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Rasch Analysis of the Behavioral Assessment Screening Tool (BAST) in Chronic Traumatic Brain Injury

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Abstract

The Behavioral Assessment Screening Tool (BAST) measures neurobehavioral symptoms in adults with traumatic brain injury (TBI). Exploratory Factor Analyses established five subscales: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse. In the current study, we assessed all the subscales except Substance Abuse using Rasch analysis following the Rasch Reporting Guidelines in Rehabilitation Research (RULER) framework. RULER identifies unidimensionality and fit statistics, item hierarchies, targeting, and symptom severity strata as areas of interest for Rasch analysis. The BAST displayed good unidimensionality with only one item from the Impulsivity scale exhibiting potential item misfit (MnSQ 1.40). However, removing this item resulted in a lower average domain measure (1.42 to − 1.49) and higher standard error (0.34 to 0.43) so the item was retained. Items for each of the four subscales also ranged in difficulty (i.e. endorsement of symptom frequency) with more severe symptoms being endorsed in the Fatigue subscale and more mild symptoms being endorsed in the Impulsivity subscale. Though Negative Affect and Executive Function displayed appropriate targeting, the Fatigue and Impulsivity Subscales had larger average domain values (1.35 and − 1.42) meaning that more items may need to be added to these subscales to capture differences across a wider range of symptom severity. The BAST displayed excellent reliability via item and person separation indices and distinct strata for each of the four subscales. Future work should use Rasch analysis in a larger, more representative sample, include more items for the Fatigue and Impulsivity subscale, and include the Substance Abuse subscale.

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Data Availability

The dataset generated for this study will not be made publicly available. The corresponding author can provide the dataset upon request and execution of the necessary data use agreements.

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Funding

This work was funded by the National Institutes for Health, Eunice Kennedy Shriver.

National Institute of Child Health and Human Development (NIH/NICHD). Grant No: R03HD09445 (PI: Juengst).  Funding for RedCap to support data collection came from CTSA NIH Grant UL1TR001105.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9055, USA

    Shannon Juengst

  2. Department of Applied Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA

    Shannon Juengst & Brittany Wright

  3. Department of Health Professions, Medical University of South Carolina, Charleston, SC, USA

    Emily Grattan

  4. Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA

    Lauren Terhorst

Authors
  1. Shannon Juengst
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  2. Emily Grattan
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  4. Lauren Terhorst
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Corresponding author

Correspondence to Shannon Juengst.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical Approval

Approval was obtained from the Institutional Review Board (IRB) at UT Southwestern Medical Center and the study was performed in line with the principles of the Declaration of Helsinki.

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Participants involved in this study were made aware of and consented to publication.

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Juengst, S., Grattan, E., Wright, B. et al. Rasch Analysis of the Behavioral Assessment Screening Tool (BAST) in Chronic Traumatic Brain Injury. J. Psychosoc. Rehabil. Ment. Health 8, 231–246 (2021). https://doi.org/10.1007/s40737-021-00218-8

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  • DOI: https://doi.org/10.1007/s40737-021-00218-8

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