Item Banks for Measuring the Impact of Blood Pressure Dysregulation on Health-Related Quality of Life in Persons with Spinal Cord Injury
1Wecht J, 2Morin K, 3Kallen M
1Dr., Bronx, Ny - new y, USA; 2James J Peters VA Medical Center, Bronx, NY, USA; 3epartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Objective: The authors report on the development and calibration of item banks for determination of the impact of high blood pressure (HBP), low blood pressure (LBP), and autonomic dysreflexia (AD) on quality of life (QOL) in veterans and non-veterans with spinal cord injury (SCI).
Design: Field testing of a quantitative tool for assessment of the impact of blood pressure dysregulation on QOL (BPQOL) in persons with SCI.
Participants Methods: The calibration sample included 454 respondents: 262 American veterans and 186 non-veterans. A total of 181 items were identified after qualitative analysis (using focus groups and cognitive interviews), and items were written in the first person. Items identified as affecting quality of life (HBP-QOL and LBP-QOL) employed a time frame of “within the past 7 days” for responses; those identified as impacting daily activities (LBP-IMPT and AD-IMPT) employed a response time frame of “within the past month”. Example items are: “I had a headache when my bowel or bladder was full” (HBP-QOL), “I had to lean forward in m wheelchair” (LBP-IMPT), “I felt uncomfortable after eating a meal” (LBP-QOL), and “I had to call the person who takes care of me to help me manage my symptoms of AD” (AD-IMPT). Analyses included confirmatory factor analysis (CFA) and item response theory (IRT)-based model and item fit assessments. Item parameters were estimated for the HBP-QOL, LBP-IMPT, and LBP-QOL banks, which enabled their computer-adaptive-testing (CAT) readiness; 10-item short forms were also evaluated for those three item banks.
Results: Final banks included 28 items (HBP-QOL), 14 items (LBP-IMPT), 30 items (LBP-QOL), and 2 items (AD-IMPT). CFAs indicated each bank possessed essential unidimensionality (e.g., CFIs≥0.95, TLIs≥0.94, RMSEAs≤0.08), while IRT-based analyses supported appropriate individual item fit (e.g., no item misfit chi-square at p<.01). Marginal reliabilities for the HBP-QOL, LBP-IMPT, and LBP-QOL banks were 0.86, 0.72, and 0.91, respectively. Identified 10-item short forms showed acceptable reliability (i.e., ≥0.70) across average to clinically meaningful scores (e.g., evaluated T-scores 50 to 78).
Conclusion: Development of the BPQOL assessment tool will aid in the clinical evaluation of how the inability to adequately regulate BP affects QOL and impacts everyday function in persons with SCI.
Support: Veterans Affairs Rehabilitation Research & Development Service (grant # B7537R).
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