@article{ref1,
title="The "Miserable Minority" Following Mild Traumatic Brain Injury: Who Are They and do Meta-Analyses Hide Them?",
journal="Clinical neuropsychologist, The",
year="2012",
author="Rohling, Martin L. and Larrabee, Glenn J. and Millis, Scott R.",
volume="26",
number="2",
pages="197-213",
abstract="Ruff et al. (1994; Ruff, Camenzuli, & Mueller, 1996) hypothesized that some mild traumatic brain injury (MTBI) patients will suffer chronic symptomatic complaints and impairments, identifying this subgroup as the &quot;miserable minority.&quot; However, several meta-analyses of the effects of MTBI have been published (e.g., Rohling et al., 2011) showing no significant cognitive impairments following recovery. Recently Pertab, James, and Bigler (2009) suggested that meta-analysis might be obscuring impairments in some MTBI patients, presenting a hypothetical score distribution to illustrate their claim. Our statistical analyses of their hypothetical figure and of several other potential distributions containing an impaired subgroup that varied as a function of effect size and base rate of occurrence did not support the existence of a miserable minority that is obscured in meta-analyses by the larger group of MTBI patients experiencing full recovery. Indeed, given our recent published MTBI effect size of -0.07 (Rohling et al., 2011), for an impaired subgroup to exist, the level of impairment would have to be just under a tenth of a standard deviation, equivalent to a WMS-IV Index score value of 1 point. At effect sizes this small, any cut score chosen on a test to diagnose patients would result in more false positives than true positives. This greatly increases the risk of misdiagnosis in persons who are susceptible to misattribution, expectancy effects, and &quot;diagnosis threat,&quot; thereby increasing the risk of iatrogenic illness.<p /> <p>Language: en</p>",
language="en",
issn="1385-4046",
doi="10.1080/13854046.2011.647085",
url="http://dx.doi.org/10.1080/13854046.2011.647085"
}