Geriatric Research, Education and Clinical Center (GRECC), and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, and Harvard Medical School , Boston , Massachusetts , USA.
OBJECTIVE: Veterans from recent military conflicts frequently report persisting symptoms associated with concussion well beyond the expected period of recovery following mild traumatic brain injury. This study examined differences in the reporting of symptoms associated with concussion between clinical and research contexts.
METHODS: This naturalistic comparison included 91 Veterans from Operations Enduring Freedom (OEF), Iraqi Freedom (OIF) and New Dawn (OND). All participants were enrolled in a longitudinal study focused on traumatic brain injury and stress-related disorders and had also completed a VHA Comprehensive TBI Evaluation. Individuals completed the Neurobehavioral Symptom Inventory (NSI) during their research and clinical evaluations; additional measures of performance and symptom validity were also available for a subset of participants.
RESULTS: NSI mean total and subscale scores were significantly higher when assessed in the clinical compared to the research setting, irrespective of the order and duration of time between evaluations. Rates of over-reporting on the NSI and performance validity test failure were also higher during the clinical evaluation.
CONCLUSION: Clinicians and researchers must appreciate the possible effects of context on the reporting of symptoms commonly associated with concussion. Future research identifying and mitigating factors influencing the effect of context on symptom reporting is needed.