ORIGINAL ARTICLE Development of the Participation Assessment With Recombined Tools–Objective for Use After Traumatic Brain Injury Gale G. Whiteneck, PhD, Marcel P. Dijkers, PhD, Allen W. Heinemann, PhD, Jennifer A. Bogner, PhD, Tamara Bushnik, PhD, Keith D. Cicerone, PhD, John D. Corrigan, PhD, Tessa Hart, PhD, James F. Malec, PhD, Scott R. Millis, PhD ABSTRACT. Whiteneck GG, Dijkers MP, Heinemann AW, Bogner JA, Bushnik T, Cicerone KD, Corrigan JD, Hart T, Malec JF, Millis SR. Development of the Participation Assess- ment With Recombined Tools–Objective for use after trau- matic brain injury. Arch Phys Med Rehabil 2011;92:542-51. Objective: To develop a new measure, the Participation Assessment With Recombined Tools–Objective (PART-O), based on items from 3 participation instruments. Design: Instrument development based on survey research. Setting: Community. Participants: Adults (N=400) with traumatic brain injury (TBI) 1 to 15 years postinjury, recruited from 8 TBI Model Systems (TBIMS). Interventions: None. Main Outcome Measure: Community Integration Question- naire version 2; Participation Objective, Participation Subjective; Craig Handicap Assessment and Reporting Technique; PART-O. Results: Using Rasch rating scale analysis to evaluate the psychometric properties of participation items drawn from 3 instruments, a set of 24 items was developed that covered a broad range of participation content and formed a measure with person separation of 2.47, person reliability of .86, item spread of 4.25 logits, item separation of 11.36, and item reliability of .99. Items were well targeted on the sample with only 1 item misfitting. The PART-O showed expected relationships with measures of impairment, activity limitations, and subjective well-being. Conclusions: The 24-item PART-O is an acceptable mea- sure of objective participation for persons with moderate and severe TBI. It has been adopted as the measure of participation in the TBIMS. Key Words: Brain injury, chronic; Interpersonal relations; Outcome assessment, health care; Psychometrics; Question- naires; Rehabilitation; Reproducibility of results; Role; Social adjustment. © 2011 by the American Congress of Rehabilitation Medicine W ITH THE PUBLICATION of the ICF, the World Health Organization attempted to differentiate “health-related states,” or more specifically disablement, into separate domains. Impairment (or its positive counterpart, Body Functions and Structures) is distinguished from Activity Limitations (activities) and Participation Restrictions (participation). Participation is defined as “involvement in life situations,” 1(p14) whereas par- ticipation restrictions are defined as “problems an individual may experience in involvement in life situations.” 1(p14) The construct of participation restrictions has much in common with the concept of handicap as it was used in the forerunner of the ICF, the International Classification of Impairments, Dis- From Craig Hospital, Englewood, CO (Whiteneck); Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY (Dijkers); Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago (Heinemann); Rehabilitation Institute of Chicago (Heinemann), Chicago, IL; Ohio State University, Columbus, OH (Bogner, Corrigan); Rusk Insti- tute for Rehabilitation Medicine–NYU Langone Medical Center, New York, NY (Bushnik); JFK Johnson Rehabilitation Institute, Edison, NJ (Cicerone); Moss Reha- bilitation Research Institute, Elkins Park, PA (Hart); Rehabilitation Hospital of Indiana, Indianapolis, IN (Malec); and Wayne State University School of Medicine, Detroit, MI (Millis). Supported by the National Institute on Disability and Rehabilitation Research through Traumatic Brain Injury Model System (TBIMS) awards to the Rocky Moun- tain Regional Brain Injury System (grant nos. H133A020510, H133A070022); New York TBIMS (grant nos. H1331020501, H133A070033); Ohio Regional TBIMS (grant nos. H133A020503, H133A070029); Northern California TBIMS (grant nos. H133A020524, H133A070038); JFK Johnson Rehabilitation Institute TBIMS (grant nos. H133A020518, H133A070030); The Moss TBIMS (grant nos. H133A020505, H133A070040); Rehabilitation Research and Training Center on the Community Integration of Individuals With Traumatic Brain Injury (grant no. H133B30038); and Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (grant no. H133B040032). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organi- zation with which the authors are associated. Correspondence to Gale G. Whiteneck, PhD, Director of Research, Craig Hospital, 3425 S Clarkson St, Englewood, CO 80113, e-mail: gale@craig-hospital.org. Re- prints are not available from the author. Published online March 2, 2011 at www.archives-pmr.org 0003-9993/11/9204-00401$36.00/0 doi:10.1016/j.apmr.2010.08.002 List of Abbreviations CHART Craig Handicap Assessment and Reporting Technique CHART-SF Craig Handicap Assessment and Reporting Technique–Short Form CIQ Community Integration Questionnaire CIQ-2 Community Integration Questionnaire version 2 DRS Disability Rating Scale GCS Glasgow Coma Scale GOS Glasgow Outcome Scale GOS-E Glasgow Outcome Scale–Extended ICF International Classification of Functioning, Disability and Health M2PI Mayo-Portland Participation Index PART-O Participation Assessment With Recombined Tools–Objective POPS Participation Objective, Participation Subjective PTA posttraumatic amnesia SRS Supervision Rating Scale TBI traumatic brain injury TBIMS Traumatic Brain Injury Model Systems 542 Arch Phys Med Rehabil Vol 92, April 2011