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Assessment of the Psychometric Properties of the Brachial Assessment Tool (BrAT) a New Patient-reported Outcome Measure for Adult Traumatic Brachial Plexus Injury
Bridget Hill, MD1; Julie Pallant, MD2; Gavin Williams, MD3; Scott Ferris, MD4; John Olver, MD3; Andrea Bialocerkowski, MD1
1Menzies Health Institute, Griffith University, Queensland, Australia; 2University of Melbourne, Melbourne, Australia; 3Epworth Monash Rehabilitation Unit, Melbourne, Australia; 4Alfred Healthcare, The Alfred, Melbourne, Australia

Introduction: People with Brachial Plexus Injury (BPI) form a very heterogeneous group, with a wide spectrum of ability to use their affected limb. While a number of patient-reported outcome measures have been used to assess outcome following adult traumatic BPI, none has been psychometrically evaluated for this population. This paper outlines the development of a new BPI specific patient–reported outcome measure, the BrAT, based on the International Classification of Functioning, Disability and Health (ICF) definition of activity.

Method: The development of the BrAT followed a number of steps including:

  • Item generation - involving adults with BPI and clinical experts
  • Item reduction - using a consensus based approach
  • Pilot testing of a 51 item pro-forma by adults with traumatic BPI
  • Rasch analysis to determine content validity and unidimensionality. Items were removed in a series of iterations based on misfit to the model, local dependency, targeting to ability, importance and difficulty as determined by people with BPI.
  • Classical test theory to determine the psychometric properties of test retest, construct validity and responsiveness

Results: One hundred and six adults with a traumatic BPI completed a 51-item BrAT proforma. Participants mean age was 40 years (range 18-82) and mean time post injury was 121 weeks (range 10 - 740 weeks). Injury severity ranged from pan plexus to those with infraclavicular injury. Items retained represented 16 of the 29 ICF Comprehensive Core Set for Hand Conditions (CCS-HC) activity categories.

Conclusion: Preliminary analysis shows the BrAT to be a unidimensional; targeted patient reported measure of the upper limb following adult traumatic BPI that assess a cross section of day-to-day activity as defined by the CCS-HC.

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