Publications by authors named "Scott R Millis"

85 Publications

The Template for Intervention Description and Replication as a Measure of Intervention Reporting Quality: Rasch Analysis.

Arch Rehabil Res Clin Transl 2020 Sep 23;2(3):100055. Epub 2020 Apr 23.

Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan.

Objective: To determine whether the 12 items of the Template for Intervention Description and Replication (TIDieR) can be combined into a single summary score reflecting intervention reporting completeness and quality.

Design: Systematic review and reanalysis of published data. After a systematic search of the published literature, 16 review articles were retrieved with 489 sets of 12 TIDieR ratings of experimental intervention, comparator, or the 2 combined as reported in primary studies. These 489 sets were recoded into a common format and analyzed using Rasch analysis for binary items.

Setting: Not applicable.

Participants: Not applicable.

Interventions: Not applicable.

Main Outcome Measures: Psychometric qualities of a Rasch Analysis-based TIDieR summary score.

Results: The data fit the Rasch model. Infit and outfit values were generally acceptable (range, 0.70-1.45). TIDieR was reasonably unidimensional in its structure. However, the person (here: study) separation ratio was 1.25 with a corresponding reliability of 0.61. In addition, the confidence interval around each estimate of reporting completeness was wide (model standard error of 0.78).

Conclusion: Several Rasch indicators suggested that TIDieR is not a strong instrument for assessing the quality of a researcher's reporting on an intervention. It is recommended that it be used with caution. Improvements in TIDieR itself may make it more helpful as a reporting tool.
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http://dx.doi.org/10.1016/j.arrct.2020.100055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853349PMC
September 2020

What determines the quality of rehabilitation Clinical Practice Guidelines? An overview study.

Am J Phys Med Rehabil 2020 Nov 18. Epub 2020 Nov 18.

Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit MI Kessler Institute for Rehabilitation, West Orange, NJ and Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, NJ Department of Physical Medicine and Rehabilitation, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, TX Educational Psychology Department, University of Texas, Austin, TX Strauss Heath Sciences Library, University of Colorado, Aurora CO Department of Physical Medicine and Rehabilitation, and Department of Emergency Medicine, Wayne State University, Detroit, MI.

Objective: To determine what factors determine the quality of rehabilitation Clinical Practice Guidelines (CPGs).

Design: 6 Databases were searched for papers that had applied the Appraisal of Guidelines for Research & Evaluation II (AGREE II) quality assessment tool to rehabilitation CPGs. The 573 de-duplicated abstracts were independently screened by two authors, resulting in 81 articles, the full texts of which were independently screened by two authors for AGREE II application to rehabilitation CPGs, resulting in a final selection of 40 reviews appraising 504 CPGs. Data were extracted from these by one author and checked by a second. Data on each CPG included the 6 AGREE II domain scores, as well as the two AGREE II global evaluations.

Results: All six AGREE II domain scores were statistically significant predictors of Overall CPG quality rating; D3 (rigor of development) was the strongest and D1 (scope and purpose) the weakest; overall model p < 0.001; R = 0.53. Five of the 6 domain scores were significant predictors of the CPG use Recommendation, with D3 the strongest predictor and D5 (applicability) the weakest; overall model p < 0.001; pseudo R = 0.53.

Conclusions: Quality of rehabilitation CPGs may be improved by addressing key domains such as Rigor of development.
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http://dx.doi.org/10.1097/PHM.0000000000001645DOI Listing
November 2020

Frequency of Electrodiagnostically Measurable Berrettini Anastomosis.

J Clin Neurophysiol 2020 May;37(3):214-219

Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan, U.S.A.

Purpose: Ulnar sensory palmar crossover to digit three (D3), the Berrettini anastomosis, is measurable in routine electrodiagnostic nerve conduction studies. The crossover is reported as occurring in 60% of anatomic dissections, but the frequency of measurable ulnar crossover to D3 and its potential as a nerve conduction pitfall is not established. The purpose of this article was to present descriptive statistics regarding the frequency of measurable Berrettini anastomosis in nerve conduction studies.

Methods: A retrospective chart review and data analysis was completed on 248 patients representing 411 extremities with a main outcome measure of ulnar sensory stimulated nerve conduction simultaneous waveform recording on D3 and digit four (D4). Consistent electrodiagnostic technique with waveform recording data analysis in a private practice and independent university waveform verification was completed on sequential patients referred for upper extremity electrodiagnostic testing.

Results: Measurable ulnar stimulated D3 sensory nerve action potentials were demonstrated in 34% of patients with amplitudes of 27%, the simultaneously recorded corresponding ulnar D4 amplitudes representing electrophysiological evidence of ulnar sensory crossover.

Conclusions: The Berrettini anastomosis can frequently be seen as a small amplitude sensory nerve action potential response, but at times can be observed with an amplitude greater than 10 μV. It is possible that patients with an absent or significantly delayed median nerve response may have simultaneous inadvertent spread of stimulus to ulnar axons measurable on D3 that may be interpreted as a falsely normal response. All electromyographers need to be aware of this potential pitfall.
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http://dx.doi.org/10.1097/WNP.0000000000000622DOI Listing
May 2020

Outcomes after Concussion Recovery Education: Effects of Litigation and Disability Status on Maintenance of Symptoms.

J Neurotrauma 2019 02 6;36(4):554-558. Epub 2018 Sep 6.

4 Department of Emergency Medicine, Wayne State University School of Medicine , Detroit, Michigan.

This study examined the hypothesis that people who receive concussion recovery education would have better outcomes than those who received usual discharge paperwork from the emergency department (ED) and tested whether participants who were in litigation or seeking disability compensation had more symptoms than individuals not engaged in these activities. Two hundred and fifty-five persons with a diagnosis of concussion were assigned randomly to a brief education group (one-page double-sided document), a longer education group (10-page document), and usual care (standard ED discharge instructions), and were these documents in the ED. A (non-concussion) trauma comparison group was enrolled to determine the symptom rate unrelated to brain injury. The Concussion Symptom Checklist (CSC) and litigation and disability status questions were completed by telephone at one week, three months, and six months. Neither long nor brief information handouts had a significant impact on symptoms over time; the standard form had an average decrease of 1.20 symptoms compared with the brief instructional intervention group (p = 0.031). Litigation status and disability seeking status were significant predictors of symptoms on CSC over time: disability seeking (p = 0.017) and litigation status (p = 0.05). Persons seeking Social Security disability or legal compensation endorsed more symptoms over time than those who were not. Number of symptoms on the CSC for the trauma control group was the same as those who sustained concussion. Type of recovery material was not as important as noting that concussion symptoms resolve over time, and that remaining symptoms are not specific to brain injury. Litigation and disability seeking behavior accounted for maintained symptoms, rather than the concussion itself.
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http://dx.doi.org/10.1089/neu.2018.5873DOI Listing
February 2019

Cognitive Log performance among individuals without brain injury in an inpatient rehabilitation setting.

Rehabil Psychol 2018 Aug;63(3):479-485

Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan.

Purpose/objective: Despite the widespread use of the Cognitive Log, information regarding normative performance is only available in individuals with known brain injury and in healthy college students. The purpose of the current research is to provide information about Cognitive Log performance in a regional group of rehabilitation patients without history of brain injury. Secondarily, non-neurological factors that may predict performance are considered. Research Method/Design: Participants included in this study were 121 consecutive patients admitted to an inpatient rehabilitation hospital spinal cord and orthopedic floor. Based on history, only patients without insult to the brain were included.

Results: This study provides normative information for Cognitive Log performance in a nonbrain injured population, showing that these patients score in between those with acquired brain injury and healthy controls. Variables including age, estimated intelligence, and self-reported pain, fatigue, and affective distress accounted for 47.5% of the variance in Cognitive Log scores, although age and estimated intelligence, which accounted for 43.3% of the variance, were the only individually significant contributors to performance.

Conclusions/implications: This study provides an estimate of normative Cognitive Log performance in a nonbrain injured population. This information is especially useful in that it signifies that both neurological and non-neurological factors contribute to Cognitive Log performance, and this information may shape how clinicians conceptualize scores in patients with and without brain injury. Age and longstanding intellectual abilities should be taken into consideration when interpreting Cognitive Log performances, developing rehabilitation strategies, and determining need for additional testing. (PsycINFO Database Record
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http://dx.doi.org/10.1037/rep0000236DOI Listing
August 2018

Social Competence Treatment After Traumatic Brain Injury: A Multicenter, Randomized Controlled Trial of Interactive Group Treatment Versus Noninteractive Treatment.

Arch Phys Med Rehabil 2018 11 30;99(11):2131-2142. Epub 2018 Jun 30.

Polytrauma Rehabilitation Center, VA Palo Alto Health Care System, Livermore, CA.

Objective: To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI).

Design: Multicenter randomized controlled trial comparing 2 methods of conducting a social competency skills program, an interactive group format versus a classroom lecture.

Setting: Community and veteran rehabilitation centers.

Participants: Civilian, military, and veteran adults with TBI and social competence difficulties (N=179), at least 6 months postinjury.

Interventions: The experimental intervention consisted of 13 weekly group interactive sessions (1.5h) with structured and facilitated group interactions to improve social competence, and the control consisted of 13 traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction.

Main Outcome Measures: Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments after TBI. LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale, Posttraumatic Stress Disorder Checklist-C (PCL) civilian version, Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self-Efficacy (PSSE).

Results: Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and 2 of the secondary outcomes (LCQ and BSI) were seen immediately posttreatment and at 3 months posttreatment in the alternative treatment arm only; however, these improvements were not significantly different between the group interactive structured treatment and alternative treatment arms. Similar trends were observed for PSSE and PCL-C.

Conclusions: Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study.
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http://dx.doi.org/10.1016/j.apmr.2018.05.030DOI Listing
November 2018

A Chemical-Biological-Radio-Nuclear (CBRN) Filter can be Added to the Air-Outflow Port of a Ventilator to Protect a Home Ventilated Patient From Inhalation of Toxic Industrial Compounds.

Disaster Med Public Health Prep 2018 12 21;12(6):739-743. Epub 2018 Feb 21.

3IDF Medical Corps,Tel Hashomer,Ramat Gan,Israel.

Objectives: Chemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients.

Methods: Eight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial.

Results: For all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator's trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators.

Conclusions: A CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients' mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;12:739-743).
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http://dx.doi.org/10.1017/dmp.2018.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112992PMC
December 2018

Safety and effectiveness of high-dose, weight-based factor VIII inhibitor bypassing activity for warfarin-induced life-threatening bleeding.

Blood Coagul Fibrinolysis 2018 Mar;29(2):205-210

Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.

: Previous studies suggest low, fixed-dose regimens of activated prothrombin complex concentrate [factor VIII inhibitor bypassing activity (FEIBA); 500 U for international normalized ratio (INR) < 5; 1000 U for INR > 5] is effective for reversal of warfarin-induced life-threatening bleeds. Little data are available on the use of high-dose, weight-based FEIBA for this indication. The objective of this study was to evaluate effectiveness and safety of high-dose, weight-based FEIBA (50 U/kg) vs. frozen plasma alone in this population. This was a matched case-control, multicenter retrospective study including patients who received high-dose, weight-based FEIBA or frozen plasma alone for warfarin-induced life-threatening bleeds matched (1 : 1) based on age and bleed location. Forty-eight patients were included in the analysis (24 FEIBA, 24 frozen plasma). The primary endpoint was time to INR less than 1.5 after administration of FEIBA or frozen plasma. Secondary endpoints include rates of thromboembolic events and mortality. Median baseline INR was 3.7 (interquartile range 2.7, 7.30) and 2.9 (2.3, 6.61) in the FEIBA and frozen plasma groups, respectively (P = 0.13). Median FEIBA dose was 4530 (3672, 5028) U. Use of FEIBA resulted in faster time to INR less than 1.5 with a median of 2.5 (1.25, 4.15) vs. 12 (5.6, 28.35) h; (P < 0.0001). Thromboembolic events occurred in nine (16.7%) patients (FEIBA n = 5; plasma n = 4); (P = 1.0). Mortality was similar in both groups (FEIBA 33% vs. frozen plasma 15%; P = 0.2). The use of high-dose, weight-based FEIBA resulted in faster time to reversal of warfarin-induced coagulopathy compared with frozen plasma alone and showed a similar safety profile.
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http://dx.doi.org/10.1097/MBC.0000000000000705DOI Listing
March 2018

Predictors of readmission to acute care during inpatient rehabilitation for non-traumatic spinal cord injury.

J Spinal Cord Med 2018 07 22;41(4):444-449. Epub 2018 Jan 22.

b Department of Physical Medicine and Rehabilitation , Rehabilitation Institute of Michigan , Detroit , Michigan , USA.

Objectives: To investigate the frequency of and reasons for readmissions to acute care (RTAC) during inpatient rehabilitation (IPR) after non-traumatic spinal cord injury (NT-SCI). To develop a predictive model for RTAC using identified risk factors.

Design: Retrospective case-control.

Setting: Academic IPR hospital.

Participants: Individuals with NT-SCI admitted to an academic SCI rehabilitation unit from January 2014-December 2015.

Interventions: Not applicable.

Main Outcome Measures: Readmissions to acute care services from IPR.

Results: Thirty-seven participants (20%) experienced a RTAC for a total of 39 episodes. Thirty-five experienced 1 RTAC, while two had 2. The most common medical reasons for RTAC were infection (27%), neurological (27%), and noninfectious respiratory (16%). Multivariable logistic regression was used to develop a model to predict RTAC. Paraplegia was associated with 3.2 times increase in the odds of RTAC (P = 0.03). For every unit increase in FIM-Motor, there was a 5% reduction in the odds of RTAC (P = 0.03) Body mass index less than 30 decreased odds of RTAC by 61% (P = 0.004).

Conclusion: RTACs were associated with body mass index greater than 30, decreased FIM-Motor subscore on admission, and paraplegia. Physiatrists caring for the non-traumatic SCI patient need be more circumspect of individuals with these parameters to potentially prevent the problems necessitating acute care transfer.
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http://dx.doi.org/10.1080/10790268.2018.1426235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055975PMC
July 2018

Emergency department visits in patients with low acuity conditions: Factors associated with resource utilization.

Am J Emerg Med 2018 08 13;36(8):1327-1331. Epub 2017 Dec 13.

Department of Emergency Medicine, Wayne State University, 4201 St. Antoine St., Detroit, MI 48201, United States; Department of Emergency Medicine and Cardiovascular Research Institute, Integrated Biosciences Center, Wayne State University School of Medicine, 6135 Woodward Ave., Detroit, MI 48202, United States.

Objectives: To identify health beliefs of emergency department (ED) patients with low acuity conditions and how these affect ambulance (AMB) utilization.

Methods: We performed a prospective, observational study on a convenience sample of patients 18years or older, who presented to the ED of an urban, academic hospital with an Emergency Severity Index (ESI) triage level of 4 or 5. Demographics, treatment, and disposition data were obtained along with self-administered surveys. Characteristics of patients with low acuity conditions who presented to the ED by AMB were compared to the patients who came to the ED by private transportation (PT). Data were analyzed with the chi-square test, t-test, and Mann-Whitney test.

Results: A total of 197 patients (97 AMB and 100 PT) were enrolled. Compared to PT, AMB patients were more likely to: be insured (82% vs. 56%; p=0.000), have a primary care provider (62% vs. 44%; p=0.048), and lack a regular means of transportation (53% vs. 33%; p=0.005). Three surveys were used the SF-8, Short Test of Functional Health Literacy in Adults [STOFHLA], and Health Belief Model [HBM]. Answers to HBM showed patients perceive that their illness required care within one hour of arrival (38% vs. 21%; p=0.04), have used an ambulance in the past year (76% vs. 33%; p=0.001) and to utilize an ambulance in the future for similar concerns (53% vs. 15%; p=0.000). AMB patients were more likely to call an ambulance for any health concern (p=0.035) and felt that there were enough ambulances for all patients in the city (p=0.01). There were no differences in age, employment, level of income and education, nor hospital admission rate between groups.

Conclusions: Ambulance use in low-acuity ED patients is associated with misperceptions regarding severity of illness and resource allocation as well as limited access to private transportation. Understanding patient perceptions of illness and other barriers to receiving care is imperative for the development of interventions aimed at enabling change in health behaviors such as the elective use of limited resources.
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http://dx.doi.org/10.1016/j.ajem.2017.12.033DOI Listing
August 2018

Blood pressure variability as an indicator of sepsis severity in adult emergency department patients.

Am J Emerg Med 2018 Apr 14;36(4):560-566. Epub 2017 Sep 14.

Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.

Study Objective: Quantify the correlation between blood pressure variability (BPV) and markers of illness severity: serum lactate (LAC) or Sequential Organ Failure Assessment (SOFA) scores.

Methods: We performed a secondary analysis of data from a prospective, observational study evaluating fluid resuscitation on adult, septic, ED patients. Vital signs and fluid infusion volumes were recorded every 15min during the 3h following ED arrival. BPV was assessed via average real variability (ARV): the average of the absolute differences between consecutive BP measurements. ARV was calculated for the time periods before and after 3 fluid infusion milestones: 10-, 20-, and 30-mL/kg total body weight (TBW). Spearman's rho correlation coefficient analysis was utilized. A p-value<0.05 was considered statistically significant.

Results: Forty patients were included. Mean fluid infusion was 33.7mL/kg TBW (SD 22.1). All patients received fluid infusion≥10mL/kg TBW, 25 patients received fluid infusion>20mL/kg TBW, and 16 patients received fluid infusion>30mL/kg TBW. Mean initial LAC was 4.0mmol/L (SD 3.2). Mean repeat LAC was 3.1mmol/L (SD 3.2), obtained an average of 6.6h (SD 5.3) later. Mean SOFA score was 7.0 (SD 4.4). BPV correlated with both follow-up LAC (r=0.564; p=0.023) and SOFA score (r=0.544; p=0.024) among the cohort that received a fluid infusion>20-mL/kg TBW.

Conclusion: With the finding of a positive correlation between BPV and markers of illness severity (LAC and SOFA scores), this pilot study introduces BPV analysis as a real-time, non-invasive tool for continuous sepsis monitoring in the ED.
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http://dx.doi.org/10.1016/j.ajem.2017.09.017DOI Listing
April 2018

Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure.

Am J Emerg Med 2017 Jan 18;35(1):126-131. Epub 2016 Oct 18.

Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI 48201. Electronic address:

Objectives: The purpose of this study was to compare health care resource utilization among patients who were given intravenous nitroglycerin for acute heart failure (AHF) in the emergency department (ED) by intermittent bolus, continuous infusion, or a combination of both.

Methods: We retrospectively identified 395 patients that received nitroglycerin therapy in the ED for the treatment of AHF over a 5-year period. Patients that received intermittent bolus (n=124) were compared with continuous infusion therapy (n=182) and combination therapy of bolus and infusion (n=89). The primary outcomes were the frequency of intensive care unit (ICU) admission and hospital length of stay (LOS).

Results: On unadjusted analysis, rates of ICU admission were significantly lower in the bolus vs infusion and combination groups (48.4% vs 68.7% vs 83%, respectively; P<.0001) and median LOS (interquartile range) was shorter (3.7 [2.5-6.2 days]) compared with infusion (4.7 [2.9-7.1 days]) and combination (5.0 [2.9-6.7 days]) groups; P=.02. On adjusted regression models, the strong association between bolus nitroglycerin and reduced ICU admission rate remained, and hospital LOS was 1.9 days shorter compared with infusion therapy alone. Use of intubation (bolus [8.9%] vs infusion [8.8%] vs combination [16.9%]; P=.096) and bilevel positive airway pressure (bolus [26.6%] vs infusion [20.3%] vs combination [29.2%]; P=.21) were similar as was the incidence of hypotension, myocardial injury, and worsening renal function.

Conclusions: In ED patients with AHF, intravenous nitroglycerin by intermittent bolus was associated with a lower ICU admission rate and a shorter hospital LOS compared with continuous infusion.
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http://dx.doi.org/10.1016/j.ajem.2016.10.038DOI Listing
January 2017

Barriers to emergency physician diagnosis and treatment of uncontrolled chronic hypertension.

Am J Emerg Med 2016 Nov 27;34(11):2241-2242. Epub 2016 Aug 27.

Wayne State University School of Medicine, Detroit, MI.

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http://dx.doi.org/10.1016/j.ajem.2016.08.050DOI Listing
November 2016

Prevalence of below-criterion Reliable Digit Span scores in a clinical sample of older adults.

Arch Clin Neuropsychol 2016 Aug 8;31(5):426-33. Epub 2016 May 8.

Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA

Objective: The Reliable Digit Span (RDS) is a well-validated embedded indicator of performance validity. An RDS score of ≤7 is commonly referenced as indicative of invalid performance; however, few studies have examined the classification accuracy of the RDS among individuals suspected for dementia. The current study evaluated performance of the RDS in a clinical sample of 934 non-litigating individuals presenting to an outpatient memory disorders clinic for assessment of dementia.

Method: The RDS was calculated for each participant in the context of a comprehensive neuropsychological assessment completed as part of routine clinical care. Score distributions were examined to establish the base rate of below criterion performance for RDS cutoffs of ≤7, ≤6, and ≤5. One-way ANOVA was used to compare performance on a cognitive screening measure and informant reports of functional independence of those falling below and above cutoffs.

Results: A cutoff score of ≤7 resulted in a high prevalence of below-criterion performance (29.7%), though an RDS of ≤6 was associated with fewer below-criterion scores (12.8%) and prevalence of an RDS of ≤5 was infrequent (4.3%). Those scoring below cutoffs performed worse on cognitive measures compared with those falling above cutoffs.

Conclusions: Using the RDS as a measure of performance validity among individuals presenting with a possibility of dementia increases the risk of misinterpreting genuine cognitive impairment as invalid performance when higher cutoffs are used; lower cutoffs may be useful when interpreted in conjunction with other measures of performance validity.
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http://dx.doi.org/10.1093/arclin/acw025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283019PMC
August 2016

Correlates of resilience in the first 5 years after traumatic brain injury.

Rehabil Psychol 2016 08 8;61(3):269-276. Epub 2016 Feb 8.

Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan/Wayne State University.

Purpose/objective: To examine resilience in the context of adjustment to traumatic brain injury (TBI), including the relative roles of demographic and theoretically related constructs such as coping, social support, and positive affectivity on resilience within the first 5 years postinjury.

Research Method/design: This was a cross-sectional, observational study of 67 persons with medically documented mild complicated to severe TBI. Participants completed a battery of measures including cognitive tests; questionnaires assessing self-report of emotional symptoms, perceived social support, and coping style; and a measure of resilience.

Results: Approximately 60% of the sample endorsed moderate to high levels of resilience during the first 5 years postinjury. Brain injury severity, premorbid intelligence, and cognitive flexibility did not predict resilience, as measured by the Connor-Davidson Resilience Scale. By contrast, task-oriented coping and perceived social support were strong and unique covariates of resilience. Positive and negative affectivity were related to resilience but were not unique covariates of it in the presence of task-oriented coping and perceived social support. Discriminant validity of resilience as a concept and the means of assessing it was supported by findings that emotion-oriented and avoidance coping were not meaningfully related to resilience.

Conclusions/implications: Overall, the findings indicate that the majority of individuals in this sample reported high levels of resilience after brain injury and that correlates of resilience in adults with TBI is similar to that observed in adults without the history of cognitive impairment. (PsycINFO Database Record
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http://dx.doi.org/10.1037/rep0000069DOI Listing
August 2016

Reply to commentary by Bilder, Sugar, and Helleman (2014 this issue) on minimizing false positive error with multiple performance validity tests.

Clin Neuropsychol 2014 10;28(8):1224-9. Epub 2014 Dec 10.

a Division of Physical Medicine and Rehabilitation , University of Utah School of Medicine , Salt Lake City , UT 84132 , USA.

Bilder, Sugar, and Helleman (2014 this issue) have criticized recent publications on performance validity test (PVT) failure in clinical samples. Bilder and colleagues appear to make an idiosyncratic interpretation of recent research and inconsistently apply principles of null hypothesis significance testing. Overall, their position seems to propose that PVTs should be held to a higher psychometric standard than conventional neuropsychological tests. Problematic aspects of these criticisms are discussed. Additional consideration is given to research aims and findings.
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http://dx.doi.org/10.1080/13854046.2014.987167DOI Listing
April 2015

Rasch analysis of the coping inventory for stressful situations in individuals with moderate to severe traumatic brain injury.

Arch Phys Med Rehabil 2015 Apr 25;96(4):659-66. Epub 2014 Nov 25.

Department of Psychology, Wayne State University, Detroit, MI.

Objective: To evaluate psychometric properties of the Coping Inventory for Stressful Situations (CISS) in individuals with traumatic brain injury (TBI).

Design: Archival study using Rasch analysis.

Setting: Postacute rehabilitation hospital.

Participants: Adults (N=331) 1 to 15 years after moderate to severe TBI, recruited consecutively.

Interventions: Not applicable.

Main Outcome Measure: CISS.

Results: Indices of unidimensionality and model fit supported the scale's proposed multidimensional structure consisting of Task, Emotion, and Avoidant coping style; 3 unidimensional scales showed better fit than a single combined scale. The 3 scales met Rasch expectations of reliability and separation for persons and items, as well as adequate response category functioning. The scales were generally well targeted but showed some evidence of ceiling effect for Task, and floor effects for Emotion and Avoidant coping; item difficulties did not fully capture extreme ranges demonstrated by some participants, suggesting that measurement of coping after TBI on the CISS would be improved with additional items at low and high ranges of difficulty. Results were generally equivalent for cross-sectional groups representing short-term (1y), intermediate (2y), and long-term (5-15y).

Conclusions: The CISS showed good psychometric properties as a measure of coping style among persons with moderate to severe TBI in acute and chronic phases of recovery, and showed evidence of multidimensionality as predicted by theory, consistent with 3 unidimensional scales. Added items tapping broader (or more accessible, less cognitively complex) ranges of coping responses would likely benefit the scale overall and improve correspondence with the response needs of people with TBI.
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http://dx.doi.org/10.1016/j.apmr.2014.11.006DOI Listing
April 2015

Intent to fail: significance testing of forced choice test results.

Clin Neuropsychol 2014 11;28(8):1366-75. Epub 2014 Nov 11.

a Independent practice , Portland , OR , USA.

A score that is significantly below the level of chance on a forced choice (FC) performance validity test results from the deliberate production of wrong answers. In order to increase the power of significance testing of a below chance result on standardized FC tests with empirically derived cutoff scores, we recommend using one-tailed tests of significance and selecting probability levels greater than .05 (.20 for most standardized FC tests with empirically derived cutoff scores). Under certain circumstances, we also recommend combining scores from different sections of the same FC test and combining scores across different FC tests. These recommendations require modifications when applied to non-standardized FC tests that lack empirically derived cutoff scores or to FC tests with a non-random topographical distribution of correct and incorrect answers.
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http://dx.doi.org/10.1080/13854046.2014.978383DOI Listing
April 2015

Psychosocial outcomes after traumatic brain injury: life satisfaction, community integration, and distress.

Rehabil Psychol 2014 Aug 14;59(3):298-305. Epub 2014 Jul 14.

Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine.

Objective: To examine the relationship between life satisfaction, community integration, and emotional distress in adults with traumatic brain injury (TBI).

Method: This was an archival study of a longitudinal data set on the outcome and recovery process of persons with TBI. Participants were 253 consecutive adults with mild complicated, moderate, and severe TBI who were enrolled in a large, longitudinal study of persons with TBI. Main measures included the Satisfaction with Life Scale, the Positive Affective and Negative Affective Schedule, the Craig Hospital Assessment and Reporting Technique Short-Form, the Community Integration Measure, and the Brief Symptom Inventory-18.

Results: The three-factor model adequately fit the data, and a higher-order model did not necessarily improve model fit but revealed significant relationships with first-order constructs and one second-order construct.

Conclusions: Life satisfaction, community integration, and emotional distress were found to be related yet unique concepts in persons with TBI. Life satisfaction was positively related to community involvement and inversely related to emotional distress. Community integration was inversely related to emotional distress. In addition, these concepts are related to a higher-order concept of psychosocial status, a global representation of subjective and objective functioning. These findings demonstrate the interrelated and dynamic nature of psychosocial well-being after brain injury and highlight the need for integrative and holistic treatment plans.
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http://dx.doi.org/10.1037/a0037164DOI Listing
August 2014

Role of character strengths in outcome after mild complicated to severe traumatic brain injury: a positive psychology study.

Arch Phys Med Rehabil 2014 Nov 7;95(11):2096-102. Epub 2014 Jul 7.

Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI.

Objective: To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI).

Design: Prospective study with consecutive enrollment.

Setting: A Midwestern rehabilitation hospital.

Participants: Persons with mild complicated to severe TBI (N=65).

Interventions: Not applicable.

Main Outcome Measures: Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading.

Results: Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes.

Conclusions: Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities.
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http://dx.doi.org/10.1016/j.apmr.2014.06.017DOI Listing
November 2014

Comparisons of five performance validity indices in bona fide and simulated traumatic brain injury.

Clin Neuropsychol 2014 1;28(5):851-75. Epub 2014 Jul 1.

a Department of Psychology , Wayne State University , Detroit , MI 48202 , USA.

A number of performance validity tests (PVTs) are used to assess memory complaints associated with traumatic brain injury (TBI); however, few studies examine the concordance and predictive accuracy of multiple PVTs, specifically in the context of combined models in known-group designs. The present study compared five widely used PVTs: the Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), Reliable Digit Span (RDS), Word Choice Test (WCT), and California Verbal Learning Test - Forced Choice (CVLT-FC). Participants were 51 adults with bona fide moderate to severe TBI and 58 demographically comparable healthy adults coached to simulate memory impairment. Classification accuracy of individual PVTs was evaluated using logistic regression and receiver operating characteristic (ROC) curves, examining both the dichotomous cutting scores as recommended by the test publishers and continuous scores for the measures. Results demonstrated nearly equivalent discrimination ability of the TOMM, MSVT, and CVLT-FC as individual predictors, all of which markedly outperformed the WCT and RDS. Models of combined PVTs were examined using Bayesian information criterion statistics, with results demonstrating that diagnostic accuracy showed only small to modest growth when the number of tests was increased beyond two. Considering the clinical and pragmatic issues in deriving a parsimonious assessment battery, these findings suggest that using the TOMM and CVLT in conjunction or the MSVT and CVLT in conjunction maximized predictive accuracy as compared to a single index or an assortment of these widely used measures.
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http://dx.doi.org/10.1080/13854046.2014.927927DOI Listing
October 2014

Comorbidity and insurance as predictors of disability after traumatic brain injury.

Arch Phys Med Rehabil 2014 Dec 24;95(12):2396-401. Epub 2014 Jun 24.

Touchstone Neurorecovery Center/Nexus Health Systems, Conroe, TX.

Objective: To examine the unique contribution of self-reported medical comorbidity and insurance type on disability after traumatic brain injury (TBI).

Design: Inception cohort design at 1-year follow up.

Setting: A university affiliated rehabilitation hospital.

Participants: Adults with mild-complicated to severe TBI (N=70).

Intervention: Not applicable.

Main Outcome Measures: Self-reported medical comorbidities were measured using the Modified Cumulative Illness Rating Scale, while insurance type was classified as commercial or government-funded; disability was measured using the Disability Rating Scale.

Results: Two models were run using multiple linear regression, and the best-fitting model was selected on the basis of Bayesian information criterion. The full model, which included self-reported medical comorbidity and insurance type, was significantly better fitting than the reduced model. Participants with a longer duration of posttraumatic amnesia, more self-reported medical comorbidities, and government insurance were more likely to have higher levels of disability. Meanwhile, individual organ systems were not predictive of disability.

Conclusions: The cumulative effect of self-reported medical comorbidities and type of insurance coverage predict disability above and beyond well-known prognostic variables. Early assessment of medical complications and improving services provided by government-funded insurance may enhance quality of life and reduce long-term health care costs.
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http://dx.doi.org/10.1016/j.apmr.2014.06.004DOI Listing
December 2014

Examination of performance validity test failure in relation to number of tests administered.

Clin Neuropsychol 2014 17;28(2):199-214. Epub 2014 Feb 17.

a Division of Physical Medicine and Rehabilitation , University of Utah School of Medicine , Salt Lake City , UT , USA.

This study examined the relationship among performance validity test (PVT) failure, number of PVTs administered, and participant characteristics including demographic, diagnostic, functional, and contextual factors in a clinical sample (N = 158) of outpatient physiatry referrals. The number of PVTs failed and the number administered showed a small non-significant correlation (rs = .13, p = .10). Participant characteristics showed associations with PVT failure consistent with prior research. A negative binomial regression model was fitted using number of PVTs failed as outcome and age, education, number of PVTs administered, clinical versus medico-legal context, and functional status as predictors. Although education and functional status were significant predictors of number of PVTs failed, the number of PVTs administered was not. A second analytic approach focused on observed false positive rates in a neurologic no-incentive (NNI) sample subset (n = 87). In contrast to a recent proposal based on statistical simulation, observed false positive rates were lower than predicted rates in NNI participants administered six, seven, or eight PVTs using a two-PVT failure cutoff. These results are interpreted as mitigating concerns that increased PVT failure is necessarily the outcome of increased PVT administration.
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http://dx.doi.org/10.1080/13854046.2014.884633DOI Listing
May 2014

Rasch analysis of the community integration measure in persons with traumatic brain injury.

Arch Phys Med Rehabil 2014 Apr 18;95(4):734-40. Epub 2013 Dec 18.

Department of Psychology, Wayne State University, Detroit, MI.

Objective: To examine the measurement properties of the Community Integration Measure (CIM) in persons with traumatic brain injury (TBI).

Design: Rasch analysis was used to retrospectively evaluate the CIM.

Setting: Rehabilitation hospital.

Participants: Persons (N=279) 1 to 15 years after a TBI.

Interventions: None.

Main Outcome Measure: CIM RESULTS: The CIM met Rasch expectations of unidimensionality and reliability (person separation ratio=2.01, item separation ratio=4.52). However, item endorsibility was poorly targeted to the participants' level of community integration. A ceiling effect was found with this sample.

Conclusions: The CIM is a relatively reliable and unidimensional scale. Future iterations might benefit from the addition of items that are more difficult to endorse (ie, improved targeting).
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http://dx.doi.org/10.1016/j.apmr.2013.11.020DOI Listing
April 2014

Assessing effort: differentiating performance and symptom validity.

Clin Neuropsychol 2013 12;27(8):1234-46. Epub 2013 Sep 12.

a Neuropsychology Department , Rehabilitation Institute of Michigan , Detroit , MI , USA .

The current study aimed to clarify the relationship among the constructs involved in neuropsychological assessment, including cognitive performance, symptom self-report, performance validity, and symptom validity. Participants consisted of 120 consecutively evaluated individuals from a veteran's hospital with mixed referral sources. Measures included the Wechsler Adult Intelligence Scale-Fourth Edition Full Scale IQ (WAIS-IV FSIQ), California Verbal Learning Test-Second Edition (CVLT-II), Trail Making Test Part B (TMT-B), Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), WAIS-IV Reliable Digit Span (RDS), Post-traumatic Check List-Military Version (PCL-M), MMPI-2 F scale, MMPI-2 Symptom Validity Scale (FBS), MMPI-2 Response Bias Scale (RBS), and the Postconcussive Symptom Questionnaire (PCSQ). Six different models were tested using confirmatory factor analysis (CFA) to determine the factor model describing the relationships between cognitive performance, symptom self-report, performance validity, and symptom validity. The strongest and most parsimonious model was a three-factor model in which cognitive performance, performance validity, and self-reported symptoms (including both standard and symptom validity measures) were separate factors. The findings suggest failure in one validity domain does not necessarily invalidate the other domain. Thus, performance validity and symptom validity should be evaluated separately.
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http://dx.doi.org/10.1080/13854046.2013.835447DOI Listing
April 2014

Calorie and protein intake in acute rehabilitation inpatients with traumatic spinal cord injury versus other diagnoses.

Top Spinal Cord Inj Rehabil 2013 ;19(3):229-35

Department of Physical Medicine and Rehabilitation at the Rehabilitation Institute of Michigan in the Detroit Medical Center, Wayne State University , Detroit, Michigan.

Background: Obesity and its consequences affect patients with spinal cord injury (SCI). There is a paucity of data with regard to the dietary intake patterns of patients with SCI in the acute inpatient rehabilitation setting. Our hypothesis is that acute rehabilitation inpatients with SCI consume significantly more calories and protein than other inpatient rehabilitation diagnoses.

Objective: To compare calorie and protein intake in patients with new SCI versus other diagnoses (new traumatic brain injury [TBI], new stroke, and Parkinson's disease [PD]) in the acute inpatient rehabilitation setting.

Methods: The intake of 78 acute rehabilitation inpatients was recorded by registered dieticians utilizing once-weekly calorie and protein intake calculations.

Results: Mean ± SD calorie intake (kcal) for the SCI, TBI, stroke, and PD groups was 1,967.9 ± 611.6, 1,546.8 ± 352.3, 1,459.7 ± 443.2, and 1,459.4 ± 434.6, respectively. ANOVA revealed a significant overall group difference, F(3, 74) = 4.74, P = .004. Mean ± SD protein intake (g) for the SCI, TBI, stroke, and PD groups was 71.5 ± 25.0, 61.1 ± 12.8, 57.6 ± 16.6, and 55.1 ± 19.1, respectively. ANOVA did not reveal an overall group difference, F(3, 74) = 2.50, P = .066.

Conclusions: Given the diet-related comorbidities and energy balance abnormalities associated with SCI, combined with the intake levels demonstrated in this study, education with regard to appropriate calorie intake in patients with SCI should be given in the acute inpatient rehabilitation setting.
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http://dx.doi.org/10.1310/sci1903-229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743973PMC
August 2013

The effect of protein and calorie intake on prealbumin, complications, length of stay, and function in the acute rehabilitation inpatient with stroke.

NeuroRehabilitation 2013 ;33(3):367-76

Department of Physical Medicine and Rehabilitation at the Rehabilitation Institute of Michigan in the Detroit Medical Center, Wayne State University, Detroit, MI, USA.

Background: Nutrition's impact on stroke rehabilitation outcomes is controversial. Existing studies utilize albumin without correcting for inflammation in nutritional assessments. Here, prealbumin was used and inflammation assessed to determine if nutrition impacts rehabilitation outcomes.

Objective: Determine the effect of dietary intake on prealbumin level, number of complications, length of stay, and Functional Independence Measure (FIM) efficiency in rehabilitation stroke inpatients.

Methods: Patients had admission and discharge prealbumin and C-reactive protein (CRP) levels drawn; and, weekly protein and calorie counts obtained. Patients were followed for number of complications, length of stay, and FIM efficiency.

Results: Mean protein and calorie intake was 57.6 ± 16.2 g/d and 1452.2 ± 435.8 kcal/d, respectively. 77.6% of patients had normal prealbumin on admission with 94.9% on discharge. Prealbumin increased significantly from admission to discharge (22.3 ± 6.2 mg/dL vs. 24.6 mg/dL ± 5.1 mg/dL, P = 0.007). Number of complications and length of stay were predicted by CRP in regression models. Total, motor, and cognitive FIM efficiencies were not universally affected by prealbumin levels, protein intake, or calorie intake.

Conclusions: Nearly all hypoprealbuminemic stroke rehabilitation inpatients correct their levels eating a non-supplemented diet. Number of complications, length of stay, and functional outcomes in this patient are not affected by prealbumin levels, protein intake, or calorie intake.
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http://dx.doi.org/10.3233/NRE-130966DOI Listing
June 2014

Efficacy of methylprednisolone versus other pharmacologic interventions for the treatment of central post-stroke pain: a retrospective analysis.

J Pain Res 2013 18;6:557-63. Epub 2013 Jul 18.

Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Rehabilitation Institute of Michigan in the Detroit Medical Center, Detroit, MI, USA.

Purpose: To determine if an oral, tapered methylprednisolone regimen is superior to other commonly used pharmacologic interventions for the treatment of central post-stroke pain (CPSP).

Patients And Methods: In this study, the charts of 146 stroke patients admitted to acute inpatient rehabilitation were retrospectively reviewed. Patients diagnosed with CPSP underwent further chart review to assess numerical rating scale for pain scores and as-needed pain medication usage at different time points comparing CPSP patients treated with methylprednisolone to those treated with other pharmacologic interventions.

Results: In the sample, 8.2% were diagnosed with CPSP during acute care or inpatient rehabilitation. Mean numerical rating scale for pain scores day of symptom onset did not differ between those patients treated with methylprednisolone versus those treated with other pharmacologic interventions (mean ± standard deviation; 6.1 ± 2.3 versus 5.7 ± 1.6, P = 0.77). However, mean numerical rating scale for pain scores differed significantly 1-day after treatment initiation (1.7 ± 2.1 versus 5.0 ± 1.9, P = 0.03) and 1-day prior to rehabilitation discharge (0.3 ± 0.9 versus 4.1 ± 3.2, P = 0.01) between the two groups. Compared to day of symptom onset, as-needed pain medication usage within the methylprednisolone group was marginally less 1-day after treatment initiation (Z = -1.73, P = 0.08) and 1-day prior to rehabilitation discharge (Z = -1.89, P = 0.06). No difference in as-needed pain medication usage existed within the non-steroid group at the same time points.

Conclusion: Methylprednisolone is a potential therapeutic option for CPSP. The findings herein warrant study in prospective trials.
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http://dx.doi.org/10.2147/JPR.S46530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720594PMC
July 2013

Changes in sexual functioning from 6 to 12 months following traumatic brain injury: a prospective TBI model system multicenter study.

J Head Trauma Rehabil 2013 May-Jun;28(3):179-85

Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Rehabilitation Institute of Michigan, Detroit, MI 48201, USA.

Objective: To investigate longitudinal changes in sexual functioning during the first year following moderate to severe traumatic brain injury (TBI).

Design: Prospective cohort study.

Setting: Community.

Participants: 182 persons (53 women and 129 men) with moderate to severe TBI who were admitted to 1 of 6 participating TBI Model System centers and followed in the community at 6 and 12 months after injury.

Main Measures: Derogatis Interview for Sexual Functioning-Self-Report (DISF-SR); Global Sexual Satisfaction Index (GSSI).

Results: Mean T-scores on the DISF-SR Arousal subscale demonstrated marginal improvement over time, with a 2.59-point increase (P = .05) from 6 to 12 months after injury. There were no significant differences over this 6-month period on the remaining DISF-SR subscales, including sexual cognition/fantasy, sexual behavior/experience, and orgasm. There was no significant change in satisfaction with sexual functioning on the GSSI from 6 months (72% satisfied) to 12 months (71% satisfied).

Conclusions And Implications: Sexual function and satisfaction appears to be stable in those with moderate to severe TBI from 6 to 12 months after injury, with the exception of minimal improvement in arousal. These findings, to our knowledge, reflect the first evidence regarding prospective changes in sexual functioning in this population. Future research can go far to assist clinicians in treatment planning and managing patient expectations of recovery of sexual functioning after TBI.
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http://dx.doi.org/10.1097/HTR.0b013e31828b4faeDOI Listing
January 2014

Number of impaired scores as a performance validity indicator.

J Clin Exp Neuropsychol 2013 20;35(4):413-20. Epub 2013 Mar 20.

Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.

This study examined embedded performance validity indicators (PVI) based on the number of impaired scores in an evaluation and the overall test battery mean (OTBM). Adult participants (N = 175) reporting traumatic brain injury were grouped using eight PVI. Participants who passed all PVI (n = 67) demonstrated fewer impaired scores and higher OTBM than those who failed two or more PVI (n = 66). Impairment was defined at three levels: T scores < 40, 35, and 30. With specificity ≥.90, sensitivity ranged from .51 to .71 for number of impaired scores and .74 for OTBM.
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http://dx.doi.org/10.1080/13803395.2013.781134DOI Listing
January 2014