New Questionnaires in the Evaluation of MTBI
The objective of this study was to evaluate three recently developed questionnaires for their sensitivity to mild traumatic brain injury (MTBI) and its corresponding effects on the quality of life of patients. The questionnaires were:
- The Problem Checklist (PCL) from the New York Head Injury Family Interview to assess MTBI symptoms.
- Short Form 36 Health Survey (SF-36) to assess functional burdens associated with health problems.
- Community Integration Questionnaire (CIQ) to assess home, social and productive activities.
All of the questionnaires were administered to a group of 120 MTBI patients and 120 normal controls. Results showed that MTBI patient self-ratings on the PCL and the SF-36 were generally worse than the self-ratings of the controls. Self-reporting on the PCL showed that both the MTBI and the control group showed similar rates of affective/behavioral problems, but the MTBI group was more affected by those problems in their daily functioning. The authors suggest that this may indicate that it is unlikely for new affective/behavioral problems to result after MTBI but problems that were present before injury may be likely to worsen.
The most significant differences between the groups were in the SF-36 physically oriented scales. These scales look at daily activities such as walking, lifting and climbing stairs. By assessing patients' problems in such activities, the SF-36 could prove useful in evaluating musculoskeletal injuries that might not be immediately evident to health care providers. Results for the CIQ indicate that 2 of its 3 scales were not particularly sensitive to differences between the MTBI and the control group. Only the CIQ productivity scale proved sensitive- showing that soon after injury the patients' ability to work is impaired. This finding was consistent with the SF-36 role functioning scores.
Of the three questionnaires evaluated the PCL and the SF-36 are the most promising tools for MTBI assessment. The SF-36 appears to be particularly useful in detecting the presence of non-brain injury and previous studies have shown that such injuries can be useful predictors of outcome after MTBI. The authors state:
"The most immediate clinical application of our data is to validate MTBI patients' experience of their problems, though generally mild, in the days and weeks after MTBI. The SF-36 results should alert clinicians not to automatically attribute all problems to MTBI, but to seriously consider the effects of accompanying musculoskeletal injuries. Future research evaluating the sensitivity of these or other questionnaires to MTBI-related effects would do well to use an orthopedic or other injury control group. This would help to more systematically evaluate the relative contribution of nonbrain injuries to what are commonly considered 'post-concussive' symptoms."
Paniak C, Phillips K, Toller-Lobe G, Durand A, Nagy J. Sensitivity of three recent questionnaires to mild traumatic brain injury – related effects. Journal of Head Trauma Rehabilitation 1999;14(3):211-219.
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