Community Integration Questionnaire

TBI: (Zhang et al, 2002; n = 70; mean Glasgow Coma Scale (GCS) = 5.8 (3.05); mean time to following commands = 32.49 (32.53) days)

Means & standard deviation across scales:

Traumatic Brain Injury: (Seale at al 2002; n=71; mean GCS for subjects less than 1 year post-injury(L1Y) =6.5 (3.7); mean GCS for subjects 1-5 years post-injury (G1Y)=5.3 (2.2); mean time from injury to admission for subjects less than 1 year post injury (L1Y)=210 days (83); mean time from injury to admission for subjects 1-5 years post-injury (G1Y)=868 days (415)

Mean and Standard deviation for L1Y and G1Y groups at admission and follow-up

Traumatic Brain Injury: (Andelic et al 2016; n= 105; Mean age= 30.9(11.2); One, two, and five years post injury); CIQ total score remained stable over the first five years post-TBI.

Traumatic Brain Injury: (Zhang et al. 2002; Willer et al. 1993, n = 16, TBI patients, mean days between assessments = 10)

• Excellent test-retest reliability (ICC = 0.83-0.93, across 3 domains)
• Excellent test-retest reliability (r= 0.91 total score for individuals; r = 0.97 by proxy- family members)

Traumatic Brain Injury: (Willer et al 1993, n=16, mean days between assessments=10; Cusick et al 2000, n=204, time after discharge: 6 months – 5 years post-discharge; Seale et al 2002, n=71, 2 groups: admitted for treatment < 1 year post-injury and admitted for treatment between 1-5 years post-injury) 

• ICC values for individuals with TBI ranged from: 
  • 0.81-0.91 = total scores (Excellent)
  • 0.71-0.93 = home integration (Adequate to Excellent) 
  • 0.66-0.86 = social integration (Adequate to Excellent) 
  • 0.63-0.83 = productivity activities (Adequate to Excellent) 

Traumatic Brain Injury: (Willer et al 1993, n=16, mean days between assessments=10) 

• ICC values for family members-proxy: 
  • 0.97 = total score (Excellent)
  • 0.96 = home integration (Excellent) 
  • 0.90 = social integration (Excellent) 
  • 0.97 = productive activities (Excellent)

Traumatic Brain Injury: (Willer et al 1993, n=16, mean days between assessments=10) 

Correlations of ratings made by patients and family members 

• Excellent Home Integration r =.81* 
• Excellent Social Integration r =.74* 
• Excellent Productive Activities r =.96* 
• Excellent Total CIQ score r =.89* 

*p<.01 

Traumatic Brain Injury: (van Baalen et al, 2008; Study at discharge n=25, age range=18-50; Study at one year post-injury n=14, age range=19-51) 

• Squared Weighted Kappa Statistic between 2 raters (psychologists) for study at one year post-injury 
• Kw=0.70, 0.78 and 0.92 for social, productivity and home integration scores, respectively

Traumatic Brain Injury: (Willer et al. 1993)

• Excellent internal consistency, Cronbach's alpha = 0.76

Traumatic Brain Injury: (Corrigan et al, 1995; premorbid/control samples: premorbid TBI n=104, premorbid other disabilities n=357; disability samples: follow-up TBI n=46, follow-up other disabilities n=171) 

• Total score, Cronbach’s alpha = 0.84 (Excellent) 
• Home integration, Cronbach’s alpha = 0.95 (Excellent) 
• Social integration, Cronbach’s alpha = 0.64 (Adequate) 
• Productive activities, Cronbach’s alpha = 0.26 (Poor) 

Traumatic Brain Injury: (Willer et al, 1994; TBI n=231 male and 110 females; mean age at time of injury=28.15 (12.71) 

• Item to total correlations = 0.32 – 0.67 (Poor to Adequate) 

Traumatic Brain Injury: (Corrigan et al, 1995; premorbid/control samples: premorbid TBI n=104, premorbid other disabilities n=357; disability samples: follow-up TBI n=46, follow-up other disabilities n=171 ) 

• Sub-total to total correlations = 0.54, 0.74, 0.79 for productivity, social, home integration (Poor to Adequate) 

Acquired Brain Injury (eg, TBI, stroke, tumor, infection, others): (Kuipers et al, 2004; n=96; proxy n=121; ABI mean age=35.6; proxy mean age=34.6) 

Item Total and Item Subscale correlations for the CIQ across client and proxy ratings (Spearman’s Rho)

All correlations are significant at p <0.01, except * where p <0.05 and ns where not significant. 

Traumatic Brain Injury: (Andelic et al, 2016; n=105; Mean age= 30.9(11.2)) Internal consistency of CIQ scores was examined using Cronbach’s alpha 

• One year, Cronbach’s alpha= 0.81
• Two years, Cronbach’s alpha= 0.84
• Five years:, Cronbach’s alpha= 0.80

Traumatic Brain Injury: (Willer et al, 1994) 

The occupation subscale of the CIQ demonstrated poor to moderate correlations with the Home integration (as rated by family members), Social Integration and productive activities (as rated by both family members and TBI patient) scales (17 and .45). 

• Demonstrate 3 subscales are measuring different components of community integration. 

All three subscales (home, social, productivity) demonstrate excellent to moderate correlation to total CIQ respectively (0.82,0.80, 0.56) 

Traumatic Brain Injury: (Zhang et al, 2002)

• CIQ and CHART r=0.67 
• CIQ and DRS r=0.43 
• Chart and DRS r=0.53

Traumatic Brain Injury: (Sander et al, 1999; n=312; 75% male, 25% female; TBI > 12 months post-event) 

• 3 factors identified, corresponding to home competency, social integration and productive activity accounted for 51% variance. Finance item loaded on home competency, travelling on social integration, shopping item excluded 

Traumatic Brain Injury: (Willer et al, 1994; TBI n=231 male and 110 females; mean age at time of injury=28.15 (12.71) 

• Associations between sub-scales reported only weak to moderate correlation 

Acquired Brain Injury (eg, TBI, stroke, tumor, infection, others): (Kuipers et al, 2004; n=96; proxy n=121; ABI mean age=35.6; proxy mean age=34.6) 

• Spearman’s rho correlations between the corresponding sub-scale scores on the CIQ and the Sydney Psychosocial Reintegration Scale (SPRS) were modest but significant at the p< 0.01 level. 
• Correlations between the CIQ Home Competency and the SPRS Independent Living sub-scales were 0.42 and 0.57 for client and proxy scores, respectively. 
• Correlations between the CIQ Social Interaction and the SPRS Interpersonal Relationships sub-scales were 0.45 and 0.49 for client and proxy scores, respectively. 
• Correlations between the CIQ Productive Activity and the SPRS Occupational Activity sub-scales were 0.42 and 0.41 for client and proxy scores, respectively. 
• Total scores of the CIQ and the SPRS were correlated at 0.56 and 0.60 for client and proxy scores, respectively. 
• Stable 2-dimension solution identified (productivity vs personal life and independence vs dependence); a 3-cluster solution corresponding to the CIQ subscales could also be identified 

Traumatic Brain Injury: (Zhang et al, 2002; n = 70; mean Glasgow Coma Scale (GCS) = 5.8 (3.05); post-traumatic amnesia more than 7 days=57.60 (56.73) days; mean time to following commands = 32.49 (32.53) days); (Willer et al. 1993, n = 16, TBI patients, mean days between assessments = 10) 

Significant correlations between: 

• CHART physical domain with CIQ home and social domains and with total CIQ ratings 
• CHART social domain correlated (r=0.38) with CIQ social domain and the total CIQ score 
• CHART motor and occupation domains correlated with each CIQ domain and with total ratings (r=0.33-0.58, P < 0.01) 
• CHART total score correlated with each domain of CIQ and total score (r=0.41-0.67, P < .01) 

Traumatic Brain Injury: (Sander et al, 1999; n=312; 75% male, 25% female; TBI > 12 months post-event) 

• Significant correlations of DRS and FIM + FAM items and all CIQ sub-scales (r=-0.25 – 0.57; P < .003)

Convergent Validity

Traumatic Brain Injury: ( Burleigh et al, 1997; n=30; mean age=37 (8.61); time post-TBI=13.70 years (4.05)) 

• CIQ social integration scores were correlated with life satisfaction scores (r=0.37, p=0.047), although total scores were not (r=-0.06, p=0.77) 

Traumatic Brain Injury: (Heinemann et al, 1995—unable to find full text, taken from Salter et al, 2008) 

• CIQ subscores correlated with ratings of ADL’s (r=0.37, 0.37 and 0.40—home, social and productivity, respectively) 

Traumatic Brain Injury: (Sander et al, 1999; n=312; 75% male, 25% female; TBI > 12 months post-event) 

• Significant correlations between DRS level of function and both CIQ home (r=-0.46) and CIQ total (r=-0.47), Disability Rating Scale (DRS) employability and CIQ productivity (-0.58) and CIQ total (-0.58), Functional Assessment Measure (FAC) community access and CIQ home (r=0.46) 

Traumatic Brain Injury: (Zhang et al, 2002; n = 70; mean Glasgow Coma Scale (GCS) = 5.8 (3.05); post-traumatic amnesia more than 7 days=57.60 (56.73) days; mean time to following commands = 32.49 (32.53) days) 

• Significant associations between CIQ and DRS total scores (-0.43), CIQ home and level of functioning, cognitive ability and employability subscales of the DRS; social integration and productivity did not correlate with any DRS subscales

Discriminant Validity

Traumatic Brain Injury: (Willer et al, 1993, n = 446)

• Patients with brain injury were significantly less integrated on all subscales of the CIQ than non-injured participants. However, injured and uninjured females were equally integrated into home activities. *p-values not reported 

Traumatic Brain Injury: (Willer et al, 1993 and 1994) 

• Significant between-group differences on CIQ scores were reported in groups of TBI vs non-injured respondents. 

Traumatic Brain Injury: (Burleigh et al, 1997 and Willer et al, 1994) 

• Significant between group differences on CIQ scores in groups of independent vs supported vs institutionalized living environment (Burleigh et al, 1997 and Willer et al, 1994). 
• A significant difference was found between the three residential groups on the home integration subscale scores (Burleigh et al, 1997) 
• Significant difference between participants living in supported apartments and a residential shared home on home integration subscale scores (Burleigh et al, 1997) 
• Participants living in supported apartment settings reported significantly more home integration than did participants living in residential or shared homes (Burleigh et al, 1997) 

Traumatic Brain Injury: (Winkler et al, 2006; n=40; mean age at injury=28; mean age at time of study=36.77; mean length of PTA=65.18 days (35.05)) 

• Groups identified as high vs low integration via cluster analysis demonstrated significant differences on CIQ

Traumatic Brain injury: (Willer et al, 1993)

• Three groups of 14 rehabilitation experts created the pilot version of the CIQ. Each was then asked to focus on ones aspect of community integration (family integration, social networks and occupational integration). 
• Pilot version of the measure was tested on 49 TBI patients diagnosed with moderate to severe TBI. 
• Factor analysis resulted in 3 factors that largely mirrored those of the three groups of experts.

Traumatic Brain Injury: (Sanders et al, 1999; n = 312 TBI patients > 12 post-event; retrospective study)

Based on this data, the authors concluded:

• Subscale scores are sensitive at one year post injury 
• There does not appear to be a substantial floor effect one year post injury, although the "Productivity Activity" subscale may be more susceptible to floor effects than other subscales.
• There does not appear to be a substantial ceiling effect one year post injury, although the "social integration" subscale may be more sensitive to ceiling effects.

Traumatic Brain injury: (Gurka et al, 1999; n=88 at 6 months follow-up and n=79 at 24 month follow up; mean age=33 years (12) at 6 months follow up and mean age=39 (16) at 24 month follow up) 

• Scores are normally distributed; sensitive to a range of levels of community integration (6 and 24 months post-rehabilitation discharge) 

Traumatic Brain Injury: (Hall et al, 2001; n=48; mean age=37 years; mean years post injury=5 years) 

• Ceiling effects of 33%, 48% and 44% reported for productivity, social and home integration sub scales, respectively 

Traumatic Brain Injury: (Corrigan and Deming, 1995; n=461 individuals with TBI (n=104)and other disabilities (eg, stroke, SCI, non-traumatic brain injury, orthopedic injury, neurologic injury, other) (n=357)) 

• Normal distributions for CIQ total scores, home integration and social integration sub scales; productivity sub scale positively skewed with restricted variability in TBI samples

Change Over Time:

Traumatic Brain Injury:

• Significant change over time reported before and after rehabilitation interventions(Seale et al, 2002 and Willer et al, 1999); in pre-morbid to post-injury ratings (Corrigan and Deming, 1995)
• Smallest detectable difference (SDD) = 6.18, SDD%=20.6 (insufficient sensitivity to change (van Baalen et al, 2006; n=25 at discharge and n=14 patients one year post injury study)

Chronic SCI: (Gontkovsky et al, 2009; n = 28; AIS (% of sample), A = 32.1, B= 32.1, C= 14.4, D = 21.4; mean age = 42 (17) years, at least one year post injury)

Chronic SCI : (Gontkovsky et al, 2009)

• CIQ and CHART-SF total scores positively and significantly correlated 
• CHART-SF total score significantly correlated with all three CIQ subscales 
• CIQ total score significantly correlated with 4 of 6 CHART-SF subscales (no correlation with economic self-sufficiency and physical independence) 

Chronic SCI : (Jensen et al, 2005; n = 147; (% of sample) C1-4 = 15.6, C5-8 = 34.7, T1-5 = 10.2, T6-12 = 32.0, L1-S4/5 = 7.5; mean age = 48.8 (13.0) years; measured twice 2 to 6 years between assessments; mean time since injury 16.6 (10.4) years)

**Statistically significant differences in SF-36 MHI and social integration in individuals with and without pain suggest poorer psychological functioning and social integration among individuals who report pain.

Convergent Validity

Spinal Cord Injury: (Saffari et al, 2015; n= 220; Mean age= 58.18 (10.32); Time post injury (months)= 50.96 (35.05))

• CIQ subscale scores correlated with scores from the Spinal Cord Lesions Coping Strategies Questionnaire (SCL-CSQ) (r > 0.40)

Chronic Stroke with Aphasia: (Dalemans et al, 2010; n= 150; months post-onset 90.6 (80.9); age 35-87; minimum to severe aphasia present)

•   Excellent test-retest reliability (ICC = 0.96)

Convergent Validity

Chronic Stroke with Aphasia: (Dalemans et al, 2010) 

• Poor correlation with the Dartmouth Coop Functional Health Assessment Charts (r = -0.16) 
• Adequate correlation with the Barthel Index (r = 0.41) and Life Satisfaction Questionnaire (r = 0.35)

Geriatric: (Sighn & Sharma, 2015, n = 30, Mean + S.D = 72.96 mean days between assessments = 10, 22 male and 8 female with 24 being community dwellers and 6 old-age homes.) 

• Excellent: ICC Home integration found to be .9830 for single raters and .9914 for average measures.

Geriatric Population: (Singh & Sharma, 2015) n= 30, Mean + S.D = 72.96 Cronbach’s Alpha = .799, SD = 4.987, Mean = 22.90

Physical Disability: (Hirsh et al., 2011; Spinal Cord Injury (n=146), Multiple Sclerosis (n=174), Limb Loss (n=158), or Muscular Dystrophy (n=372); Mean Age=50.86(13.48); time post Injury not reported). 

• Total score, Cronbach’s alpha = 0.75 (Adequate to Good)
• Home integration, Cronbach’s alpha = 0.84 (Adequate to Good)
• Social integration, Cronbach’s alpha = 0.51 (Poor) 
• Productive activities, Cronbach’s alpha = 0.45 (Poor)

Burn Injury: (Gerrard et al., 2015; n=492; Mean Age=41(14); 6 months post injury) 

• CIQ-15 was changed to a 13 item questionnaire with two factors: Self/Family Care and Social Integration. 
• Total score, Cronbach’s alpha = 0.79 (Adequate to Good)
• Self/Family Care (Items 1-3, 5-7), Cronbach’s alpha = 0.80 (Adequate to Good): Response options “yourself alone” and “yourself with someone else” were combined to form only one option for items 1-3. The two original options were seen as personal preferences rather than community integration limitations. Dropping item #4 (childcare) improved the CIQ’s psychometrics. Not all respondents had children. However, the item should not be removed altogether, so as to not lose potentially meaningful data from those with children. 
• Social integration (Items 7-10, 12-15), Cronbach’s alpha = 0.77 (Adequate to Good): Item 7 was put in both Self/Family Care and Social Integration factors. Item 11 on the CIQ was also taken out of this statistic because it was deemed "not clinically meaningful.” No information is given why item 11 was not clinically meaningful.

Discriminant Validity

Physical Disability: (Hirsh et al., 2011; Spinal Cord Injury (n=146), Multiple Sclerosis (n=174), Limb Loss (n=158), or Muscular Dystrophy (n=372); Mean Age=50.86(13.48); time post Injury not reported). 

• Post Hoc comparisons indicated that MS group reported better functioning on Home Integration than the SCI group. However, the difference was modest (Cohen's d=.30) and no other significant differences were found.
• CIQ does not demonstrate measurement invariance across disability groups.