Development of Military Concussion Readiness Inventory for Dizziness and Balance

Figures & data

Figure 1 Interactions between the components of the ICF.

Note: Reprinted from the World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization; 2001. Available from: www.who.int/classifications/drafticfpracticalmanual.pdf.³⁶
Abbreviation: ICF, International Classification of Functioning, Disability and Health.

Table 1 Items included in the Military Concussion Readiness Inventory for Dizziness and Balance after the nominal group and Delphi group

Included items (n=68)	ICF codes	% Included	% Excluded
Body functions (n=8)
Anxiety, worry, fear	b1522: Range of emotions	100%	0%
Migraines/headaches	b28010: Pain in head and neck	100%	0%
Sleep deprivation: waking up at early hours/working long hours >24 hours	b1340: Sleep functions	100%	0%
Over exerting/physical exertion/excessive physical activity	b455: Exercise tolerance functions	92%	8%
Tinnitus/inner ear disturbance	b2400 Ringing in ears or tinnitus	92%	8%
Nuclear biological chemical mask	b210: Seeing functions b152: Emotional functions	85%	15%
Strain/bearing down	b5250: Elimination of feces	85%	15%
Dehydration	b54501: Maintenance of water balance	77%	23%
Activities and participation (n=37)
Abrupt movement	d410: Changing basic body position	100%	0%
Mental exertion	d240: Handling stress and other psychological demands	100%	0%
Riding in military vehicle/enclosed vehicles	d4709: Using transportation, unspecified	100%	0%
Running	d4552: Running	100%	0%
Standing in formation	d4154: Maintaining a standing position	100%	0%
Uneven surfaces	d4502: Walking on different surfaces	100%	0%
Walking in crowds	d469: Walking and moving, other specified and unspecified surfaces	100%	0%
Walking a straight line	d469: Walking and moving, other specified and unspecified surfaces	100%	0%
Adrenaline rushes, stress	d240: Handling stress and other psychological demands	92%	8%
Bending/reaching beyond neutral	d4105: Bending	92%	8%
Combat load/wearing gear	d4303: Carrying on shoulders, hip, and back	92%	8%
Drill and ceremony (D & C)	d4502: Walking on different surfaces	92%	8%
Driving	d4751: Driving motorized vehicles	92%	8%
Picking things off the ground	d4105: Bending	92%	8%
Maintaining equip/vehicles	d4550: Pulling d4551: Pushing	92%	8%
Obstacle course	d455: Moving around	92%	8%
Ruck marching	d4501: Walking long distances d4303: Carrying on shoulders, hip, and back	92%	8%
Sprinting with quick stops	d4552: Running	92%	8%
Dismounting vehicles in gear	d455: Moving around	85%	15%
Driving during the night	d4751: Driving motorized vehicles	85%	15%
Getting up (bed, chair, toilet)	d410: Changing basic body position	85%	15%
Getting in/out of bed	d4100: Lying down	85%	15%
Navigate on rough terrain	d4502: Walking on different surfaces	85%	15%
Walking/hiking narrow paths	d4509: Walking, unspecified	85%	15%
Climbing	d4551: Climbing	83%	17%
Sports: basketball/volleyball/football	d9201: Sports	80%	20%
Sports: surfing/snow/wake boarding/skate boarding	d9201: Sports	80%	20%
Carrying heavy objects	d430: Lifting and carrying objects	77%	23%
Clearing houses	d2402: Handling crisis	77%	23%
Facing backward while flying	d4709: Using transportation, unspecified	77%	23%
Firing large caliber weapons/missile firing	d4308: Lifting and carrying, other specified	77%	23%
Jumping (trampoline)	d4553: Jumping	77%	23%
Riding in the back of vehicles	d470: Using transportation	77%	23%
Traveling (trains/planes/auto/bus/boat)	d470: Using transportation	77%	23%
Walking down/up stairs	d4551: Climbing	77%	23%
Wearing advanced combat helmet (ACH)	d4304: Carrying on the head	77%	23%
Clearing obstacles	d455: Moving around	70%	30%
Alcohol/drugs/medication	e1101: Drugs	100%	0%
Busy vision (transitioning through a change in light, looking at busy background)	e2401: Light quality	100%	0%
Flash bangs (loud noises and bright lights)	e250: Sound e2400: Light intensity	100%	0%
Flashing lights	e2400: Light intensity	100%	0%
Sound	e250: Sound	100%	0%
Confined areas (rooms/vehicles)	e299: Natural environment and human-made changes to environment, unspecified	85%	15%
Excessive light	e2400: Light intensity	85%	15%
Heat	e2250: Temperature	85%	15%
Staring at TV/computer	e2400: Light intensity e2401: Light quality	77%	23%
Altitude/elevation (combined with high altitude/elevation)	e2100: Land forms e2252: Atmospheric pressure	70%	20%
Multiple ICF categories (n=5)
Land navigation	b140: Attention functions d4502: Walking on different surfaces d4551: Pushing	100%	0%
Food/caffeine (too much/too little)	b5153: Tolerance to food e1100: Food	92%	8%
Reading	d166: Reading b2100: Visual acuity functions	92%	8%
Rifle marksmanship/shooting a weapon	d4102: Kneeling d430: Lifting and carrying objects d450: Walking b140: Attention functions	92%	8%
Playing video games	b210: Seeing functions	80%	20%
	d4402: Find hand use: manipulating
Unable to be coded to a specific ICF code (n=8)
Looking up	Not coded	100%	0%
Moving the head with eyes closed	Not coded	100%	0%
Using gym equipment	Not coded	100%	0%
Heights	Not coded	92%	8%
Turning around	Not coded	92%	8%
Mounted gun turrets	Not coded	85%	15%
Night vision goggles (NVG)	Not coded	83%	17%
Multiple transition colors	Not coded	77%	23%

Abbreviation: ICF, International Classification of Functioning, Disability and Health.

Table 2 Items excluded from the Military Concussion Readiness Inventory for Dizziness and Balance following nominal group technique and Delphi group

Excluded items (n=25)	ICF codes	% Included	% Excluded
Body functions (n=6)
Intimate relations/sex	b640: Sexual functions	60%	40%
Not eating/hunger/dehydration	b545: Water, mineral, and electrolyte balance functions	60%	40%
Not wearing proper prescription eye glasses	b2100: Visual acuity functions	50%	50%
Smells: cooking smells/smell of blood/burnt flesh	b1562: Olfactory perception	60%	40%
Watching 3D movies	b210: Seeing functions	15%	85%
Wearing eye protection	b210: Seeing functions	23%	77%
Activities and participation (n=17)
Cleaning/housework	d640: Doing housework	15%	85%
Constructing obstacles	d430: Lifting and carrying objects	23%	77%
Construction	d6501: Maintaining dwelling and furnishing d4453: Turning or twisting the hands or arms	8%	92%
Dancing	d4106: Shifting the body’s center of gravity	15%	85%
Driving long distances	d4751: Driving motorized vehicles	50%	50%
Driving through change of weather/elevation	d4751: Driving motorized vehicles	40%	60%
Grenade throwing	d4454: Throwing	15%	85%
Mowing lawn	d4502: Walking on different surfaces	8%	92%
Operating power tools	d4453: Turning or twisting the hands or arms	40%	60%
Parachute rigging	d540: Dressing	23%	77%
Picking up children	d4105: Bending	33%	67%
Showering	d510: Washing oneself	50%	50%
Swimming	d4554: Swimming	60%	40%
Rappelling	d4401: Grasping d4350: Pushing with lower extremities	60%	40%
Riding motorcycle	d4751: Driving motorized vehicles	30%	70%
Roller coasters/amusement park rides	d4709: Using transportation, unspecified	40%	60%
Wading	d4502: Walking on different surfaces	15%	85%
Environmental factors (n=1)
Changes in temperature	e2250: Temperature	23%	77%
Unable to be coded to a specific ICF code (n=1)
Wear MOPP (mission-oriented protective posture) gear	Not coded	50%	50%
Deleted items (n=21)
Activities of daily living
After an MRI
Airborne/air assault operations
Clearing improvised explosive device/mine sweeping
Combatives
Demolitions
Environmental conditions
Field sobriety test
Flight duty/operations
Hitting your head
Keeping up with the kids
Long power point presentations
Medical training/mass casualty evacuation
Physical readiness training
Real-world combat missions
Spatial orientation
Spinning in chair
Tasers
Teaching a class

Abbreviation: ICF, International Classification of Functioning, Disability, and Health.

Figure 2 Model of item analysis.

Abbreviations: ICF, International Classification of Functioning, Disability, and Health; NGT, nominal group technique.

Table S1 Military Concussion Readiness Inventory for Dizziness and Balance (MCRI-DB)

Please answer each question as it relates to your dizziness or balance problems. Check “always,” OR “sometimes,” OR “never” to each question.
Performing or being exposed to … increases my problems with dizziness or balance.
1	… Abrupt movement	Always	Sometimes	Never	A&P
2	… Adrenaline rushes, stress	Always	Sometimes	Never	A&P
3	… Bending/reaching beyond neutral	Always	Sometimes	Never	A&P
4	… Carrying heavy objects	Always	Sometimes	Never	A&P
5	… Clearing houses	Always	Sometimes	Never	A&P
6	… Clearing obstacles	Always	Sometimes	Never	A&P
7	… Climbing	Always	Sometimes	Never	A&P
8	… Combat load/wearing gear	Always	Sometimes	Never	A&P
9	… Dismounting vehicles in gear	Always	Sometimes	Never	A&P
10	… Drill and ceremony (D & C)	Always	Sometimes	Never	A&P
11	… Driving	Always	Sometimes	Never	A&P
12	… Driving during the night	Always	Sometimes	Never	A&P
13	… Facing backwards while flying	Always	Sometimes	Never	A&P
14	… Firing large caliber weapons/missile firing	Always	Sometimes	Never	A&P
15	… Getting in/out of bed	Always	Sometimes	Never	A&P
16	… Getting up (bed, chair, toilet)	Always	Sometimes	Never	A&P
17	… Jumping (trampoline)	Always	Sometimes	Never	A&P
18	… Maintaining equipment/vehicles	Always	Sometimes	Never	A&P
19	… Mental exertion	Always	Sometimes	Never	A&P
20	… Navigating on rough terrain	Always	Sometimes	Never	A&P
21	… Obstacle course	Always	Sometimes	Never	A&P
22	… Picking things off the ground	Always	Sometimes	Never	A&P
23	… Riding in back of vehicles	Always	Sometimes	Never	A&P
24	… Riding in military vehicle/enclosed vehicles	Always	Sometimes	Never	A&P
25	… Ruck marching	Always	Sometimes	Never	A&P
26	… Running	Always	Sometimes	Never	A&P
27	… Sports: basketball/volleyball/football	Always	Sometimes	Never	A&P
28	… Sports: surfing/snow/wake/skate boarding	Always	Sometimes	Never	A&P
29	… Sprinting with quick stops	Always	Sometimes	Never	A&P
30	… Standing in formation	Always	Sometimes	Never	A&P
31	… Traveling (trains/planes/auto/bus/boat)	Always	Sometimes	Never	A&P
32	… Uneven surfaces	Always	Sometimes	Never	A&P
33	… Walking a straight line	Always	Sometimes	Never	A&P
34	… Walking down/up stairs	Always	Sometimes	Never	A&P
34	… Walking down/up stairs	Always	Sometimes	Never	A&P
35	… Walking in crowds	Always	Sometimes	Never	A&P
36	… Walking/hiking narrow paths	Always	Sometimes	Never	A&P
37	… Wearing an advanced combat helmet (ACH)	Always	Sometimes	Never	A&P
38	… Anxiety, worry, fear	Always	Sometimes	Never	BF
39	… Dehydration	Always	Sometimes	Never	BF
40	… Migraines/headaches	Always	Sometimes	Never	BF
41	… Nuclear Biological Chemical (NBC) mask	Always	Sometimes	Never	BF
42	… Over exerting/physical exertion/excessive physical activity	Always	Sometimes	Never	BF
43	… Sleep deprivation: waking up at early hours/working long hours >24 hours	Always	Sometimes	Never	BF
44	… Strain/bearing down	Always	Sometimes	Never	BF
45	… Tinnitus/inner ear disturbance	Always	Sometimes	Never	BF
46	… Alcohol/drugs/medication	Always	Sometimes	Never	EF
47	… Altitude/elevation	Always	Sometimes	Never	EF
48	… Busy vision (transitioning through a change in light, looking at busy background)	Always	Sometimes	Never	EF
49	… Confined areas (rooms/vehicles)	Always	Sometimes	Never	EF
50	… Excessive light	Always	Sometimes	Never	EF
51	… Flash bangs (bright light and loud noises)	Always	Sometimes	Never	EF
52	… Flashing lights	Always	Sometimes	Never	EF
53	… Heat	Always	Sometimes	Never	EF
54	… Sound	Always	Sometimes	Never	EF
55	… Staring at TV/computer	Always	Sometimes	Never	EF
56	… Food/caffeine (too much/too little)	Always	Sometimes	Never	Multi
57	… Land navigation	Always	Sometimes	Never	Multi
58	… Playing video games	Always	Sometimes	Never	Multi
59	… Reading	Always	Sometimes	Never	Multi
60	… Rifle marksmanship/shooting a weapon	Always	Sometimes	Never	Multi
61	… Heights	Always	Sometimes	Never	None
62	… Looking up	Always	Sometimes	Never	None
63	… Mounted gun turrets	Always	Sometimes	Never	None
64	… Moving the head with eyes closed	Always	Sometimes	Never	None
65	… Multiple transition colors	Always	Sometimes	Never	None
66	… Night vision goggles (NVG)	Always	Sometimes	Never	None
67	… Turning around	Always	Sometimes	Never	None
68	… Using gym equipment	Always	Sometimes	Never	None
How many Total		×4	×2	×0	<g>

Abbreviations: A&P, activity and participation; BF, body functions; EF, environmental functions; Multi, multiple ICF categories; None, unable to be coded to a specific ICF category.

World Health OrganizationInternational Classification of Functioning, Disability and Health: ICFGenevaWorld Health Organization2001 Available from: www.who.int/classifications/drafticfpracticalmanual.pdfAccessed August 27, 2018

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