Measuring self-esteem after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Self-esteem item bank and short form

Figures & data

Table 1. Participant characteristics

Variable	Emotional domain sample, N = 717; Mean (SD), N (%)
Age (years)	43.0 (15.3)
Age at injury (years)	36.1 (16.8)
Sex
Male	559 (78%)
Female	158 (22%)
Ethnicity
Hispanic	82 (11%)
Non-Hispanic	631 (88%)
Unknown/Not reported	4 (1%)
Race
Caucasian	505 (70%)
African-American	125 (17%)
Asian	8 (1%)
American Indian/Alaska Native or Native Hawaiian/Pacific Islander	7 (1%)
More than one race	9 (1%)
Other	50 (7%)
Unknown/Not reported	13 (2%)
Time since injury	7.1 (10.0)
<1 year post injury	196 (27%)
1–3 years post injury	186 (26%)
>3 years post injury	335 (47%)
Diagnosis
Paraplegia complete	182 (25%)
Paraplegia incomplete	143 (20%)
Tetraplegia complete	157 (22%)
Tetraplegia incomplete	231 (33%)
Unknown	4 (1%)

Table 2. Self-esteem items and item bank parameters

			Item response theory calibration statistics
Item ID	Response set	Item stem	Slope	Threshold 1	Threshold 2	Threshold 3	Threshold 4
SelfE_13	a	I felt bad about myself.	2.88369	−2.09421	−1.39942	−0.50925	0.18300
SelfE_10	a	I've been unhappy with the person I've become since my injury.	2.36523	−2.16006	−1.50417	−0.71821	−0.04493
AltStem_NQSTG07	a	Because of my injury, I felt embarrassed in social situations.	2.58943	−2.12140	−1.45995	−0.58047	0.04373
AltStem_NQSTG12	a	I am unhappy about how my injury affected my appearance.	2.20770	−1.46038	−0.87027	0.02849	0.62986
SelfE_27	b	I had high self-esteem.	2.03773	−1.97060	−1.17425	−0.10977	0.85562
SelfE_9	a	Because of my injury, I worried about performing tasks in front of other people.	2.12675	−2.12899	−1.35373	−0.41048	0.20603
SelfE_33	b	I felt good about myself.	2.46332	−2.36479	−1.46769	−0.39789	0.62883
SelfE_15	a	I felt insecure.	2.63998	−2.33476	−1.51394	−0.52884	0.20976
SelfE_25	a	I felt invisible to other people.	1.53538	−3.93586	−2.73207	−1.12792	−0.31595
Self_23	a	I was unhappy with the way my clothes fit me.	1.28351	−2.42998	−1.57067	−0.38942	0.33344
SelfE_8	a	I felt it was difficult to achieve goals I set for myself.	1.87950	−2.13671	−1.27073	0.01359	0.72910
SelfE_32	b	I was comfortable with myself.	2.14478	−1.97928	−1.27433	−0.30659	0.65866
SelfE_17	b	I felt attractive.	1.56495	−1.74028	−0.73346	0.55838	1.38189
SelfE_18	a	I was ashamed of my injury.	2.48201	−2.24720	−1.77481	−1.04727	−0.55576
SelfE_26	a	I felt embarrassed about needing a bowel or bladder management program.	1.68809	−2.09160	−1.49499	−0.59452	−0.02095
SelfE_22	a	I was unhappy with changes in my posture.	1.38021	−2.34324	−1.22061	−0.24168	0.38506
AltStem_NQSTG17	a	I felt embarrassed about my physical limitations.	2.65439	−2.09386	−1.46426	−0.50970	0.04897
SelfE_7	a	Because of my injury, I was unhappy with who I am.	3.33880	−2.03852	−1.30383	−0.54243	−0.05638
SelfE_12	a	I felt inferior to my friends or family.	2.64976	−2.32666	−1.70477	−0.84988	−0.32136
AltStem_NQSTG20	a	I tended to blame myself for my problems.	1.45220	−2.24114	−1.47577	−0.47925	0.19288
SelfE_24	a	I felt I was no longer a "whole person".	2.68332	−1.73861	−1.23531	−0.50265	−0.00837
SelfE_14	a	I had poor self-esteem.	3.74315	−2.07225	−1.34651	−0.52923	0.06185
SelfE_20	a	I always compared myself to people who have not been injured.	1.78641	−2.10016	−1.40414	−0.44759	0.17593

NOTE: Context for all self-esteem items is ‘Lately’; Response set ‘a’ was: 5 = Never/4 = Rarely/3 = Sometimes/2 = Often/1 = Always; Response set ‘b’ is 1 = Never/2 = Rarely/3 = Sometimes/4 = Often/5 = Always.

Items in bold represent short form selections. Items and parameters copyright © 2015 David Tulsky and Kessler Foundation. All Rights Reserved. Scales should be accessed and used through the corresponding author or http://www.assessmentcenter.net. Do not modify items without permission from the copyright holder.

Figure 1. SCI-QOL Self-esteem Item Bank Information and Precision

Figure 2. Measurement Reliability by T-Score and Assessment Method. Note: CAT, Computer Adaptive Testing, which was simulated from calibration data using Firestar³⁶

Table 3. Accuracy of variable- and fixed-length CAT and 8-item short form: correlations with full-bank score

Mode	N	# Items admin						Corr. w/Full-bank score
		Mean	SD	Min	Max	%Min	%Max
Variable-length CAT (min 4)	716	6.78	3.17	4	12	40.4	20.7	0.974
Variable-length CAT (min 8)	716	8.98	1.64	8	12	71.0	20.7	0.983
8-Item fixed-length CAT	716	8	0	8	8	n/a	n/a	0.975
8-Item short form	716	8	0	8	8	n/a	n/a	0.953

Table 4. Breadth of coverage for variable length CAT, fixed length CAT, 8-item short form, and full item bank

Mode	N	T score				Standard error
		Mean ± SD	Range	% Ceiling	% Floor	Mean ± SD	Range
Variable-length CAT (min 4)	716	50.45 ± 9.57	18.86–70.07	5.03%	0.14%	0.307 ± 0.067	0.248–0.529
Variable-length CAT (min 8)	716	50.45 ± 9.58	18.86–70.07	5.03%	0.14%	0.275 ± 0.083	0.190–0.529
8-Item fixed-length CAT	716	50.48 ± 9.58	20.16–68.90	6.42%	0.56%	0.286 ± 0.096	0.190–0.543
8-Item short form	716	50.25 ± 9.05	21.30–63.90	14.94%	0.28%	0.327 ± 0.116	0.21–0.57
Full bank	716	50.36 ± 9.65	18.50–70.80	4.33%	0.14%	0.216 ± 0.089	0.140–0.510

Table 5. T-score lookup table for SCI-QOL Self-esteem SF8a

Raw score	Scaled score	Standard error
8	19.6	4.5
9	21.9	4.0
10	24.0	3.6
11	26.1	3.2
12	27.7	3.0
13	29.1	2.8
14	30.4	2.7
15	31.6	2.7
16	32.7	2.6
17	33.8	2.6
18	34.8	2.6
19	35.8	2.6
20	36.8	2.6
21	37.7	2.6
22	38.7	2.6
23	39.6	2.6
24	40.6	2.6
25	41.5	2.6
26	42.4	2.6
27	43.3	2.6
28	44.3	2.6
29	45.2	2.6
30	46.2	2.6
31	47.1	2.6
32	48.1	2.6
33	49.2	2.7
34	50.3	2.8
35	51.6	2.9
36	53.0	3.2
37	54.6	3.4
38	56.7	3.9
39	58.7	4.1
40	63.9	5.7