outcome. Journal of Critical Care, 28(3), 316.e311-316.e318.
Gurka, J. A., Felmingham, K. L., Baguley, I. J., Schotte, D. E., Crooks, J., & Marosszeky, J. E. (1999). Utility of the functional assessment measure after discharge from inpatient rehabilitation. J Head Trauma Rehabil, 14(3), 247-256.
Hagen, C. (1982). Language-Cognitive Disorganization Following Closed Head Injury: A Conceptualization. In L. Trexler (Ed.), Cognitive Rehabilitation (pp. 131-151): Springer US.
Hagen, C., Malkmus, D., & Durham, P. (1972). Levels of cognitive functioning. Traumatic Brain Injury Resource Guide.
Hall, K., Cope, D. N., & Rappaport, M. (1985). Glasgow Outcome Scale and Disability Rating Scale: comparative usefulness in following recovery in traumatic head injury. Arch Phys Med Rehabil, 66(1), 35-37.
Hall, K., Hamilton, B., Gordon, W., & Zasler, N. (1993). Characteristics and comparisons of functional assessment indices: Disability Rating Scale, Functional Independence Measure, and Functional Assessment Measure. J Head Trauma Rehabil, 8(2), 60-74.
Hall, K., Mann, N., High, W., Wright, J., Kreutzer, J., & Wood, D. (1996a). Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS and CIQ. F J Head Trauma Rehabil, 11, 27-39.
Hall, K., Mann, N., High, W., Wright, J., Krutzer, J., & Wood, D. (1996b). Functional measures after traumatic brain injury: Ceiling effects of FIM, FIM+FAM, DRS, and CIQ. Journal of Head Trauma Rehabilitation, 11(5), 27-39.
Hall, K. M. (1997). Establishing a national traumatic brain injury information system based upon a unified data set. Arch Phys Med Rehabil, 78(8 Suppl 4), S5-11.
Hall, K. M., & Johnston, M. V. (1994). Outcomes evaluation in TBI Rehabilitation. Part II: measurement tools for a nationwide data system. Arch Phys Med Rehabil, 75(12 Spec No), SC10-18; discussion SC 27-18.
Hall, K. M., Mann, N., High Jr, W. M., Wright, J., Kreutzer, J. S., & Wood, D. (1996). Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS and CIQ. Journal of Head Trauma Rehabilitation, 11(5), 27-39.
Hammond, F. M., Grattan, K. D., Sasser, H., Corrigan, J. D., Bushnik, T., & Zafonte, R. D. (2001). Long-term recovery course after traumatic brain injury: a comparison of the functional independence measure and disability rating scale. J Head Trauma Rehabil, 16(4), 318-329.
Hart, T., Whyte, J., Polansky, M., Millis, S., Hammond, F. M., Sherer, M., Bushnik, T., Hanks, R., & Kreutzer, J. (2003). Concordance of patient and family report of neurobehavioral symptoms at 1 year after traumatic brain injury. Arch Phys Med Rehabil, 84(2), 204-213.
Hartley, C., Cozens, A., Mendelow, A. D., & Stevenson, J. C. (1995). The Apache II scoring system in neurosurgical patients: a comparison with simple Glasgow coma scoring. British Journal of Neurosurgery, 9(2), 179-187.
Hawley, C. A., Taylor, R., Hellawell, D. J., & Pentland, B. (1999). Use of the functional assessment measure (FIM+FAM) in head injury rehabilitation: a psychometric analysis. J Neurol Neurosurg Psychiatry, 67(6), 749-754.
Hayes, N., & Joseph, S. (2003). Big 5 correlates of three measures of subjective well-being. Personality and Individual Differences, 34(4), 723-727.
Hayes, V., Morris, J., Wolfe, C., & Morgan, M. (1995). The SF-36 health survey questionnaire: is it suitable for use with older adults? Age Ageing, 24(2), 120-125.
Healey, C., Osler, T. M., Rogers, F. B., Healey, M. A., Glance, L. G., Kilgo, P. D., Shackford, S. R., & Meredith, J. W. (2003). Improving the Glasgow Coma Scale score: motor score alone is a better predictor. J Trauma, 54(4), 671-678; discussion 678-680.
Heinemann, A. W., Linacre, J. M., Wright, B. D., Hamilton, B. B., & Granger, C. (1994). Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil, 75(2), 133-143.
Heinemann, A. W., & Whiteneck, G. G. (1995). Relationships among impairment, disability, handicap, and life satisfaction in persons with traumatic brain injury. J Head Trauma Rehabil, 10(4), 54-63.
Hellawell, D. J., & Signorini, D. F. (1997). The Edinburgh Extended Glasgow Outcome Scale (EEGOS): rationale and pilot studies. Int J Rehabil Res, 20(4), 345-354.
Hellawell, D. J., Signorini, D. F., & Pentland, B. (2000). Simple assessment of outcome after acute brain injury using the Glasgow Outcome Scale. Scand J Rehabil Med, 32(1), 25-27.
Herrero, M. J., Blanch, J., Peri, J. M., De Pablo, J., Pintor, L., & Bulbena, A. (2003). A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. Gen Hosp Psychiatry, 25(4), 277-283.
Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale–a review of validation data and clinical results. J Psychosom Res, 42(1), 17-41.
Hobart, J. C., Lamping, D. L., Freeman, J. A., Langdon, D. W., McLellan, D. L., Greenwood, R. J., & Thompson, A. J. (2001). Evidence-based measurement: which disability scale for neurologic rehabilitation? Neurology, 57(4), 639-644.
Hobart, J. C., Williams, L. S., Moran, K., & Thompson, A. J. (2002). Quality of life measurement after stroke: uses and abuses of the SF-36. Stroke, 33(5), 1348-1356.
Hsueh, I. P., Lin, J. H., Jeng, J. S., & Hsieh, C. L. (2002). Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke. J Neurol Neurosurg Psychiatry, 73(2), 188-190.
Inness, E., Howe, J., Verrier, M.C., Williams, J.I. . (1999). Development of the community balance and mobility scale for clients with traumatic brain injury. Arch Phys Med Rehabil, 80, 968.
Inness, E. L., Howe, J.-A., Niechwiej-Szwedo, E., Jaglal, S. B., McIlroy, W. E., & Verrier, M. C. (2011). Measuring Balance and Mobility after Traumatic Brain Injury: Validation of the Community Balance and Mobility Scale (CB&M). Physiotherapy Canada, 63(2), 199-208.
Jain, N. S., Layton, B. S., & Murray, P. K. (2000). Are aphasic patients who fail the GOAT in PTA? A modified Galveston Orientation and Amnesia Test for persons with aphasia. Clin Neuropsychol, 14(1), 13-17.
Jenkinson C., W. L. C. A. (1993). Quality of Life Measurement in Health Care. Oxford, UK:: Health Services Research Unit, University of Oxford.
Jennett, B., & Bond, M. (1975). Assessment of outcome after severe brain damage. Lancet, 1(7905), 480-484.
Jennett, B., Snoek, J., Bond, M. R., & Brooks, N. (1981). Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry, 44(4), 285-293.
Johnston, M., Pollard, B., & Hennessey, P. (2000). Construct validation of the hospital anxiety and depression scale with clinical populations. J Psychosom Res, 48(6), 579-584.
Johnston, M. V., Findley, T. W., DeLuca, J., & Katz, R. T. (1991). Research in physical medicine and rehabilitation. XII. Measurement tools with application to brain injury. Am J Phys Med Rehabil, 70(1), 40-56.
Juarez, V. J., & Lyons, M. (1995). Interrater reliability of the Glasgow Coma Scale. J Neurosci Nurs, 27(5), 283-286.
Juneja, G., Czyrny, J. J., & Linn, R. T. (1998). Admission balance and outcomes of patients admitted for acute inpatient rehabilitation. Am J Phys Med Rehabil, 77(5), 388-393.
Jutai, J. W., & Teasell, R. W. (2003). The necessity and limitations of evidence-based practice in stroke rehabilitation. Top Stroke Rehabil, 10(1), 71-78.
Kaplan, C. P. (2001). The community integration questionnaire with new scoring guidelines: concurrent validity and need for appropriate norms. Brain Inj, 15(8), 725-731.
Katz, D. I., & Alexander, M. P. (1994). Traumatic brain injury. Predicting course of recovery and outcome for patients admitted to rehabilitation. Arch Neurol, 51(7), 661-670.
Keller, S. D., Bayliss, M. S., Ware, J. E., Jr., Hsu, M. A., Damiano, A. M., & Goss, T. F. (1997). Comparison of responses to SF-36 Health Survey questions with one-week and four-week recall periods. Health Serv Res, 32(3), 367-384.
Kidd, D., Stewart, G., Baldry, J., Johnson, J., Rossiter, D., Petruckevitch, A., & Thompson, A. J. (1995). The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil, 17(1), 10-14.
Kleinman, L., Zodet, M. W., Hakim, Z., Aledort, J., Barker, C., Chan, K., Krupp, L., & Revicki, D. (2000). Psychometric evaluation of the fatigue severity scale for use in chronic hepatitis C. Qual Life Res, 9(5), 499-508.
Kornetti, D. L., Fritz, S. L., Chiu, Y. P., Light, K. E., & Velozo, C. A. (2004). Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil, 85(7), 1128-1135.
Kreutzer , J., Leininger , K., Doherty , K., & Waaland , P. (1987). General health and history questionnaire. Richmond, VA: Medical College of Virginia.
Kreutzer, J., Seel, R., & Marwitz, J. (1999). The Neurobehavioral Functioning Inventory. San Antonio, Texas:: The Psychological Corporation.
Kreutzer, J. S., Marwitz, J. H., Seel, R., & Serio, C. D. (1996). Validation of a neurobehavioral functioning inventory for adults with traumatic brain injury. Arch Phys Med Rehabil, 77(2), 116-124.
Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol, 46(10), 1121-1123.
Kuipers, P., Kendall, M., Fleming, J., & Tate, R. (2004). Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): psychometric properties. Brain Inj, 18(2), 161-177.
Kwon, S., Hartzema, A. G., Duncan, P. W., & Min-Lai, S. (2004). Disability measures in stroke: relationship among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke, 35(4), 918-923.
Labi, M. L. C., Brentjens, M., Shaffer, K., Weiss, C., & Zielezny, M. A. (1998). Functional cognition index: A new instrument to assess cognitive disability after traumatic brain injury. Journal of Neurologic Rehabilitation, 12(2), 45-52.
LaChapelle, D. L., & Finlayson, M. A. (1998). An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls. Brain Inj, 12(8), 649-659.
Lai, S. M., Perera, S., Duncan, P. W., & Bode, R. (2003). Physical and social functioning after stroke: comparison of the Stroke Impact Scale and Short Form-36. Stroke, 34(2), 488-493.
Langfitt, T. W., & Gennarelli, T. A. (1982). Can the out come from head injury be improved? J Neurosurg, 56(1), 19-25.
Law, M. (2002). Evidence-based Rehabilitation. A Guide to Practice. Thorofare, NJ: Slack Press.
Lequerica, A. H., Chiaravalloti, N. D., Sander, A. M., Pappadis, M. R., Arango-Lasprilla, J. C., Hart, T., Banos, J. H., Marquez De La Plata, C. D., Hammond, F. M., & Sherman, T. E. (2013). The Community Integration Questionnaire: factor structure across racial/ethnic groups in persons with traumatic brain injury. J Head Trauma Rehabil, 28(6), E14-22.
Levin, H. S., Boake, C., Song, J., McCauley, S., Contant, C., Diaz-Marchan, P., Brundage, S., Goodman, H., & Kotrla, K. J. (2001). Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury. J Neurotrauma, 18(6), 575-584.
Levin, H. S., O’Donnell, V. M., & Grossman, R. G. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis, 167(11), 675-684.
Levy, M., Berson, A., Cook, T., Bollegala, N., Seto, E., Tursanski, S., Kim, J., Sockalingam, S., Rajput, A., Krishnadev, N., Feng, C., & Bhalerao, S. (2005). Treatment of agitation following traumatic brain injury: a review of the literature. NeuroRehabilitation, 20(4), 279-306.
Lezak, M. D. (1987). Relationships between personality disorders, social disturbances, and physical disability following traumatic brain injury. J Head Trauma Rehabil, 2(1), 57-69.
Linacre, J. M., Heinemann, A. W., Wright, B. D., Granger, C. V., & Hamilton, B. B. (1994). The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil, 75(2), 127-132.
Lindsay, K. W., Carlin, J., Kennedy, I., Fry, J., McInnes, A., & Teasdale, G. M. (1981). Evoked potentials in severe head injury–analysis and relation to outcome. J Neurol Neurosurg Psychiatry, 44(9), 796-802.
Lisspers, J., Nygren, A., & Soderman, E. (1997). Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand, 96(4), 281-286.
Liston, R. A., & Brouwer, B. J. (1996). Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil, 77(5), 425-430.
Lorentz, W. J., Scanlan, J. M., & Borson, S. (2002). Brief screening tests for dementia. Can J Psychiatry, 47(8), 723-733.
Lowry, M. (1999). The Glasgow Coma Scale in clinical practice: a critique. Nurs Times, 95(22), 40-42.
Maas, A. I., Braakman, R., Schouten, H. J., Minderhoud, J. M., & van Zomeren, A. H. (1983). Agreement between physicians on assessment of outcome following severe head injury. J Neurosurg, 58(3), 321-325.
MacKenzie, E. J., McCarthy, M. L., Ditunno, J. F., Forrester-Staz, C., Gruen, G. S., Marion, D. W., & Schwab, W. C. (2002). Using the SF-36 for characterizing outcome after multiple trauma involving head injury. J Trauma, 52(3), 527-534.
Malasi, T. H., Mirza, I. A., & el-Islam, M. F. (1991). Validation of the Hospital Anxiety and Depression Scale in Arab patients. Acta Psychiatr Scand, 84(4), 323-326.
Malec, J., & Lezak, M. (2003). Manual for The Mayo-Portland Adaptability Inventory (MPAI-4) 1-77.
Malec, J. F. (2001). Impact of comprehensive day treatment on societal participation for persons with acquired brain injury. Arch Phys Med Rehabil, 82(7), 885-895.
Malec, J. F. (2004a). Comparability of Mayo-Portland Adaptability Inventory ratings by staff, significant others and people with acquired brain injury. Brain Inj, 18(6), 563-575.
Malec, J. F. (2004b). The Mayo-Portland Participation Index: A brief and psychometrically sound measure of brain injury outcome. Arch Phys Med Rehabil, 85(12), 1989-1996.
Malec, J. F., Buffington, A. L., Moessner, A. M., & Degiorgio, L. (2000a). A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes. Arch Phys Med Rehabil, 81(8), 1007-1015.
Malec, J. F., & Degiorgio, L. (2002). Characteristics of successful and unsuccessful completers of 3 postacute brain injury rehabilitation pathways. Arch Phys Med Rehabil, 83(12), 1759-1764.
Malec, J. F., Kean, J., Altman, I. M., & Swick, S. (2012). Mayo-Portland adaptability inventory: comparing psychometrics in cerebrovascular accident to traumatic brain injury. Arch Phys Med Rehabil, 93(12), 2271-2275.
Malec, J. F., Kragness, M., Evans, R. W., Finlay, K. L., Kent, A., & Lezak, M. D. (2003). Further psychometric evaluation and revision of the Mayo-Portland Adaptability Inventory in a national sample. J Head Trauma Rehabil, 18(6), 479-492.
Malec, J. F., Moessner, A. M., Kragness, M., & Lezak, M. D. (2000b). Refining a measure of brain injury sequelae to predict postacute rehabilitation outcome: rating scale analysis of the Mayo-Portland Adaptability Inventory. J Head Trauma Rehabil, 15(1), 670-682.
Malec, J. F., & Thompson, J. M. (1994). Relationship of the Mayo-Portland Adaptability Inventory to functional outcome and cognitive performance measures. J Head Trauma Rehabil, 9(4), 1-15.
Mallinson, S. (2002). Listening to respondents: a qualitative assessment of the Short-Form 36 Health Status Questionnaire. Soc Sci Med, 54(1), 11-21.
Mao, H. F., Hsueh, I. P., Tang, P. F., Sheu, C. F., & Hsieh, C. L. (2002). Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke, 33(4), 1022-1027.
Marion, D. W., & Carlier, P. M. (1994). Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries: results of a national survey. J Trauma, 36(1), 89-95.
Massagli, T. L., Michaud, L. J., & Rivara, F. P. (1996). Association between injury indices and outcome after severe traumatic brain injury in children. Arch Phys Med Rehabil, 77(2), 125-132.
Matsushima, M., Yabe, I., Uwatoko, H., Shirai, S., Hirotani, M., & Sasaki, H. (2014). Reliability of the Japanese version of the Berg balance scale. Intern Med, 53(15), 1621-1624.
Mayo, N. E., Wood-Dauphinee, S., Cote, R., Durcan, L., & Carlton, J. (2002). Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil, 83(8), 1035-1042.
McCauley, S. R., Hannay, H. J., & Swank, P. R. (2001). Use of the Disability Rating Scale Recovery curve as a predictor of psychosocial outcome following closed-head injury. J Int Neuropsychol Soc, 7(4), 457-467.
McCullagh, S., Oucherlony, D., Protzner, A., Blair, N., & Feinstein, A. (2001). Prediction of neuropsychiatric outcome following mild trauma brain injury: an examination of the Glasgow Coma Scale. Brain Inj, 15(6), 489-497.
McDowell, I. (2006). Measuring health: a guide to rating scales and questionnaires: Oxford University Press.
McDowell, I., & Newell, C. (1996). Measuring health: A Guide to Rating Scales and Questionnaires (Vol. 2nd ed. ).
McHorney, C. A. (1996). Measuring and monitoring general health status in elderly persons: practical and methodological issues in using the SF-36 Health Survey. Gerontologist, 36(5), 571-583.
McHorney, C. A., Ware, J. E., Jr., & Raczek, A. E. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care, 31(3), 247-263.
McNaughton, H. K., Weatherall, M., & McPherson, K. M. (2005). Functional measures across neurologic disease states: analysis of factors in common. Arch Phys Med Rehabil, 86(11), 2184-2188.
McPherson, K. M., & Pentland, B. (1997). Disability in patients following traumatic brain injury–which measure? Int J Rehabil Res, 20(1), 1-10.
McPherson, K. M., Pentland, B., Cudmore, S. F., & Prescott, R. J. (1996). An inter-rater reliability study of the Functional Assessment Measure (FIM+FAM). Disabil Rehabil, 18(7), 341-347.
Mills, R., Young, C., Nicholas, R., Pallant, J., & Tennant, A. (2009). Rasch analysis of the Fatigue Severity Scale in multiple sclerosis. Mult Scler, 15(1), 81-87.
Mossberg, K., & McFarland, C. (2001). A patient-oriented health status measure in outpatient rehabilitation. Am J Phys Med Rehabil, 80(12), 896-902.
Murray, G. D., Teasdale, G. M., Braakman, R., Cohadon, F., Dearden, M., Iannotti, F., Karimi, A., Lapierre, F., Maas, A., Ohman, J., Persson, L., Servadei, F., Stocchetti, N., Trojanowski, T., & Unterberg, A. (1999). The European Brain Injury Consortium Survey of Head Injuries. Acta Neurochir (Wien), 141(3), 223-236.
Mykletun, A., Stordal, E., & Dahl, A. A. (2001). Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry, 179, 540-544.
Mysiw, W. J., Corrigan, J. D., Hunt, M., Cavin, D., & Fish, T. (1989). Vocational evaluation of traumatic brain injury patients using the functional assessment inventory. Brain Inj, 3(1), 27-34.
Nakamura, D. M., Holm, M. B., & Wilson, A. (1999). Measures of balance and fear of falling in the elderly: a review. Physical & Occupational Therapy in Geriatrics, 15(4), 17-32.
Neese, L. E., Caroselli, J. S., Klaas, P., High, W. M., Jr., Becker, L. J., & Scheibel, R. S. (2000). Neuropsychological assessment and the Disability Rating Scale (DRS): a concurrent validity study. Brain Inj, 14(8), 719-724.
Neto, F. (1993). The satisfaction with life scale: Psychometrics properties in an adolescent sample. Journal of Youth and Adolescence, 22(2), 125-134.
Novack, T. A., Bergquist, T. F., Bennett, G., & Gouvier, W. D. (1991). Primary caregiver distress following severe head injury. Journal of Head Trauma Rehabilitation, 6(4), 69-77.
Novack, T. A., Dowler, R. N., Bush, B. A., Glen, T., & Schneider, J. J. (2000). Validity of the Orientation Log, relative to the Galveston Orientation and Amnesia Test. J Head Trauma Rehabil, 15(3), 957-961.
O’Mahony, P. G., & Rodgers H, T. R., Dobson R, James OFW. (1998). Is the SF-36 suitable for assessing health status of older
stroke patients? 27:19-22. Age Ageing, 27, 19-22.
Ocampo, S., Dawson, D., & Colantonio, A. (1997). Outcomes after head injury: level of agreement between subjects and their informants. Occupational Therapy International, 4(3), 163-179.
Oczkowski, W. J., & Barreca, S. (1993). The functional independence measure: its use to identify rehabilitation needs in stroke survivors. Arch Phys Med Rehabil, 74(12), 1291-1294.
Oppenheim, J. S., & Camins, M. B. (1992). Predicting outcome in brain-injured patients. Using the Glasgow Coma Scale in primary care practice. Postgrad Med, 91(8), 261-264, 267-268.
Ottenbacher, K. J., Hsu, Y., Granger, C. V., & Fiedler, R. C. (1996). The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil, 77(12), 1226-1232.
Paniak, C., Phillips, K., Toller-Lobe, G., Durand, A., & Nagy, J. (1999). Sensitivity of three recent questionnaires to mild traumatic brain injury-related effects. J Head Trauma Rehabil, 14(3), 211-219.
Pastorek, N. J., Hannay, H. J., & Contant, C. S. (2004). Prediction of global outcome with acute neuropsychological testing following closed-head injury. J Int Neuropsychol Soc, 10(6), 807-817.
Pavot, W., & Diener, E. (1993). Review of the Satisfaction With Life Scale. Psychological Assessment, 5(2), 164-172.
Pavot, W., & Diener, E. (1993). Review of the Satisfaction with Life Scale. Psychological Assessment, 5, 164-172.
Pavot, W., Diener, E., Colvin, C. R., & Sandvik, E. (1991). Further validation of the Satisfaction with Life Scale: evidence for the cross-method convergence of well-being measures. J Pers Assess, 57(1), 149-161.
Petrella, R. J., Overend, T., & Chesworth, B. (2002). FIM after hip fracture: is telephone administration valid and sensitive to change? Am J Phys Med Rehabil, 81(9), 639-644.
Pettigrew, L. E., Wilson, J. T., & Teasdale, G. M. (1998). Assessing disability after head injury: improved use of the Glasgow Outcome Scale. J Neurosurg, 89(6), 939-943.
Pettigrew, L. E., Wilson, J. T., & Teasdale, G. M. (2003). Reliability of ratings on the Glasgow Outcome Scales from in-person and telephone structured interviews. J Head Trauma Rehabil, 18(3), 252-258.
Pierre, U., Wood-Dauphinee, S., Korner-Bitensky, N., Gayton, D., & Hanley, J. (1998). Proxy use of the Canadian SF-36 in rating health status of the disabled elderly. J Clin Epidemiol, 51(11), 983-990.
Pons, D., Atienza, F. L., Balaguer, I., & Garcia-Merita, M. L. (2000). Satisfaction with life scale: analysis of factorial invariance for adolescents and elderly persons. Percept Mot Skills, 91(1), 62-68.
Rao, N., & Kilgore, K. M. (1992). Predicting return to work in traumatic brain injury using assessment scales. Arch Phys Med Rehabil, 73(10), 911-916.
Rappaport, M., Hall, K. M., Hopkins, K., Belleza, T., & Cope, D. N. (1982). Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil, 63(3), 118-123.
Riddle, D. L., & Stratford, P. W. (1999). Interpreting validity indexes for diagnostic tests: an illustration using the Berg balance test. Phys Ther, 79(10), 939-948.
Ring, H., Feder, M., Schwartz, J., & Samuels, G. (1997). Functional measures of first-stroke rehabilitation inpatients: usefulness of the Functional Independence Measure total score with a clinical rationale. Arch Phys Med Rehabil, 78(6), 630-635.
Roberts, L., & Counsell, C. (1998). Assessment of clinical outcomes in acute stroke trials. Stroke, 29(5), 986-991.
Rowley, G., & Fielding, K. (1991). Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. Lancet, 337(8740), 535-538.
Ruchinskas, R. A., & Curyto, K. J. (2003). Cognitive screening in geriatric rehabilitation. Rehabil Psychol, 48(1), 14-22.
Rutledge, R., Lentz, C. W., Fakhry, S., & Hunt, J. (1996). Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma, 41(3), 514-522.
Salbach, N. M., Mayo, N. E., Higgins, J., Ahmed, S., Finch, L. E., & Richards, C. L. (2001). Responsiveness and predictability of gait speed and other disability measures in acute stroke. Arch Phys Med Rehabil, 82(9), 1204-1212.
Sander, A. M., Fuchs, K. L., High, W. M., Jr., Hall, K. M., Kreutzer, J. S., & Rosenthal, M. (1999). The Community Integration Questionnaire revisited: an assessment of factor structure and validity. Arch Phys Med Rehabil, 80(10), 1303-1308.
Sander, A. M., Seel, R. T., Kreutzer, J. S., Hall, K. M., High, W. M., Jr., & Rosenthal, M. (1997). Agreement between persons with traumatic brain injury and their relatives regarding psychosocial outcome using the Community Integration Questionnaire. Arch Phys Med Rehabil, 78(4), 353-357.
Satz, P., Zaucha, K., Forney, D. L., McCleary, C., Asarnow, R. F., Light, R., Levin, H., Kelly, D., Bergsneider, M., Hovda, D., Martin, N., Caron, M. J., Namerow, N., & Becker, D. (1998). Neuropsychological, psychosocial and vocational correlates of the Glasgow Outcome Scale at 6 months post-injury: a study of moderate to severe traumatic brain injury patients. Brain Inj, 12(7), 555-567.
Schonberger, M., & Ponsford, J. (2010). The factor structure of the Hospital Anxiety and Depression Scale in individuals with traumatic brain injury. Psychiatry Res, 179(3), 342-349.
Schwarzbold, M. L., Diaz, A. P., Nunes, J. C., Sousa, D. S., Hohl, A., Guarnieri, R., Linhares, M. N., & Walz, R. (2014). Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury. Rev Bras Psiquiatr, 36(3), 206-212.
Seale, G. S., Caroselli, J. S., High, W. M., Becker, C. L., Neese, L. E., & Scheibel, R. (2002). Use of the Community Integration Questionnaire (CIQ) to characterize changes in functioning for individuals with traumatic brain injury who participated in a post-acute rehabilitation programme. Brain Injury, 16(11), 955-967.
Seel, R. T., Kreutzer, J. S., & Sander, A. M. (1997). Concordance of patients’ and family members’ ratings of neurobehavioral functioning after traumatic brain injury. Arch Phys Med Rehabil, 78(11), 1254-1259.
Segal, M. E., Gillard, M., & Schall, R. (1996). Telephone and in-person proxy agreement between stroke patients and caregivers for the functional independence measure. Am J Phys Med Rehabil, 75(3), 208-212.
Segal, M. E., & Schall, R. R. (1994). Determining functional/health status and its relation to disability in stroke survivors. Stroke, 25(12), 2391-2397.
Shevlin, M., Brunsden, V., & Miles, J. N. V. (1998). Satisfaction With Life Scale: analysis of factorial invariance, mean structures and reliability. Personality and Individual Differences, 25(5), 911-916.
Shukla, D., Devi, B. I., & Agrawal, A. (2011). Outcome measures for traumatic brain injury. Clin Neurol Neurosurg, 113(6), 435-441.
Shumway-Cook, A., Baldwin, M., Polissar, N. L., & Gruber, W. (1997). Predicting the probability for falls in community-dwelling older adults. Phys Ther, 77(8), 812-819.
Singh, A., Black, S. E., Herrmann, N., Leibovitch, F. S., Ebert, P. L., Lawrence, J., & Szalai, J. P. (2000). Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook Stroke Study. Stroke, 31(3), 637-644.
Smith, P. M., Illig, S. B., Fiedler, R. C., Hamilton, B. B., & Ottenbacher, K. J. (1996). Intermodal agreement of follow-up telephone functional assessment using the Functional Independence Measure in patients with stroke. Arch Phys Med Rehabil, 77(5), 431-435.
Snaith, R. P. (2003). The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes, 1, 29.
Sternbach, G. L. (2000). The Glasgow coma scale. J Emerg Med, 19(1), 67-71.
Stevenson, T. J. (2001). Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother, 47(1), 29-38.
Suhr, J. A., & Grace, J. (1999). Brief cognitive screening of right hemisphere stroke: relation to functional outcome. Arch Phys Med Rehabil, 80(7), 773-776.
Taylor, R. R., Jason, L. A., & Torres, A. (2000). Fatigue rating scales: an empirical comparison. Psychol Med, 30(4), 849-856.
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2(7872), 81-84.
Teasdale, G., & Jennett, B. (1976). Assessment and prognosis of coma after head injury. Acta Neurochir (Wien), 34(1-4), 45-55.
Teasdale, G., Jennett, B., Murray, L., & Murray, G. (1983). Glasgow Coma Scale: to sum or not to sum? The Lancet, 322(8351), 678.
Teasdale, G., Knill-Jones, R., & van der Sande, J. (1978). Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry, 41(7), 603-610.
Teasdale, G. M., & Murray, L. (2000). Revisiting the Glasgow Coma Scale and Coma Score. Intensive Care Med, 26(2), 153-154.
Teasdale, G. M., Pettigrew, L. E., Wilson, J. T., Murray, G., & Jennett, B. (1998). Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma, 15(8), 587-597.
Teng, E. L., & Chui, H. C. (1987). The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry, 48(8), 314-318.
Teoh, L. S., Gowardman, J. R., Larsen, P. D., Green, R., & Galletly, D. C. (2000). Glasgow Coma Scale: variation in mortality among permutations of specific total scores. Intensive Care Med, 26(2), 157-161.
Tepper, S., Beatty, P., & DeJong, G. (1996). Outcomes in traumatic brain injury: self-report versus report of significant others. Brain Inj, 10(8), 575-581.
Timmons, M., Gasquoine, L., & Scibak, J. W. (1987). Functional changes with rehabilitation of very severe traumatic brain injury survivors. J Head Trauma Rehabil, 2(3), 64-73.
Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: a comprehensive review. J Am Geriatr Soc, 40(9), 922-935.
Truelle, J. L., Koskinen, S., Hawthorne, G., Sarajuuri, J., Formisano, R., Von Wild, K., Neugebauer, E., Wilson, L., Gibbons, H., Powell, J., Bullinger, M., Hofer, S., Maas, A., Zitnay, G., & Von Steinbuechel, N. (2010). Quality of life after traumatic brain injury: the clinical use of the QOLIBRI, a novel disease-specific instrument. Brain Inj, 24(11), 1272-1291.
Turner-Stokes, L., Nyein, K., Turner-Stokes, T., & Gatehouse, C. (1999). The UK FIM+FAM: development and evaluation. Functional Assessment Measure. Clin Rehabil, 13(4), 277-287.
Turner-Stokes, L., & Siegert, R. J. (2013). A comprehensive psychometric evaluation of the UK FIM + FAM. Disabil Rehabil, 35(22), 1885-1895.
Tyson, S. F., & Brown, P. (2014). How to measure fatigue in neurological conditions? A systematic review of psychometric properties and clinical utility of measures used so far. Clin Rehabil, 28(8), 804-816.
Udekwu, P., Kromhout-Schiro, S., Vaslef, S., Baker, C., & Oller, D. (2004). Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma, 56(5), 1084-1089.
van Baalen, B., Odding, E., Maas, A. I., Ribbers, G. M., Bergen, M. P., & Stam, H. J. (2003). Traumatic brain injury: classification of initial severity and determination of functional outcome. Disabil Rehabil, 25(1), 9-18.
van der Putten, J. J., Hobart, J. C., Freeman, J. A., & Thompson, A. J. (1999). Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry, 66(4), 480-484.
von Steinbuchel, N., Wilson, L., Gibbons, H., Hawthorne, G., Hofer, S., Schmidt, S., Bullinger, M., Maas, A., Neugebauer, E., Powell, J., von Wild, K., Zitnay, G., Bakx, W., Christensen, A. L., Koskinen, S., Sarajuuri, J., Formisano, R., Sasse, N., & Truelle, J. L. (2010). Quality of Life after Brain Injury (QOLIBRI): scale development and metric properties. J Neurotrauma, 27(7), 1167-1185.
Wade, D. T. (1992). Measurement in neurological rehabilitation. Curr Opin Neurol Neurosurg, 5(5), 682-686.
Wallace, D., Duncan, P. W., & Lai, S. M. (2002). Comparison of the responsiveness of the Barthel Index and the motor component of the Functional Independence Measure in stroke: the impact of using different methods for measuring responsiveness. J Clin Epidemiol, 55(9), 922-928.
Walters, S. J., Munro, J. F., & Brazier, J. E. (2001). Using the SF-36 with older adults: a cross-sectional community-based survey. Age Ageing, 30(4), 337-343.
Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 30(6), 473-483.
Waxman, K., Sundine, M. J., & Young, R. F. (1991). Is early prediction of outcome in severe head injury possible? Arch Surg, 126(10), 1237-1241; discussion 1242.
Wee, J. Y., Bagg, S. D., & Palepu, A. (1999). The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting. Arch Phys Med Rehabil, 80(4), 448-452.
Wee, J. Y., Wong, H., & Palepu, A. (2003). Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation. Arch Phys Med Rehabil, 84(5), 731-735.
Weinberger, M., Oddone, E. Z., Samsa, G. P., & Landsman, P. B. (1996). Are health-related quality-of-life measures affected by the mode of administration? J Clin Epidemiol, 49(2), 135-140.
Weinfurt, K. P., Willke, R., Glick, H. A., & Schulman, K. A. (1999). Towards a composite scoring solution for the Neurobehavioral Functioning Inventory. Qual Life Res, 8(1-2), 17-24.
Westaway, M. S., Maritz, C., & Golele, N. J. (2003). Empirical testing of the Satisfaction With Life Scale: a South African pilot study. Psychol Rep, 92(2), 551-554.
Whelan-Goodinson, R., Ponsford, J., & Schonberger, M. (2009). Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. J Affect Disord, 114(1-3), 94-102.
Whitney, S. L., Poole, J. L., & Cass, S. P. (1998). A review of balance instruments for older adults. Am J Occup Ther, 52(8), 666-671.
WHO. (2001). International Classification of Functioning, Disability and Health: ICF. Retrieved from http://www.who.int/classifications/icf/en/
Willer, B., Button, J., & Rempel, R. (1999). Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: a case control study. Arch Phys Med Rehabil, 80(4), 399-406.
Willer, B., Ottenbacher, K. J., & Coad, M. L. (1994). The community integration questionnaire. A comparative examination. Am J Phys Med Rehabil, 73(2), 103-111.
Willer, B., Rosenthal, M., Kreutzer, J., Gordon, W., & Rempel, R. (1993). Assessment of community integration following rehabilitation for traumatic brain injury. J Head Trauma Rehabil, 8(2), 75-87.
Williams, L. S., Weinberger, M., Harris, L. E., & Biller, J. (1999). Measuring quality of life in a way that is meaningful to stroke patients. Neurology, 53(8), 1839-1843.
Wilson, J. T., Edwards, P., Fiddes, H., Stewart, E., & Teasdale, G. M. (2002). Reliability of postal questionnaires for the Glasgow Outcome Scale. J Neurotrauma, 19(9), 999-1005.
Wilson, J. T., Pettigrew, L. E., & Teasdale, G. M. (1998). Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma, 15(8), 573-585.
Wilson, J. T., Pettigrew, L. E., & Teasdale, G. M. (2000). Emotional and cognitive consequences of head injury in relation to the glasgow outcome scale. J Neurol Neurosurg Psychiatry, 69(2), 204-209.
Witol, A. D., Kreutzer, J. S., & Sander, A. M. (1999). Emotional, behavioral and personality assessment after traumatic brain injury. In Rosenthal M, Kreutzer J S, Griffith E R, & P. B. (Eds.), Rehabilitation of the Adult and Child with Traumatic Brain Injury. (Vol. F.A. Davis Company, pp. 167-182): Philadelphia, PA.
Wood-Dauphinee, S., Berg, K., Bravo, G., & Williams, J. I. (1996). The balance scale: Responsiveness to clinically meaningful changes. Canadian Journal of Rehabilitation, 10(1), 35-50.
Wu, C.-h., & Yao, G. (2006). Analysis of factorial invariance across gender in the Taiwan version of the Satisfaction with Life Scale. Personality and Individual Differences, 40(6), 1259-1268.
Young, B., Rapp, R. P., Norton, J. A., Haack, D., Tibbs, P. A., & Bean, J. R. (1981). Early prediction of outcome in head-injured patients. J Neurosurg, 54(3), 300-303.
Zafonte, R. D., Hammond, F. M., Mann, N. R., Wood, D. L., Black, K. L., & Millis, S. R. (1996). Relationship between Glasgow coma scale and functional outcome. Am J Phys Med Rehabil, 75(5), 364-369.
Zafonte, R. D., Mann, N. R., Millis, S. R., Black, K. L., Wood, D. L., & Hammond, F. (1997). Posttraumatic amnesia: its relation to functional outcome. Arch Phys Med Rehabil, 78(10), 1103-1106.
Zhang, L., Abreu, B. C., Gonzales, V., Seale, G., Masel, B., & Ottenbacher, K. J. (2002). Comparison of the Community Integration Questionnaire, the Craig Handicap Assessment and Reporting Technique, and the Disability Rating Scale in traumatic brain injury. J Head Trauma Rehabil, 17(6), 497-509.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatr Scand, 67(6), 361-370.
Ziino, C., & Ponsford, J. (2005). Measurement and prediction of subjective fatigue following traumatic brain injury. J Int Neuropsychol Soc, 11(4), 416-425.
Zwick, D., Rochelle, A., Choksi, A., & Domowicz, J. (2000). Evaluation and treatment of balance in the elderly: A review of the efficacy of the Berg Balance Test and Tai Chi Quan. NeuroRehabilitation, 15(1), 49-56.
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17.1.1 Evaluation Criteria for Outcome Measures