Assessment method influences the severity and type of symptoms reported after self-reported mild traumatic brain injury

Abstract

Objective: To investigate the influence of assessment method (spontaneous report versus checklist) on the report of postconcussive syndrome (PCS) symptoms after mild traumatic brain injury (mTBI). Setting: Community. Participants: Thirty-six participants (58% female) with postacute self-reported mTBI (i.e., sustained 1–6 months prior to participation) and 36 age-, gender-, and ethnicity-matched controls with no history of mTBI. Design: Cross-sectional. Main measures: Spontaneous symptom report from open-ended questions and checklist endorsed symptoms from the Neurobehavioral Symptom Inventory (both measures administered online). Results: Assessment method significantly affected individual symptom item frequencies (small to large effects), the number of symptoms reported, the total severity score, domain severity scores (i.e., somatic/sensory, cognitive, and affective symptom domains), and the number of participants who met a PCS caseness criterion (large effects; checklist > spontaneous report). The types of symptoms that were different between the groups differed for the assessment methods: Compared to controls, the nonclinical mTBI group spontaneously reported significantly greater somatic/sensory and cognitive domain severity scores, whilst no domain severity scores differed between groups when endorsed on a checklist. Conclusions: Assessment method can alter the number, severity, and types of symptoms reported by individuals who have sustained an mTBI and could potentially influence clinical decisions.

Keywords:

• Concussion
• Mild traumatic brain injury
• Postconcussive syndrome
• Head injuries
• Self-report symptoms
• Neurobehavioral symptom inventory
• Assessment
• Subjective symptoms

The Human Research Ethics Committee of Queensland University of Technology (QUT-HREC; no. 1300000224) approved this research. This project was granted an occupational workplace health and safety clearance. The authors would like to thank Lina Karlsson for her assistance with data collection and Lauren Cunningham for her assistance with cross coding.

Notes

¹ Although Gerber and Schraa (1995) state that they captured severity ratings of spontaneously reported symptoms in their Procedure section, they do not appear to have analyzed the severity ratings in the Results.

² These unclassifiable non-NSI symptoms included: diarrhea, earache, happiness (n = 3), insecurity, listless, restless, arrhythmia, blackouts, bruising, existential thoughts, mood changes, muscle tension, and personality changes.

Additional information

Funding

Funding for this project was contributed by the School of Psychology and Counselling, Queensland University of Technology.