Brain Injury Screening Tool (BIST): test–retest reliability in a community adult sample

Abstract

ObjectiveTo determine the test–retest reliability of the Brain Injury Screening Tool (BIST), which was designed to support the initial assessment of mild traumatic brain injury (mTBI) across a variety of contexts, including primary and secondary care.DesignTest–retest design over a 2-week period.SettingCommunity based.ParticipantsSixty-eight adults (aged 18–58 years) who had not experienced an mTBI within the last 5 years and completed the BIST on two different occasions.MeasuresParticipants were invited to complete the 15-item BIST symptom scale and the Depression, Anxiety and Stress Scale (DASS-21) online at two time-points (baseline and 2 weeks later). To account for large variations in mood affecting symptom reporting, change scores on the subscales of the DASS-21 were calculated, and outliers were removed from the analysis.ResultsThe BIST total symptom score and subscale scores (physical-emotional, cognitive and vestibular) demonstrated moderate to good test–retest reliability with intraclass correlation coefficients ranging between 0.51 and 0.83. There were no meaningful differences between symptom reporting on the total scale or subscales of the BIST between time1 and time2 at the p<0.05 level when calculated using related samples Wilcoxon signed-rank tests.ConclusionThe BIST showed evidence of good stability of symptom reporting within a non-injured, community adult sample. This increases confidence that changes observed in symptom reporting in an injured sample are related to actual symptom change rather than measurement error and supports the use of the symptom scale to monitor recovery over time. Further research is needed to explore reliability of the BIST within those aged <16 years.

Experience of mTBI-like symptoms in a sample without brain injury in Aotearoa/New Zealand

“…However, general health and stress were not found to impact symptom reporting in this sample. These results on mood generally align with an earlier study using the original version of the BIST, which was found in a bivariate analysis to be linked with depression and anxiety (Shaikh et al 2022). Differences in findings between the two studies on stress are likely due to the use of different measures of stress.…”

“…Premorbid mental health problems (e.g. depression, anxiety) are a risk factor for prolonged recovery following mTBI (Iverson et al 2020) and are also associated with greater symptom experience in the general population (Suhr and Gunstad 2002;Iverson and Lange 2003;Zakzanis and Yeung 2011;Voormolen et al 2019;Shaikh et al 2022). There is also preliminary evidence that higher levels of stress may be linked to higher levels of physical symptom reporting, but this study was not specific to mTBI-like symptoms (Goldman et al 1996).…”

“…The symptom scale has excellent internal consistency for the total symptom score (α = 0.94) and its three subscales (physical (α = 0.90), cognitive (α = 0.92) and vestibular-ocular (α = 0.80)). Test-retest reliability is moderate to good with intraclass correlation coefficients ranging between 0.51 and 0.83 (Shaikh et al 2022). High concurrent validity has been established against the RPQ (r = 0.91) and SCAT-5 (r = 0.90) symptom scales (Theadom et al 2021).…”

“…The need for symptom evaluation features consistently in mTBI guideline recommendations as part of a multimodal assessment and for monitoring recovery (Silverberg et al 2020). A number of tools have been developed to evaluate post-injury symptoms (Alla et al 2009), such as the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) (King et al 1995), Sport Concussion Assessment Tool 5th Edition (SCAT-5) (Echemendia et al 2017) and Brain Injury Screening Tool (BIST) (Theadom et al 2021;Shaikh et al 2022).…”

“…Strengths of the BIST include a useragnostic design (it can be used by any health professional), culturally responsive for the NZ Indigenous populations and use of simple language. The BIST has demonstrated sound internal consistency, factor structure, concurrent validity and test-retest reliability (Theadom et al 2021;Shaikh et al 2022). Following clinical testing, the BIST was revised in 2022 (BIST 2.0).…”