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

Figures & data

Table 1. Demographic and injury characteristics of the calibration sample

Variable	Emotional domain sample, N = 716; Mean (SD), N (%)
Age (years)	43.0 (15.3)
Age at injury (years)	36.1 (16.8)
Sex
Male	558 (78%)
Female	158 (22%)
Ethnicity
Hispanic	81 (11%)
Non-Hispanic	631 (88%)
Not reported/Refused	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	49 (7%)
Not provided/Refused	4 (1%)
Level of Education
High school or less	274 (38.3%)
Some college	248 (34.6%)
Bachelor's degree or more	194 (27.1%)
Time Since Injury	7.1 (10.0)
<1 year post injury	195 (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	230 (32%)
Unknown	4 (0%)

Table 2. Grief and Loss items and item bank parameters

		Item response theory calibration statistics
Item ID	Item stem	Slope	Threshold 1	Threshold 2	Threshold 3	Threshold 4
Grief_14	I spent a lot of time thinking about what I have lost since my injury	2.08941	−0.79108	0.07601	0.91063	1.73104
Grief_16	I felt sad thinking about things I used to enjoy	3.00519	−0.71947	−0.11166	0.78169	1.48040
Grief_15	Because of my injury, I felt like I lost many opportunities	2.49928	−0.75116	−0.22986	0.56348	1.21498
Grief_29	I felt that I lost my former life	3.01344	−0.44494	0.02941	0.70042	1.21062
Grief_10	I had difficulty accepting my injury	2.18233	0.05849	0.64106	1.37461	1.82508
Grief_7	I longed for the life I had before my injury	2.61178	−0.94542	−0.33790	0.41467	0.91664
Grief_2	I missed out on life because of my injury	2.53096	−0.45129	0.10510	0.88385	1.51899
Grief_21	I have lost spontaneity in my life.	1.64954	−0.45633	0.21509	1.13592	2.04732
Grief_13	Because of my injury, I was distressed about the abilities that I have lost	2.91124	−0.72949	−0.08964	0.81757	1.59383
Grief_30	I was overwhelmed by everything that has happened to me	1.74946	−0.00510	0.80341	1.82045	2.47958
Grief_28	I missed the activities I used to do	2.44946	−1.48060	−0.93461	0.04140	0.68014
Grief_20	Because of my injury, I had difficulty adjusting to the changes in my body	1.84725	−0.40213	0.25354	1.46142	2.35339
Grief_11	I felt that my injury has taken away my future	3.15448	−0.19293	0.22748	1.06119	1.54145
Grief_9	I questioned why I was injured	1.69676	0.16936	0.69776	1.49720	2.00782
Grief_6	I felt lost because of my injury	2.92100	0.30080	0.78731	1.62381	2.35060
Grief_1	I felt I lost time because of my injury	2.10622	−0.62952	−0.14542	0.70884	1.45129
Grief_24	I felt that I am not who I used to be	2.37777	−0.67015	−0.06706	0.68927	1.25193

Context for all grief and loss items was ‘In the past 7 days…’; Response set was 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 Grief and Loss Item Bank Information and Precision.

Table 3. Accuracy of variable- and fixed-length CAT and 9-item short form: correlations with full-bank score

Mode	N	# Items admin				%Min	%Max	Corr. w/Full bank
		Mean	SD	Min	Max
Variable-length CAT (min 4)	716	6.0	2.7	4	12	42.7	13.0	0.98
Variable-length CAT (min 8)	716	8.6	1.4	8	12	82.3	13.0	0.99
9-Item fixed-length CAT	716	9	0	9	9	n/a	n/a	0.99
9-Item short form	716	9	0	9	9	n/a	n/a	0.99

Figure 2. Measurement reliability by T-Score and assessment method.

Table 4. Breadth of coverage for variable length CAT, fixed length CAT, 9-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	50.0 ± 9.6	29.4–79.8	0.3%	4.9%	0.30 ± 0.05	0.26–0.49
Variable-length CAT (min 8)	716	50.0 ± 9.6	29.4–79.8	0.3%	4.9%	0.56 ± 0.06	0.20–0.49
9-Item fixed-length CAT	716	49.9 ± 9.6	29.9–79.1	0.3%	5.4%	0.25 ± 0.07	0.19–0.49
9-Item short form	716	50.0 ± 9.5	31.0–76.0	1.4%	6.2%	0.27 ± 0.08	0.20–0.51
Full bank	716	49.9 ± 9.7	29.1–80.0	0.3%	4.8%	2.18 ± 0.75	0.16–0.48

Table 5. T-score lookup table for SCI-QOL Grief/Loss SF9a

Raw score	Scaled score	Standard error
9	30.9	5.1
10	35.3	3.9
11	37.4	3.6
12	39.4	3.3
13	41.0	3.1
14	42.3	2.9
15	43.6	2.8
16	44.7	2.7
17	45.8	2.6
18	46.7	2.5
19	47.7	2.5
20	48.6	2.5
21	49.4	2.4
22	50.3	2.4
23	51.1	2.4
24	51.9	2.4
25	52.7	2.4
26	53.5	2.4
27	54.3	2.4
28	55.1	2.4
29	55.9	2.4
30	56.7	2.4
31	57.5	2.4
32	58.3	2.4
33	59.1	2.4
34	60.0	2.4
35	60.8	2.5
36	61.8	2.5
37	62.7	2.5
38	63.7	2.6
39	64.7	2.7
40	65.9	2.8
41	67.2	2.9
42	68.6	3.0
43	70.2	3.3
44	72.3	3.5
45	76.1	4.4