The Community Integration Questionnaire (CIQ)

Abstract

The Community Integration Questionnaire (CIQ) is a concise, 15-item inventory developed to quantify the level of community integration achieved by individuals, particularly those who have undergone rehabilitation following a Traumatic Brain Injury (TBI). The CIQ assesses integration across three primary domains: Home Integration, Social Integration, and Productivity (covering employment, education, and volunteer work). Developed by Willer and colleagues in 1993, the instrument is designed to be a brief and reliable indicator of post-acute rehabilitation adjustment, successfully distinguishing between TBI patients and non-impaired populations. A higher score on the CIQ (ranging from 0 to 29) indicates greater integration.

Keywords

Community Integration Questionnaire, CIQ, Traumatic Brain Injury, TBI, Rehabilitation, Social Integration, Home Integration, Productivity, Outcome Measure, Neuropsychology.

Authors

Willer, B., Rosenthal, M., Kreutzer, S., Gordon, A., Rempel, R.

Purpose

The primary purpose of the Community Integration Questionnaire (CIQ) is to provide a standardized, brief, and reliable measure of an individual’s level of functional independence and engagement within their home and broader community environment. It was specifically created to evaluate the long-term outcomes of rehabilitation programs for persons who have sustained a Traumatic Brain Injury (TBI).

The tool defines integration broadly, encompassing participation in the home, maintenance of social networks, and engagement in productive activities such as employment, school, or volunteer work. Although the CIQ was validated using the TBI population, it is explicitly noted by the authors that it is applicable to all individuals, disabled or not, who are living outside of institutional settings.

Construct

The CIQ measures the psychological construct of Community Integration, which is viewed as a key component of successful post-injury adjustment. This comprehensive construct is operationalized through three distinct subscales:

• Home Integration: Measures the degree of independence and participation in domestic activities and household management (e.g., shopping, cooking, housework, managing finances).
• Social Integration: Reflects the frequency and quality of social interactions, including participation in leisure activities and maintaining close friendships.
• Productivity: Quantifies engagement in socially valued roles, specifically work, school/training, and volunteer activities.

The developers stress that the CIQ provides a finite set of indicators of integration and should be used in conjunction with other clinical and demographic measures to capture a complete picture of an individual’s disability and environmental barriers.

Validity

In the foundational study (Willer et al., 1993), the CIQ demonstrated strong discriminative validity. The instrument was shown to reliably differentiate between individuals with TBI and those in a control group without obvious impairments. This suggests the CIQ effectively measures differences in community functioning related to the injury.

Furthermore, the study provided evidence of criterion-related validity by showing that patients with TBI who received rehabilitation through specialized Model Systems programs scored significantly better on the Home and Social integration subscales compared to TBI patients who did not receive the same intensive rehabilitation. This supports the CIQ’s utility as an outcome measure sensitive to the effectiveness of clinical interventions.

Reliability

The psychometrics of the Community Integration Questionnaire are thoroughly documented in the 1993 reference. The authors confirmed the instrument’s reliability in its ability to consistently discriminate between clinical and non-impaired populations. The CIQ is intended to be a reliable, brief measure suitable for clinical and research settings focused on long-term functional recovery.

Factor Analysis

The three-factor structure of the CIQ (Home Integration, Social Integration, and Productivity) was established based on both a logical grouping of activities and formal statistical investigation. The authors utilized principal components analysis to confirm that the items clustered together according to these three conceptual domains of everyday life.

The derived subscales allow clinicians and researchers to analyze integration within specific life domains:

• Home Integration: Summation of items 1 through 5.
• Social Integration: Summation of items 6 through 11.
• Productivity: Summation of item 12 (Travel outside of home) and the composite Productivity variable (derived from items 13, 14, and 15).

Instrument

Test Type: Self-report inventory, often administered with an interviewer present.

Format: 15 items. Scoring results in an overall score ranging from 0 to 29. A complex scoring procedure is used for the Productivity variable (Items 13-15).

Language Available: English (Original version).

Population Group: Primarily used for individuals recovering from Traumatic Brain Injury (TBI).

Age Group: Adults (implied by items related to work, finances, and household management).

Population Details: Applicable to all individuals living outside of institutional settings.

Test Methodology: The questionnaire is ideally completed by the assessed individual. If the individual has receptive or expressive language deficits, memory impairment, or physical disabilities, a proxy familiar with the individual may complete the form, provided the assessed individual is present. Items require respondents to indicate who performs specific activities (alone, with someone else, or by someone else).

Keywords

Neurorehabilitation, Head Injury, Outcome Assessment, Functional Independence, Psychometrics, Model Systems, Quality of Life, Social Participation.

Authors

Author ORCID Identifier: Information not provided in source.

Affiliation Email addresses: Information not provided in source.

Correspondence Address: Information not provided in source.

Permissions & Fee and Test Year

Test Year: 1993.

Permissions and Fees: Information regarding current commercial licensing or fees is not provided in the source material. The CIQ is generally considered a widely used clinical and research tool, often available for non-commercial use.

Reference’s

Willer, B., Rosenthal, M., Kreutzer, S., Gordon, A., & Rempel, R. (1993). Assessment of community integration following rehabilitation for traumatic brain injury. Journal of Head Trauma Rehabilitation, 8(2).

Items of the The Community Integration Questionnaire (CIQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Subject: Date:

1. Who usually does the shopping for groceries or other necessities in your household?	❍ Yourself alone ❍ Yourself and someone else ❍ Someone else
2. Who usually prepares meals in your household?	❍ Yourself alone ❍ Yourself and someone else ❍ Someone else
3. In your home who usually does the everyday housework?	❍ Yourself alone ❍ Yourself and someone else ❍ Someone else
4. Who usually cares for the children in your home?	❍ Yourself alone ❍ Yourself and someone else ❍ Someone else ❍ Not applicable, No children under 17 in the home
5. Who usually plans social arrangements such as get-together s with family and friends?	❍ Yourself alone ❍ Yourself and someone else ❍ Someone else
6. Who usually looks after your personal finances, such as banking or paying bills?	❍ Yourself alone ❍ Yourself and someone else ❍ Someone else
7. Approximately how many times a month do you usually participate in shopping outside your home?	❍ Never ❍ 1 – 4 times ❍ 5 or more
8. Approximately how many times a month do you usually participate in leisure activities such as movies, sports, restaurants, etc.	❍ Never ❍ 1 – 4 times ❍ 5 or more
9. Approximately how many times a month do you usually visit your friends or relatives?	❍ Never ❍ 1 – 4 times ❍ 5 or more
10. When you participate in leisure activities do you usually do this alone or with others?	❍ Mostly alone ❍ Mostly with friends who have head injuries ❍ Mostly with family member s ❍ Mostly with friends who do not have head injuries ❍ With a combination of family and friends

Please complete page two

11. Do you have a best friend with whom you confide?	❍ Yes ❍ No
12. How often do you travel outside the home?	❍ Almost every day ❍ Almost every week ❍ Seldom/never (less than once per week)
13. Please choose the answer that best corresponds to your current (during the past month) work situation:	❍ Full-time (more than 20 hours/week) ❍ Part-time (less than or equal to 20 hrs/week) ❍ Not working, but actively looking for work ❍ Not working, not looking for work ❍ Not applicable, retired due to age
14. Please choose the answer that best corresponds to your current (during the past month) school or training program situation:	❍ Full-time ❍ Part-time ❍ Not attending school, or training program ❍ Not applicable, retired due to age
15. In the past month, how often did you engage in volunteer activities?	❍ Never ❍ 1 – 4 times ❍ 5 or more

Scoring Guidelines

The CIQ consists of a total of 15 questions. The overall score, which represents a summation of the scores from individual questions, can range from 0 to 29. A higher score indicates greater integration, and a lower score reflects less integration. The CIQ can be further divided into three subscores, corresponding to integration in the home, social integration, and productivity.

The following guidelines provide scoring information for specific items or groups of items:

Items 1 to 6:

Score: 2	=	The activity is performed alone
1	=	The activity is performed with someone else
0	=	The activity is performed by someone else
		Note: For item 4, if there are no children under 17 in the home, the average (mean) score for items 1 through 3 and item 5 should be substituted.

Items 7 to 9:

Score:
2	=	The activity was performed 5 or more times in the past month
1	=	The activity was performed 1 – 4 times in the past month
0	=	The activity was not performed in the past month

Item 10:

Score:
2	=	Mostly with friends without head injury or combination of family and friends
1	=	Mostly with friends who have head injuries or with family
0	=	Mostly alone

Item 11:

Score:

• 2 = Yes response
• 0 = No response

Item 12:

Score:
2	=	Almost every day
1	=	Almost every week
0	=	Seldom/never (less than once per week)

Items 13 to 15 (Productivity Variable):

These items are collected individually but combined to form one variable, Productivity. The scoring of this variable is dependent on the combination of answers to questions 13, 14, and 15.

Scoring of the Productivity Variable

Question#13 Work		Question #14 School		Question#15 Volunteer Work	Score
Not working/not looking	+	No school	+	No Volunteering	= 0
Not working/not looking	+	No school	+	1-4 times/month	= 1
Not working/not looking	+	No school	+	5 or more times/month	= 1
Not working/looking	+	No school	+	No Volunteering	= 0
Not working/looking	+	No school	+	1-4 times/month	= 2
Not working/looking	+	No school	+	5 or more times/month	= 2
Retired due to age	+	No school	+	No Volunteering	= 0
Retired due to age	+	No school	+	1-4 times/month	= 2
Retired due to age	+	No school	+	5 or more times/month	= 3
Retired due to age	+	Part time	+	No Volunteering	= 4
Retired due to age	+	Part time	+	1-4 times/month	= 5
Retired due to age	+	Part time	+	5 or more times/month	= 5
Retired due to age	+	Full-time	+	Any answer	= 5
Not working	+	Full-time	+	Any answer	= 3
Not working	+	Part-time	+	Any answer	= 4
Part-time	+	No school	+	Any answer	= 3
Part-time	+	Part-time	+	Any answer	= 4
Part-time	+	Full-time	+	Any answer	= 5
Full time	+	No school	+	Any answer	= 4
Full-time	+	Part-time	+	Any answer	= 5

Subscales

Subscales were developed to allow for a detailed analysis of integration across different domains of everyday life. These groupings were determined logically and supported by principal components analysis of the clustered items. The CIQ total score is the additive sum of items 1 through 12 and the derived Productivity variable.

The subscales are calculated as follows:

• Home Integration: Summation of items 1 through 5.
• Social Integration: Summation of items 6 through 11.
• Productivity: Summation of item 12 and the Productivity variable (Items 13, 14, 15 combined).

The scoring sheet below provides a structure for calculating both the subscale scores and the overall CIQ total score:

Item Number	CIQ Scoring Sheet Description	Score
1	Shopping
2	Prepare Meals
3	Housework
4	Caring for Children
5	Social Arrangements
	HOME INTEGRATION SUBSCALE
6	Personal Finances
7	Shopping (times/month)
8	Leisure activities (times/month)
9	Visiting friends or relatives
10	Leisure activities (with whom)
11	Having a best friend
	SOCIAL INTEGRATION SUBSCALE
12	Travel outside of home
13,14,15	Productivity
	PRODUCTIVITY SUBSCALE
	CIQ TOTAL SCORE