Validation of the brain injury associated visual impairment ‑ impact questionnaire (BIVI‑IQ)

Lauren Hepworth, Jamie Kirkham, E Perkins, B Helliwell, C Howard, M Liptrot, S Tawana, E Wilson, Fiona Rowe

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Purpose: The Brain Injury associated Visual Impairment - Impact Questionnaire (BIVI-IQ) was developed to assess the impact of post-stroke visual impairment. The development of the questionnaire used robust methods involving stroke survivors and clinicians. The aim of this study was to assess the validity of the BIVI-IQ in a stroke population.

Methods: Stroke survivors with visual impairment were recruited from stroke units, outpatient clinics and non-healthcare settings. Participants were asked to complete questionnaire sets on three separate occasions; the BIVI-IQ at each visit with additional questionnaires at baseline and visit 2. Vision assessment and anchor questions from participants and clinicians were collected. The analysis included assessment of missing data, acceptability, Rasch model analysis, test–retest reliability, construct validity (NEI VFQ-25, EQ-5D-5L) and responsiveness to change.

Results: 316 stroke survivors completed at least one questionnaire of the 326 recruited. Mean age was 67 years and 64% were male. Adequate ft statistics to the Rasch model were reached (χ2=73.12, p=0.02) with two items removed and thresholds of two adjusted, indicating validity and unidimensionality. Excellent test–retest reliability was demonstrated (ICC=0.905) with a 3-month interval. Construct validity was demonstrated with a strong signifcant correlation to the NEI VFQ-25 (r=0.837,
p<0.01). The BIVI-IQ also demonstrated responsiveness to change with signifcant diferences identifed between groups based on participant and clinician anchor questions (X2=23.29, p<0.001; X2=24.56, p<0.001).

Conclusion The BIVI-IQ has been shown to be valid and practical for ‘everyday’ use by clinicians and researchers to monitor vision-related quality of life in stroke survivors with visual impairment.
Original languageEnglish
Pages (from-to)77–791
Number of pages15
JournalQuality of Life Research
Publication statusPublished - 19 Dec 2023


  • Brain injury
  • Stroke
  • Visual impairment
  • PROM
  • Quality of life
  • Impact


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