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      Measuring grief and loss after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Grief and Loss item bank and short form

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          To develop an item response theory (IRT) calibrated Grief and Loss item bank as part of the Spinal Cord Injury – Quality of Life (SCI-QOL) measurement system.


          A literature review guided framework development of grief/loss. New items were created from focus groups. Items were revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis (CFA), graded response IRT modeling and evaluation of differential item functioning (DIF).


          We tested a 20-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital.


          A total of 717 individuals with SCI answered the grief and loss questions.


          The final calibrated item bank resulted in 17 retained items. A unidimensional model was observed (CFI = 0.976; RMSEA = 0.078) and measurement precision was good (theta range between −1.48 to 2.48). Ten items were flagged for DIF, however, after examination of effect sizes found this to be negligible with little practical impact on score estimates.


          This study indicates that the SCI-QOL Grief and Loss item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.

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          Most cited references 26

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          Treatment of complicated grief: a randomized controlled trial.

          Complicated grief is a debilitating disorder associated with important negative health consequences, but the results of existing treatments for it have been disappointing. To compare the efficacy of a novel approach, complicated grief treatment, with a standard psychotherapy (interpersonal psychotherapy). Two-cell, prospective, randomized controlled clinical trial, stratified by manner of death of loved one and treatment site. A university-based psychiatric research clinic as well as a satellite clinic in a low-income African American community between April 2001 and April 2004. A total of 83 women and 12 men aged 18 to 85 years recruited through professional referral, self-referral, and media announcements who met criteria for complicated grief. Participants were randomly assigned to receive interpersonal psychotherapy (n = 46) or complicated grief treatment (n = 49); both were administered in 16 sessions during an average interval of 19 weeks per participant. Treatment response, defined either as independent evaluator-rated Clinical Global Improvement score of 1 or 2 or as time to a 20-point or better improvement in the self-reported Inventory of Complicated Grief. Both treatments produced improvement in complicated grief symptoms. The response rate was greater for complicated grief treatment (51%) than for interpersonal psychotherapy (28%; P = .02) and time to response was faster for complicated grief treatment (P = .02). The number needed to treat was 4.3. Complicated grief treatment is an improved treatment over interpersonal psychotherapy, showing higher response rates and faster time to response.
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            Initial research on loss and potentially traumatic events (PTEs) has been dominated by either a psychopathological approach emphasizing individual dysfunction or an event approach emphasizing average differences between exposed and nonexposed groups. We consider the limitations of these approaches and review more recent research that has focused on the heterogeneity of outcomes following aversive events. Using both traditional analytic tools and sophisticated latent trajectory modeling, this research has identified a set of prototypical outcome patterns. Typically, the most common outcome following PTEs is a stable trajectory of healthy functioning or resilience. We review research showing that resilience is not the result of a few dominant factors, but rather that there are multiple independent predictors of resilient outcomes. Finally, we critically evaluate the question of whether resilience-building interventions can actually make people more resilient, and we close with suggestions for future research on resilience. © 2011 by Annual Reviews. All rights reserved
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              Cognitive interviewing: A tool for improving questionnaire design


                Author and article information

                J Spinal Cord Med
                J Spinal Cord Med
                The Journal of Spinal Cord Medicine
                Maney Publishing
                May, 2015
                : 38
                : 3 , The Spinal Cord Injury - Quality of Life Measurement System: Development, Psychometrics, and Item Bank Calibration Guest Editors: David S. Tulsky, PhD and Pamela A. Kisala, MA Guest Associate Editor: J. Scott Richards, PhD
                : 347-355
                [1 ]Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
                [2 ]New York University Langone Medical Center, New York, NY, USA
                [3 ]Kessler Foundation Research Center, West Orange, NJ, USA
                [4 ]Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
                Author notes
                Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA. Email: dtulsky@ .
                © The Academy of Spinal Cord Injury Professionals, Inc. 2015

                MORE OpenChoice articles are open access and distributed under the terms of the Creative Commons Attribution License 3.0

                Research Articles


                psychometrics, quality of life, patient outcomes assessment, spinal cord injuries, grief


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