Abstract
BackgroundMild traumatic brain injury (mTBI) occurs at a higher frequency among military personnel than among civilians. A common symptom of mTBIs is cognitive dysfunction. Health care professionals use neuropsychological assessments as part of a multidisciplinary and best practice approach for mTBI management. Such assessments support clinical diagnosis, symptom management, rehabilitation, and return-to-duty planning. Military health care organizations currently use computerized neurocognitive assessment tools (NCATs). NCATs and more traditional neuropsychological assessments present unique challenges in both clinical and military settings. Many research gaps remain regarding psychometric properties, usability, acceptance, feasibility, effectiveness, sensitivity, and utility of both types of assessments in military environments.ObjectiveThe aims of this study were to explore evidence regarding the use of NCATs among military personnel who have sustained mTBIs; evaluate the psychometric properties of the most commonly tested NCATs for this population; and synthesize the data to explore the range and extent of NCATs among this population, clinical recommendations for use, and knowledge gaps requiring future research.MethodsStudies were identified using MEDLINE, Embase, American Psychological Association PsycINFO, CINAHL Plus with Full Text, Psych Article, Scopus, and Military & Government Collection. Data were analyzed using descriptive analysis, thematic analysis, and the Randolph Criteria. Narrative synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guided the reporting of findings. The psychometric properties of NCATs were evaluated with specific criteria and summarized.ResultsOf the 104 papers, 33 met the inclusion criteria for this scoping review. Thematic analysis and NCAT psychometrics were reported and summarized.ConclusionsWhen considering the psychometric properties of the most commonly used NCATs in military populations, these assessments have yet to demonstrate adequate validity, reliability, sensitivity, and clinical utility among military personnel with mTBIs. Additional research is needed to further validate NCATs within military populations, especially for those living outside of the United States and individuals experiencing other conditions known to adversely affect cognitive processing. Knowledge gaps remain, warranting further study of psychometric properties and the utility of baseline and normative testing for NCATs.
Highlights
BackgroundMild traumatic brain injuries, known as concussions, are generally defined as a temporary change in brain functioning caused by an insult to the head, with a period of posttraumatic amnesia lasting less than a day [1]
The mechanism of injury (MOI) for Mild traumatic brain injury (mTBI) varies, with some occurring as a result of motor vehicle collisions, falls, sports, explosions, or other forces related to combat and military training
Among Canadian Armed Forces service members deployed in Afghanistan during Operation Enduring Freedom, 5.2% self-reported experiencing an mTBI and, of these, 21% noted postconcussion symptoms (PCSs), referring to symptoms lasting longer than 3 months after MOI [1,3]
Summary
BackgroundMild traumatic brain injuries (mTBIs), known as concussions, are generally defined as a temporary change in brain functioning caused by an insult to the head, with a period of posttraumatic amnesia lasting less than a day [1]. The reported rates of mTBIs vary between militaries, the evidence base consistently demonstrates higher mTBI and PCS rates in military personnel versus civilian populations. A higher prevalence of mental health disorders, exposure to traumatic experiences, and previous mTBIs among military personnel have been identified as potential reasons that PCS is more common in military populations than in civilian populations [3,5]. Mild traumatic brain injury (mTBI) occurs at a higher frequency among military personnel than among civilians. Health care professionals use neuropsychological assessments as part of a multidisciplinary and best practice approach for mTBI management. Such assessments support clinical diagnosis, symptom management, rehabilitation, and return-to-duty planning. Many research gaps remain regarding psychometric properties, usability, acceptance, feasibility, effectiveness, sensitivity, and utility of both types of assessments in military environments
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