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Three Scoring Approaches to the Neurobehavioral Symptom Inventory for Measuring Clinical Change in Service Members Receiving Intensive Treatment for Combat-Related mTBI

Dretsch, Michael PhD; Bleiberg, Joseph PhD; Williams, Kathy MA; Caban, Jesus PhD; Kelly, James MD; Grammer, Geoffrey MD; DeGraba, Thomas MD

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

Journal of Head Trauma Rehabilitation: January/February 2016 - Volume 31 - Issue 1 - p 23–29
doi: 10.1097/HTR.0000000000000109
Original Articles

Objective: To examine the use of the Neurobehavioral Symptom Inventory to measure clinical changes over time in a population of US service members undergoing treatment of mild traumatic brain injury and comorbid psychological health conditions.

Setting: A 4-week, 8-hour per day, intensive, outpatient, interdisciplinary, comprehensive treatment program at the National Intrepid Center of Excellence in Bethesda, Maryland.

Participants: Three hundred fourteen active-duty service members being treated for combat-related comorbid mild traumatic brain injury and psychological health conditions.

Design: Repeated-measures, retrospective analysis of a single-group using a pretest-posttest treatment design.

Main Measures: Three Neurobehavioral Symptom Inventory scoring methods: (1) a total summated score, (2) the 3-factor method, and (3) the 4-factor method (with and without orphan items).

Results: All 3 scoring methods yielded statistically significant within-subject changes between admission and discharge. The evaluation of effect sizes indicated that the 3 different Neurobehavioral Symptom Inventory scoring methods were comparable.

Conclusion: Findings indicate that the different scoring methods all have potential for assessing clinical changes in symptoms for groups of patients undergoing treatment, with no clear advantage with any one method.

Department of Research, National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.

Corresponding Author: Michael Dretsch, PhD, Department of Research, National Intrepid Center of Excellence, Walter Reed National Military Medical Center, 4860 South Palmer Rd, Bethesda, MD 20889 (

The authors are grateful for the writing and editorial assistance from Ms Shalini Mehta, MPH, of Booz Allen Hamilton. The authors thank CDR Petit for her support in ensuring patients completed the Neurobehavioral Symptom Inventory at admission and discharge.

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or US Government.

The authors declare no conflicts of interest.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.