A Longitudinal Study of the Relationship Between Financial Compensation and Symptoms After Treated Mild Traumatic Brain Injury

Paniak, Chris; Reynolds, Shawn; Toller-Lobe, Geraldine; Melnyk, Amy; Nagy, Julianna; Schmidt, Douglas

doi:10.1076/jcen.24.2.187.999

Cited by 101 publications

(65 citation statements)

References 10 publications

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“…Yet the large effect sizes and significant and positive relationships between the Validity-10 and psychiatric questionnaires, in the absence of SVT group differences in demographic or injury variables, suggest that the degree of psychiatric symptoms still contributes significantly to response bias. Consistent with prior studies [29,54], VA service connection may also be contributing to response bias given the small to medium effect size of the relationship between VA service connection and the Validity-10. Those with elevated measures of response bias may warrant alternative treatment considerations [25,55].…”

Section: Discussionsupporting

confidence: 60%

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury

et al. 2016

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Abstract-A comprehensive evaluation, including the assessment of neurobehavioral symptoms, has been instituted at the Department of Veterans Affairs (VA) healthcare system to address the large number of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans returning with mild traumatic brain injuries (mTBIs). The Validity-10 is a measure of symptom overreporting embedded within the Neurobehavioral Symptom Inventory, a component of the comprehensive evaluation that assesses postconcussive symptom severity. The Validity-10 is composed of 10 unlikely/low-frequency items and a validated cutoff score to identify postconcussive symptom overreporting. We examined the items and cutoff used in the initial development and validation study of the Validity-10 through retrospective chart reviews of 331 treatment-seeking Veterans who sustained an mTBI. The Validity-10 exhibited significant relationships with psychiatric variables, VA service connection, and neuropsychological performance validity (all p < 0.01), but nonsignificant relationships with demographic and injury variables (all p > 0.05). Furthermore, the Validity-10 modestly predicted neuropsychological performance validity test failure over and above psychiatric comorbidities and VA service connection. The present study supports the use of the Validity-10 to assess symptom validity in treatment-seeking OIF/OEF Veterans with a history of mTBI.

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Section: Discussionsupporting

confidence: 60%

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury

et al. 2016

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“…Despite this statistically significant relationship, and after controlling for other variables, return to duty status only explained 1.9 percent of the variance in the Validity-10 scale. Previous research has shown that external incentives increase rates of invalid responding on neuropsychological tests [11][12][13][14][15]18,[20][21]; however, the current results suggest only a very mild relationship between external incentives and Validity-10 scale. It is likely that the small increase in Validity-10 scale in participants undergoing medical board evaluations and on limited duty (medical hold) is driven by underlying psychological distress.…”

Section: Discussioncontrasting

confidence: 55%

“…Underreporting of TBI and postconcussive symptoms is a particular concern in athletes [6][7][8][9][10]. In contrast, overreporting symptoms is often found in patients who are involved in litigation or otherwise have potential for secondary gain [11][12][13][14][15]. Performance validity test failure rates have previously been shown to be high in Active Duty and Veteran samples, ranging from 11 to 59 percent [16][17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Utility of the Validity-10 scale across the recovery trajectory following traumatic brain injury

Lange¹,

Bailie

Kennedy

et al. 2016

J Rehabil Res Dev

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Abstract-The Validity-10 scale was recently developed to screen for symptom exaggeration in patients following traumatic brain injury (TBI). However, it has only been validated on patients with TBI largely in the chronic phase of recovery. The influence of time since injury on the Validity-10 scale was investigated in 2,661 male servicemembers with TBI presenting to six U.S. Defense and Veterans Brain Injury Centers. Participants completed the Neurobehavioral Symptom Inventory (NSI). The Validity-10 scale and NSI total score were both weakly statistically significantly (1) positively correlated with time since injury, (2) negatively correlated with bodily injury severity, and (3) higher in participants undergoing medical board evaluations than in participants who returned to duty or were still hospitalized. Participants were statistically more likely to screen positive for possible symptom exaggeration on the Validity-10 scale as time since injury increased. However, the Validity-10 scale was only weakly related to time since injury, TBI severity, bodily injury severity, disposition, age, and return to duty status. That false positives are not increased in the acute phase of recovery and that the Validity-10 scale is not strongly related to clinical factors support the use of the Validity-10 scale in the acute recovery phase and across the TBI recovery trajectory.

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“…We did not collect this information at the time of the ED visit. Patients' intention to sue after the injury has also been found to be associated with a greater number and longer duration of post-concussive symptoms (Paniak et al, 2002;Feinstein et al, 2001). We did collect this variable during the 3-month follow-up contact, but elected not to include it in our multivariate models.…”

Section: Limitationsmentioning

confidence: 99%

Sex Differences in Outcome after Mild Traumatic Brain Injury

Blyth¹,

Mookerjee²,

He³

et al. 2010

Journal of Neurotrauma

300

196

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The objective of this study was to estimate the independent association of sex with outcome after mild traumatic brain injury (mTBI). We performed an analysis of a subset of an established cohort involving 1425 mTBI patients presenting to an academic emergency department (ED). The associations between sex and three outcomes determined 3 months after the initial ED visit were examined: post-concussive symptom (PCS) score (0, 1-5, 6-16, and >16), the number of days to return of normal activities (0, 1-7, and >7), and the number of days of work missed (0, 1-7,and >7). Logistic regression analyses were used to determine the relationship between sex and each outcome after controlling for 12 relevant subject-level variables. Of the 1425 subjects, 643 (45.1%) were female and 782 (54.9%) were male. Three months after mTBI, males had significantly lower odds of being in a higher PCS score category (odds ratio [OR] 0.62, 95% confidence interval [CI]: 0.50, 0.78); this association appeared to be more prominent during child-bearing years for females. Males and females did not significantly differ with respect to the odds of poorer outcome as defined by the number of days to return of normal activities or the number of days of work missed. Female sex is associated with significantly higher odds of poor outcome after mTBI, as measured by PCS score, after control for appropriate confounders. The observed pattern of peak disability for females during the child-bearing years suggests disruption of endogenous estrogen or progesterone production. Attempts to better understand how mTBI affects production of these hormones acutely after injury and during the recovery period may shed light on the mechanism behind poorer outcome among females and putative therapeutic interventions.

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A Longitudinal Study of the Relationship Between Financial Compensation and Symptoms After Treated Mild Traumatic Brain Injury

Cited by 101 publications

References 10 publications

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury

Utility of the Validity-10 scale across the recovery trajectory following traumatic brain injury

Sex Differences in Outcome after Mild Traumatic Brain Injury

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