Responsiveness of the Traumatic Brain Injury Quality of Life Cognition Banks in Recent Brain Injury

Callie E Tyner,Nancy D Chiaravalloti,Tamara Bushnik,David S Tulsky,Mark Sherer,Angelle M Sander,Pamela A Kisala,Aaron J Boulton

doi:10.3389/fnhum.2022.763311

Abstract

Patient report of functioning is one component of the neurocognitive exam following traumatic brain injury, and standardized patient-reported outcomes measures are useful to track outcomes during rehabilitation. The Traumatic Brain Injury Quality of Life measurement system (TBI-QOL) is a TBI-specific extension of the PROMIS and Neuro-QoL measurement systems that includes 20 item banks across physical, emotional, social, and cognitive domains. Previous research has evaluated the responsiveness of the TBI-QOL measures in community-dwelling individuals and found clinically important change over a 6-month assessment interval in a sample of individuals who were on average 5 years post-injury. In the present study, we report on the responsiveness of the TBI-QOL Cognition–General Concerns and Executive Function item bank scores and the Cognitive Health Composite scores in a recently injured sample over a 1-year study period. Data from 128 participants with complicated mild, moderate, or severe TBI within the previous 6 months were evaluated. The majority of the sample was male, white, and non-Hispanic. The participants were 18–92 years of age and were first evaluated from 0 to 5 months post-injury. Eighty participants completed the 1-year follow-up assessment. Results show acceptable standard response mean values (0.47–0.51) for all measures and minimal detectable change values ranging from 8.2 to 8.8 T-score points for Cognition–General Concerns and Executive Functioning measures. Anchor rating analysis revealed that changes in scores on the Executive Function item bank and the Cognitive Health Composite were meaningfully associated with participant-reported changes in the areas of attention, multitasking, and memory. Evaluation of change score differences by a variety of clinical indicators demonstrated a small but significant difference in the three TBI-QOL change scores by TBI injury severity grouping. These results support the responsiveness of the TBI-QOL cognition measures in newly injured individuals and provides information on the minimal important differences for the TBI-QOL cognition measures, which can be used for score interpretation by clinicians and researchers seeking patient-reported outcome measures of self-reported cognitive QOL after TBI.

Highlights

Cognitive concerns are common after traumatic brain injury (TBI), the presentation of subjective complaints and objective impairments are heterogeneous across individuals (Rabinowitz and Levin, 2014)
This study provides evidence to support the responsiveness of the TBI-quality of life (QOL) cognition item banks and Cognitive Health Composite score for use in individuals within the first 18 months of recovery post-TBI
The findings support the responsiveness of the TBI-QOL Cognition–General Concerns, Executive Function, and Cognitive Health Composite score for use in newly injured individuals

Summary

Introduction

Cognitive concerns are common after traumatic brain injury (TBI), the presentation of subjective complaints and objective impairments are heterogeneous across individuals (Rabinowitz and Levin, 2014). Post-injury assessment of objective cognitive functioning requires a thorough test battery, typically including performance-based measures of neuropsychological functioning— in the domains of attention, executive functioning, and memory—, caregiver or collateral ratings of symptoms and functioning, and behavioral observations (Lezak et al, 2012). Subjective patient report of symptoms and functioning are useful to contextualize the objective data and collateral ratings, since both amplification of deficits and lack of awareness of deficits have been observed after TBI (Flashman and McAllister, 2002; Jamora et al, 2012). Subjective experience of cognitive difficulties post-TBI can be evaluated via interview, formal assessments of patient-reported outcomes (PROs) are useful for settings where standardization is needed (Reeve et al, 2013). Condition-specific PROs can be useful in these settings as they provide a shared context for specificity of the item content and a relevant clinical comparison sample for score interpretation (Schifferdecker et al, 2018)

Results

Discussion

Conclusion