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Meterko M, Baker E, Stolzmann KL, Hendricks AM, Cicerone KD, Lew HL. Psychometric assessment of the Neurobehavioral Symptom Inventory-22: the structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veterans. The Journal of head trauma rehabilitation. 2012 Jan 1; 27(1):55-62.
Background: Mild traumatic brain injury (TBI) or concussion is the "signature injury" of Operations Enduring Freedom/Iraqi Freedom and persistent effects of concussion are the focus of both rehabilitation and research. A key component of TBI evaluations Veterans Health Administration (VA) is the 22-item Neurobehavioral Symptom Inventory (NSI-22). Reported psychometric properties of the NSI-22 vary and none involve a large sample with deployment-related TBI. Methods: Using data from all VA TBI evaluations in FY08 and FY09, exploratory (EFA) and confirmatory factor analysis (CFA) were performed, respectively, on randomly selected derivation (n = 6,001) and validation (n = 5,987) samples of Veterans with deployment-related TBI. Factor structure utility was assessed by comparing scores across groups defined by concussion etiology and posttraumatic stress disorder (PTSD) co-morbidity. Results: The EFA yielded credible three- and four-factor models. The three factors were somato-sensory, cognitive and affective; the four-factor solution identified a separate vestibular factor. All CFA indices were better for the four-factor model. Severity of symptoms was higher among those with PTSD across all factors, and lowest in the blast only group and highest for "blast plus non-blast" on all factors but vestibular. Conclusions: The NSI-22 appears to be multi-dimensional. Conceptualizing post-concussive symptoms in terms of four dimensions may allow clinicians to better treat patients with TBI. Key Words: traumatic brain injury; factor analysis; posttraumatic stress disorder; psychometrics.