Introduction

Community participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking.

Objective

The purpose of this study was to examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury.

Design

This was a repeated measures study with assessments administered twice (3 months apart).

Setting

Assessments were administered either over the phone, virtually (Zoom), or in person at the participant's home.

Participants

We recruited 44 participants from community settings who had either experienced a TBI within the previous year or were receiving rehabilitation interventions.

Main Outcome Measure

The Enfranchisement scale has two subscales: the Control subscale (range: 13-65) and the Importance subscale (range: 14-70). On both subscales, lower scores indicate better enfranchisement. We used the software SAS PROC Logistic and the macro %ROCPlot to examine cut points at varying levels of sensitivity and specificity. We also calculated the area under the ROC curve to determine overall classification accuracy. We calculated minimum detectable change and minimal clinically important difference.

Results

For the Control subscale, we found a cut point of 44 (AUC=.75), a minimum detectable change 8 and a minimal clinically important difference of 5. For the Importance subscale, we found a cut point of 39 (AUC=.81), a minimum detectable change of 8 and a minimal clinically important difference of 5.

Conclusions

Our cut points resulted in good classification accuracy, providing support for their reliability. We found evidence that both subscales are sensitive to change in adults with brain injury.

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