Brain 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).
J Head Trauma Rehabil. 2023;38(4):E312-E317. doi: 10.1097/HTR.0000000000000850. Epub 2022 Dec 30.
To determine correspondence between the statistically derived 8-point reliable change index for the Neurobehavioral Symptom Inventory (NSI) against clinically significant item-level change in symptom severity from intake to discharge for mild traumatic brain injury (mTBI).
Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas.
In total, 655 active-duty service members with a diagnosis of mTBI who received treatment and completed self-report measures between 2007 and 2020.
Observational retrospective analysis of outpatient clinical outcomes data.
NSI total score change was used to divide patients into responder and nonresponders based on whether they met an 8-point decrease between intake and discharge. In addition, patients who had at least one NSI item that changed from a rating of 3 (severe) or 4 (very severe) at intake to a rating of 0 (none) or 1 (mild) at discharge were coded as an individual with significant item-level change.
Forty-five percent of the sample had significant item-level change and were classified as responders according to the reliable change method. Eight percent of the sample had significant item-level change but did not meet the 8-point reliable change threshold. Fifteen percent of the sample did not experience significant item-level change but were classified as responders according to reliable change. Thirty-one percent did not meet either method's criterion for change. Classification agreement between the reliable change and item-level change methods was 76%, which was statistically significant ( = 181.32, P < .001).
There is good correspondence between reliable change and item-level change on the NSI in this population. Reliable change is easily calculated and thus much more accessible than the item-level change method. There may be some situations where calculating item-level change may be helpful.
确定神经行为症状量表（NSI）的统计得出的 8 分可靠变化指数与轻度创伤性脑损伤（mTBI）从入院到出院症状严重程度的临床显著项目水平变化之间的对应关系。
德克萨斯州圣安东尼奥市萨姆休斯顿堡的陆军医疗中心脑损伤康复服务处。
共有 655 名现役军人患有 mTBI，他们在 2007 年至 2020 年间接受治疗并完成了自我报告的测量。
门诊临床结果数据的观察性回顾性分析。
根据 NSI 总分变化，将患者分为反应者和非反应者，依据是他们在入院和出院之间是否下降了 8 分。此外，NSI 至少有一个项目从入院时的 3 分（严重）或 4 分（非常严重）变为出院时的 0 分（无）或 1 分（轻度）的患者被编码为具有显著项目水平变化的个体。
45%的样本具有显著的项目水平变化，根据可靠变化方法被归类为反应者。8%的样本具有显著的项目水平变化，但未达到 8 分的可靠变化阈值。15%的样本没有经历显著的项目水平变化，但根据可靠变化被归类为反应者。31%的样本不符合两种方法的变化标准。可靠变化和项目水平变化方法之间的分类一致性为 76%，具有统计学意义（=181.32，P<.001）。
在该人群中，NSI 的可靠变化和项目水平变化之间具有良好的对应关系。可靠变化易于计算，因此比项目水平变化方法更容易获得。在某些情况下，计算项目水平变化可能会有所帮助。
