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Neurobehavioral Symptom Inventory Item-Level Change Complements the Reliable Change Method
Emily Scarlett1, Lisa H Lu, Latiba D Cummings
1Brain Injury Rehabilitation Service, Department of Rehabilitation Medicine, Brooke Army Medical Center (Mss Scarlett and Cummings and Drs Lu and Bowles), and Traumatic Brain Injury Center of Excellence, Defense Health Agency (Dr Lu), JBSA Fort Sam Houston, Texas; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland (Ms Scarlett); and General Dynamic Information Technology, Falls Church, Virginia (Dr Lu).
The reliable change index for the Neurobehavioral Symptom Inventory (NSI) shows good agreement with clinically significant symptom changes in mild traumatic brain injury (mTBI) patients. This accessible method aids in tracking recovery for service members.
Area of Science:
- Neuroscience
- Clinical Psychology
- Rehabilitation Medicine
Background:
- Mild traumatic brain injury (mTBI) can cause persistent neurobehavioral symptoms.
- Accurate assessment of symptom change is crucial for effective rehabilitation.
- The Neurobehavioral Symptom Inventory (NSI) is a common tool for measuring mTBI symptoms.
Purpose of the Study:
- To evaluate the correspondence between the 8-point reliable change index of the NSI and clinically significant item-level symptom changes.
- To assess the utility of the reliable change index in tracking recovery in mild traumatic brain injury (mTBI) patients.
Main Methods:
- Retrospective analysis of clinical outcomes data from 655 active-duty service members with mTBI.
- Patients were classified as responders based on an 8-point decrease in NSI total score.
- Significant item-level change was defined by a reduction in severity for at least one NSI item.
Main Results:
- A 76% agreement was found between the reliable change index and item-level change methods.
- Forty-five percent of patients met both criteria for change.
- Eight percent showed item-level change but not reliable change; 15% showed reliable change but not item-level change.
Conclusions:
- The 8-point reliable change index for the NSI demonstrates good correspondence with clinically significant item-level changes in mTBI patients.
- The reliable change index is a more accessible and easily calculable method for assessing treatment response.
- Item-level change analysis may offer additional insights in specific clinical scenarios.
