Original research
Developing an Item Bank to Measure Economic Quality of Life for Individuals With Disabilities

https://doi.org/10.1016/j.apmr.2014.02.030Get rights and content

Abstract

Objective

To develop and evaluate the psychometric properties of an item set measuring economic quality of life (QOL) for use by individuals with disabilities.

Design

Survey.

Setting

Community settings.

Participants

Individuals with disabilities completed individual interviews (n=64), participated in focus groups (n=172), and completed cognitive interviews (n=15). Inclusion criteria included the following: traumatic brain injury, spinal cord injury, or stroke; age ≥18 years; and ability to read and speak English. We calibrated the items with 305 former rehabilitation inpatients.

Interventions

None.

Main Outcome Measure

Economic QOL.

Results

Confirmatory factor analysis showed acceptable fit indices (comparative fit index=.939, root mean square error of approximation=.089) for the 37 items. However, 3 items demonstrated local item dependence. Dropping 9 items improved fit and obviated local dependence. Rasch analysis of the remaining 28 items yielded a person reliability of .92, suggesting that these items discriminate about 4 economic QOL levels.

Conclusions

We developed a 28-item bank that measures economic aspects of QOL. Preliminary confirmatory factor analysis and Rasch analysis results support the psychometric properties of this new measure. It fills a gap in health-related QOL measurement by describing the economic barriers and facilitators of community participation. Future development will make the item bank available as a computer adaptive test.

Section snippets

Literature review

We completed a review of environmental factor instruments and identified 40 potential items related to economic QOL. However, none of these items were included in the item pool due to the weaknesses listed in Table 1. Then, we conducted a comprehensive literature review of patient-reported outcome measures using the following search terms: economic satisfaction, financial satisfaction, economic well-being, and financial well-being. We identified 21 items for inclusion in the economic QOL item

Participant demographic characteristics

Hammel et al39 reported the demographic characteristics of the focus group sample. Demographic characteristics of the cognitive interview sample are shown in table 2. Of the 15 participants, 6 were diagnosed with SCI, 5 with TBI, and 4 with stroke. Mean age was 45.5±11.8 years; 67% were men. Of the participants, 33% were white, 57% were black, and 13% were another race. Hispanic or Latino ethnicity was selected by 13%. Of the participants, 53% reported the ability to walk, 47% reported using a

Discussion

Costs of health care, accessible housing, reduced employment opportunities, and other economic factors are cited consistently as important issues related to QOL by people with disabilities. Despite this need, economic factors that affect QOL after traumatic injury or stroke are an understudied area. This study used a comprehensive approach to develop a measurement tool to assess economic QOL in individuals with disabilities.

We developed item pools using a participatory action research,59

Conclusions

Using participatory action research–based qualitative methods in conjunction with a contemporary psychometric approach, we developed a 28-item bank that measures economic aspects of QOL. Preliminary CFA and Rasch analysis results support the psychometric properties of this measure. It fills a gap in HRQOL measurement by describing the economic barriers and facilitators that affect community participation. This preliminary test of the item bank requires confirmation with a larger, more

Suppliers

  • a.

    ATLAS.ti software, ATLAS.ti Scientific Software Development GmbH.

  • b.

    Lexile Framework, MetaMetrics.

  • c.

    MPlus 6.1 software, MPlus (StatModel).

  • d.

    Winsteps 2014, JM Linacre. Available at: Winsteps.com.

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  • Cited by (0)

    Supported by the National Institute on Disability and Rehabilitation Research (grant nos. H133B090024, H133A030807, and H133G070138) and the National Institutes of Health (grant no. 5R01HD054659).

    Disclosures: none.

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