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Utility of the Neurobehavioral Symptom Inventory As an Outcome Measure: A VA TBI Model Systems Study

Belanger, Heather G. PhD; Silva, Marc A. PhD; Donnell, Alison J. PhD; McKenzie-Hartman, Tamara PsyD; Lamberty, Greg J. PhD; Vanderploeg, Rodney D. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

Journal of Head Trauma Rehabilitation: January/February 2017 - Volume 32 - Issue 1 - p 46–54
doi: 10.1097/HTR.0000000000000208
Original Articles

Objective: To examine the utility of the Neurobehavioral Symptom Inventory (NSI)—a measure of postconcussion symptoms used within the Veterans Health Administration—as an index of rehabilitation outcome.

Setting: Veterans Administration Polytrauma Rehabilitation Centers Traumatic Brain Injury (TBI) Model Systems program.

Participants: A total of 159 Veterans (14% with mild TBI; 86% with moderate-severe TBI).

Main Measures: Disability Rating Scale; Functional Independence Measure; Glasgow Outcome Scale–Extended; NSI; Participation Assessment with Recombined Tools–Objective; Posttraumatic Stress Disorder Checklist–Civilian Version; Satisfaction With Life Scale; Supervision Rating Scale.

Analyses: Correlations and exploratory factor analyses examined the interrelations among outcome measures. Hierarchical regression analyses were utilized to determine if the NSI predicted rehabilitation outcome measures after controlling for demographic variables, TBI severity, and time since injury. NSI reliable changes from pretreatment to 1-year follow-up were examined. Receiver operating characteristics curve analyses were conducted to evaluate the ability of changes in the NSI to predict meaningful change in functioning and employment status.

Results: The NSI correlated with psychological distress measures. The NSI administered prior to brain injury rehabilitation had limited predictive utility beyond satisfaction with life. A minority of patients (32%) demonstrated reliable changes on the NSI from baseline to 1-year follow-up. Changes on the NSI were not predictive of meaningful change in employment or functioning.

Conclusion: The NSI was not useful for assessing meaningful change in a sample of mixed severity TBI patients.

Department of Mental Health and Behavioral Sciences, James A. Haley VAMC, Tampa, Florida (Drs Belanger, Silva, Donnell, McKenzie-Hartman, and Vanderploeg); Defense and Veterans Brain Injury Center, Tampa, Florida (Drs Belanger, Silva, McKenzie-Hartman, and Vanderploeg); Departments of Psychology (Drs Belanger and Vanderploeg) and Psychiatry and Neurosciences (Drs Belanger, Donnell, and Vanderploeg), University of South Florida, Tampa; Mental Health Service Line, Minneapolis VA Health Care System, Minneapolis, Minnesota (Dr Lamberty); and Department of Psychiatry, University of Minnesota Medical School, Minneapolis (Dr Lamberty).

Corresponding Author: Heather G. Belanger, PhD, James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Blvd, MHBS-116B, Tampa, FL 33612 (

This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans' Hospital and the Minneapolis VA Health Care System, and supported in part by the Veterans Health Administration Central Office VA TBI Model Systems Program of Research, and Subcontract from General Dynamics Health Solutions (W91YTZ-13-C-0015) from the Defense and Veterans Brain Injury Center, US Army Medical Research and Material Command, US Department of Veterans Affairs grants (1 I50 HX001233-01, W81XWH-13-2-0095), and US Department of Defense Congressionally Directed Medical Research Programs, and Chronic Effects of Neurotrauma Consortium (VA CSRD W81XWH-13-2-0095).

The views expressed herein are those of the authors and do not necessarily reflect the views or the official policy of the Department of Veterans Affairs, Department of Defense, or US Government.

The authors declare no conflicts of interest.

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