Questionnaires may have advantages over interviews for assessing TBI outcomes

Questionnaires may help assess global functional outcomes after traumatic brain injury and may provide significant practical advantages vs. interviews, according to results of a cohort study published in JAMA Network Open.

“In-person clinical interviews are the standard way of collecting information about limitations and problems in daily life after TBI, but these involve significant time and effort for clinical staff,” Lindsay Wilson, PhD, of the division of psychology at the University of Stirling in the U.K., and colleagues wrote. “The study shows that in many instances, questionnaires completed by the patient or a caregiver can yield substantially the same information concerning functional outcome as an interview. Use of questionnaires can thus potentially make large-scale studies feasible on topics where there is limited funding and make routine follow-up of cases practical with limited staffing.”

Wilson and colleagues sought to investigate agreement between interview and questionnaire formats for assessment of TBI outcomes and to determine potential advantages of an interview. They analyzed data of participants of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project between December 2014 and December 2017. They included patients aged 16 years or older with TBI who had a clinical indication for CT imaging, with outcome assessments via both an interview and a questionnaire at follow-up 3 months and 6 months after injury. TBI of all severities served as the exposure. Researchers compared ratings on the Glasgow Outcome Scale-Extended (GOSE) given as a structed interview featuring investigator rating with a questionnaire that patients or caregivers completed that was scored centrally. As secondary outcomes, Wilson and colleagues compared different sections of the GOSE assessments and the link between GOSE ratings and baseline factors, as well as patient-reported mental health, health-related quality of life and TBI symptoms.

A total of 994 CENTER-TBI participants completed both GOSE assessment formats at 3 months after TBI (65.8% men; median age, 53 years) and 628 participants completed the formats at 6 months (65.1% men; median age, 51 years). Researchers noted significant agreement between outcomes of the two assessment methods at 3 months and 6 months. They reported good item-level agreement between the two methods for sections related to independence in everyday activities and moderate agreement for those related to subjective aspects of functioning, including relationships and symptoms. Interviews vs. questionnaires recorded more problems with work, fewer limitations in social and leisure activities, and more symptoms. At times, interviewers assigned an overall rating according to judgment rather than interview scoring rules, particularly for patients with potentially unfavorable TBI outcomes. However, associations between baseline factors and patient-reported outcomes had similar strength in both formats.

“There is growing evidence that a substantial proportion of individuals with mild TBI may suffer long-term problems, but these patients often do not receive any contact after discharge from acute care,” Wilson said. “Questionnaires can provide a simple and effective way of screening for continuing difficulties in daily life and help to target further follow-up and appropriate support.”