Conceptual Structure of Health-Related Quality of Life for Persons With Traumatic Brain Injury: Confirmatory Factor Analysis of the TBI-QOL

Mark Sherer, Julia M.P. Poritz, David Tulsky, Pamela Kisala, Luis Leon-Novelo, Esther Ngan

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective: To determine the factor structure of the Traumatic Brain Injury–Quality of Life (TBI-QOL) measurement system. Design: Observational. Setting: 3 TBI Model Systems rehabilitation centers. Participants: Twenty TBI-QOL item banks were administered to a sample of community-dwelling adults with TBI (N=504) as part of a study of TBI classification. A subsample of participants (n=200) was randomly selected for exploratory factor analyses, while data from the remaining participants (n=304) were used for the confirmatory factor analysis. To examine a wide range of conceptual models, confirmatory factor analyses were conducted on a total of 16 models, ranging from 1 to 7 factors. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: Initial exploratory factor analysis yielded support for a 5-factor model (negative emotion, cognitive impairment, functioning and participation, positive emotion, pain). Confirmatory factor analysis results, however, indicated a 7-factor model including physical function, physical symptoms, cognition, negative emotion, positive emotion, sense of self, and social participation (model 16; robust fit statistics root mean square error of approximation =.063, standardized root mean square residual =.035, comparative fit index =.955, Tucker-Lewis Index =.943, Bayes Information Criterion =40059.44). Conclusions: The complex 7-factor model of the TBI-QOL provides a more nuanced framework for understanding health-related quality of life for persons with TBI than the commonly used 3-factor model including physical health, mental health, and social health.

Original languageEnglish (US)
Pages (from-to)62-71
Number of pages10
JournalArchives of Physical Medicine and Rehabilitation
Issue number1
StatePublished - Jan 2020


  • Brain injuries, traumatic
  • Factor analysis, statistical
  • Patient reported outcome measures
  • Quality of life
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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