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Psychometric Properties of the Multidimensional Assessment of Fatigue Scale in Traumatic Brain Injury: An NIDRR Traumatic Brain Injury Model Systems Study

Lequerica, Anthony PhD; Bushnik, Tamara PhD; Wright, Jerry MS, CBIST; Kolakowsky-Hayner, Stephanie A. PhD, CBIST; Hammond, Flora M. MD; Dijkers, Marcel P. PhD; Cantor, Joshua PhD

Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p E28–E35
doi: 10.1097/HTR.0b013e31826fe574
Original Articles

Objective: To investigate the psychometric properties of the Multidimensional Assessment of Fatigue (MAF) scale in a traumatic brain injury (TBI) sample.

Design: Prospective survey study.

Setting: Community.

Participants: One hundred sixty-seven individuals with TBI admitted for inpatient rehabilitation, enrolled into the TBI Model Systems national database, and followed up at either the first or second year postinjury.

Interventions: Not applicable.

Main Outcome Measure(s): Multidimensional Assessment of Fatigue.

Results: The initial analysis, using items 1 to 14, which are based on a 10-point rating scale, found that only 1 item (“walking”) misfit the overall construct of fatigue in this TBI population. However, this 10-point rating scale was found to have disordered thresholds. When ratings were collapsed into 4 response categories, all MAF items used to calculate the Global Fatigue Index formed a unidimensional scale.

Conclusion(s): Findings generally support the unidimensionality of the MAF when used in a TBI population but call into question the use of a 10-point rating scale for items 1 to 14. Further study is needed to investigate the use of a 4-category rating scale across all items and the fit of the “walking” item for a measure of fatigue among individuals with TBI.

Kessler Foundation Research Center, West Orange, New Jersey (Dr Lequerica); University of Medicine and Dentistry of New Jersey, Newark, New Jersey (Dr Lequerica); Rusk Institute for Rehabilitation Medicine, NYU Langone School of Medicine, New York, New York (Dr Bushnik); Santa Clara Valley Medical Center, Rehabilitation Research Center, San Jose, California (Ms Wright and Dr Kolakowsky-Hayner); Carolinas Rehabilitation, Charlotte, North Carolina (Ms Hammond); Indiana University School of Medicine, Indianapolis, Indiana (Ms Hammond); and Mount Sinai School of Medicine, New York, New York (Drs Dijkers and Cantor).

Corresponding Author: Anthony Lequerica, PhD, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ 07042 (

This study was funded by grants from the National Institution on Disability and Rehabilitation Research (NIDRR): H133A070037, H133A070038, H133A070042, H133A070033-09. The authors thank the research participants, research assistants, and all project staff for their assistance in the success of this endeavor. In addition, they would like to acknowledge the continued support of our project officers and program director at NIDRR.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.