Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4035 — Improved Measures of Health-Related Quality of Life (HRQOL) for Veterans with Deployment-Related Post-Traumatic Stress Disorder (PTSD)

Lead/Presenter: Stephen Luther, COIN - North Florida/South Georgia and Tampa
All Authors: Luther SL (HSR&D Center of Innovation on Disability and Rehabilitation Research) Toyinbo P (HSR&D Center of Innovation on Disability and Rehabilitation Research) Erbes C (Minneapolis VA Health Care System) Kisala P (University of Delaware) Marx B (VA Boston Healthcare System) Campbell T (Hunter Holmes McGuire VA Medical Center) Tulsky D (University of Delaware)

Objectives:
Develop new and/or adapt existing PROMIS/NeuroQOL item banks and short forms that measure the impact of deployment-related post-traumatic stress disorder (PTSD) on health-related quality of life (HRQOL).

Methods:
Veteran and provider focus groups were conducted at three VA medical centers to identify HRQOL issues relevant to deployment-related PTSD. Themes were labeled within domains and were compared with existing item banks developed by the Patient-Reported Outcomes Measurement Information System (PROMIS) and Neuro-QOL. Item pools, including new and existing items, were created and iteratively refined. Because a large number of items were developed, field testing was conducted in two waves, with a minimum of 500 respondents completing each item. Using item response theory (IRT), confirmatory factor and bi-factor analyses, polytomous graded response modeling, and other methods were employed to evaluate dimensionality, item fit, scale (domain) calibration, differential item functioning (DIF), and concurrent and divergent validity.

Results:
A total of 178 new items were field tested along with relevant PROMIS/NeuroQOL items. In each survey wave, respondents were approximately 57 years of age, primarily white ( > = 90%) and approximately 40% served in the OEF/OIF/OND conflicts or Gulf War. Domains included Anger, Violence/Aggression, Avoidance/Isolation, Control Over the Environment, Social Roles, Sleep and Hypervigilance. Total number of new items ranged from 7 for the Anger domain to 39 for the for the Social Roles domain. Some of the domains currently exist in the PROMIS/NeuroQOL (e.g. Anger, Social Roles) while others describe constructs unique to deployment-related HRQOL (e.g. Avoidance/Isolation, Control Over the Environment). Psychometric testing provided strong support for the validity and reliability of the item banks and short forms in each domain. For those domains already in the PROMIS/NeuroQOL, their expansion improved the total information measured by the bank/short forms. Results for each domain will be provided.

Implications:
Results of the field test provide strong support for validity and improved reliability measure for HRQOL in Veterans with deployment-related PTSD employing methods established by the PROMIS/NeuroQOL

Impacts:
Improved measures of HRQOL for Veterans with deployment-related PTSD can facilitate improved research, program evaluation, and clinical practice.