What is it about?

This paper explains how expert clinical judgement is included in a statistical process called Rasch analysis to streamline an existing measure of vocational behavior after brain injury. Having a measure redesigned by and for clinicians that is both clinically efficient AND statistically robust is critical, and this paper describes that redesign process.

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Why is it important?

Brain injuries can impact a client's workplace safety, productivity, and interpersonal behaviors. Because most workers only get one chance to successfully return to work (RTW), measuring and treating those behaviors BEFORE a client’s attempt a RTW is critical. Measuring the RTW challenges clients face will aide occupational therapists and rehabilitation counselors when discussing the importance of clinical rehab of RTW issues with their medical model colleagues.


Clinicians and rehab counselors feel their real-world feedback on what to measure and how to measure it is not always accounted for in research efforts. This is especially true when it comes to tools intended for daily use in resource-constrained clinical environments & vocational programs. If the end user doesn’t have confidence in the clinical utility of a measurement tool, they will be less likely to use it. Our mission in this paper was to describe not only the statistical process behind a measure redesign effort (Rasch analysis), but also to emphasize how expert clinical feedback can inform and even 'override the numbers' regarding item inclusion or adjustment. The tool we selected for redesign measures basic employment characteristics of safety, productivity, and interpersonal relations after brain injury. The measure that resulted from this process, the Employment Feasibility Checklist (EFC), is not only statistically validated but also is up to 43% more efficient for clinicians to use than the original measure. The authors also ‘put their money where their statistics are’, in that we use the tool in our own clinics!

Matt Dodson

Read the Original

This page is a summary of: Use of item response theory to develop a return to work measure for acquired brain injury: The employment feasibility checklist, Work, January 2023, IOS Press,
DOI: 10.3233/wor-211055.
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