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

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.

Neurobehavioral Symptoms and Heart Rate Variability: Feasibility of Remote Collection Using Mobile Health Technology

“…The BAST is a validated, self-reported measure of neurobehavioral symptoms common after TBI; it captures symptom frequency and behavioral manifestations of 5 symptom domains: Negative Affect, Substance Abuse, Executive Dysfunction, Fatigue, and Impulsivity. 25,26 The BAST mHealth is a 10-item short form of the BAST, developed based on results from a Rasch analysis of the BAST. 25 Two items from each BAST domain were included in the BAST mHealth .…”

“…25,26 The BAST mHealth is a 10-item short form of the BAST, developed based on results from a Rasch analysis of the BAST. 25 Two items from each BAST domain were included in the BAST mHealth . These items were selected based on item-level psychometric properties and coverage of item responses across overall symptom severity levels in their respective symptom domains.…”

“…Daily or every other day self-reported neurobehavioral symptoms were measured using the Behavioral Assessment Screening Tool (BAST) short form designed specifically for remote EMA (BAST mHealth ). The BAST is a validated, self-reported measure of neurobehavioral symptoms common after TBI; it captures symptom frequency and behavioral manifestations of 5 symptom domains: Negative Affect, Substance Abuse, Executive Dysfunction, Fatigue, and Impulsivity 25,26. The BAST mHealth is a 10-item short form of the BAST, developed based on results from a Rasch analysis of the BAST 25.…”

“…These items were selected based on item-level psychometric properties and coverage of item responses across overall symptom severity levels in their respective symptom domains. 25 We calculated average scores within person per day within each BAST mHealth domain, with scores ranging from 1 to 5 indicating symptom frequency over the past 48 hours (1 = never, 2 = rarely, 3 = sometimes, 4 = often, and 5 = very often). These day-to-day scores were used in crosscorrelation analyses and scores of more than 2 could be clinically meaningful.…”

Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury

“…The BAST is a 48-item measure of emotional and behavioral function developed and validated for adults with TBI. [31][32][33] The BAST has a 5-point ordinal response scale (Never, Rarely, Sometimes, Often, Very Often). Participants are asked how often they had experiences or symptoms in the past 2 weeks.…”