A - 32 The Patient Global Impression of Change—a Powerful Complimentary Tool for Assessing Improvement in Concussion Patients

Abstract

Abstract Objective The purpose of this study was to determine the extent to which patient’s perspective of symptom improvement, as indexed by the Patient Global Impression of Change (PGIC) survey, is associated with symptom improvement on common measures of neurobehavioral and mental health symptoms following concussion. Methods Data were from 474 US active duty service members in interdisciplinary treatment programs for TBI. PGIC rating (range = 1–7) was evaluated for compatibility in assessing improvement in or clinically-elevated neurobehavioral (using Neurobehavioral Symptom Inventory, NSI) and mental health (using Post-traumatic Stress Disorder Checklist, DSM-5, PCL-5 and Patient Health Questionnaire, PHQ-8) symptoms. Results Higher PGIC scores were related to a higher prevalence of a clinically-relevant decrease in NSI, PCL-5 or PHQ-8 scores. Participants with a PGIC rating of 3+ (vs. < 3) were about 2.2 (CI = 1.4–3.5), 1.6 (CI = 1.1–1.3), and 2.7 (CI = 1.4–5.1) times more likely to report a clinically-relevant decrease in NSI, PCL-5 and PHQ-8 symptoms, respectively. Conclusion PGIC may help providers incorporate patients’ perspectives on symptom improvement achieved during rehabilitation. An approach combining PGIC with surveys such as NSI, PCL-5 and PHQ-8 may provide a more comprehensive understanding of symptom improvement and realistic view of expectations for what would be deemed recovery to pre-injury symptom levels.