Reliable Change Indices for the Serial Administration of the Concussion Clinical Profiles Screening Tool

CONTEXT

The Concussion Clinical Profile Screening Tool (CP Screen) self-report concussion symptom inventory that is often administered at weekly intervals. However, 1-week reliable change indices (RCI) for clinical cutoffs and the test-retest reliability of the CP Screen is unknown.

OBJECTIVE

Document RCI cutoff scores and 1-week test-retest reliability for each profile and modifier of the CP Screen for males and females.

DESIGN

Case Series.

SETTING

A large US university.

PATIENTS OR OTHER PARTICIPANTS

173 healthy college students.

MAIN OUTCOME MEASURE(S)

Participants completed two administrations of the CP Screen 7 days apart; CP Screen items yield five clinical profiles and two modifiers. Spearman rho coefficients (rs), intraclass correlation coefficients (ICCs) single measures and Unbiased Estimates of Reliability (UER) were used to assess test-retest reliability. Wilcoxon signed-rank tests assessed differences across time. RCI values and cutoff scores are provided at 90%/95% confidence intervals (CI). All analyses were performed for the total sample and separately for males and females.

RESULTS

RCI cutoffs for clinically significant change (increase/decrease) at a 90% CI for males were as follows: Ocular, Vestibular >2/>4, Anxiety/Mood, Cognitive/Fatigue, Migraine>3/>3, Sleep >4/>6, and Neck>2/>2. RCI cutoffs for clinically significant change (increase/decrease) at a 90% CI for females were as follows: Anxiety/Mood≥2/≥4; Cognitive/Fatigue, Migraine, Ocular, Vestibular, Sleep≥3/≥3; and Neck≥1/≥1. Correlations for CP ranged from .51 (Migraine) to .79 (Anxiety/Mood) for the total sample, .48 (Migraine) to .84 (Vestibular) for males, and .51 (Migraine) to .77 (Ocular) for females. Test-retest indices for each profile and modifier were moderate to good for the total sample (ICC: .64-.82; UER: .79-.90), males (ICC: .60-.87; UER: .76-.94), and females (ICC: .64-.80; UER: .78-.89).

CONCLUSION

The CP Screen is reliable and stable across a 1-week interval, and established RCIs for males and females can help identify meaningful change throughout recovery.

Improving the quantitative classification of Erlenmeyer flask deformities

The Erlenmeyer flask deformity is a common skeletal modeling deformity, but current classification systems are binary and may restrict its utility as a predictor of associated skeletal conditions. A quantifiable 3-point system of severity classification could improve its predictive potential in disease. Ratios were derived from volumes of regions of interests drawn in 50 Gaucher's disease patients. ROIs were drawn from the distal physis to 2 cm proximal, 2 cm to 4 cm, and 4 cm to 6 cm. Width was also measured at each of these boundaries. Two readers rated these 100 femurs using a 3-point scale of severity classification. Weighted kappa indicated reliability and one-way analysis of variance characterized ratio differences across the severity scale. Accuracy analyses allowed determination of clinical cutoffs for each ratio. Pearson's correlations assessed the associations of volume and width with a shape-based concavity metric of the femur. The volume ratio incorporating the metaphyseal region from 0 to 2 cm and the diametaphyseal region at 4-6 cm was most accurate at distinguishing femurs on the 3-point scale. Receiver operating characteristic curves for this ratio indicated areas of 0.95 to distinguish normal and mild femurs and 0.93 to distinguish mild and severe femurs. Volume was moderately associated with the degree of femur concavity. The proposed volume ratio method is an objective, proficient method at distinguishing severities of the Erlenmeyer flask deformity with the potential for automation. This may have application across diseases associated with the deformity and deficient osteoclast-mediated modeling of growing bone.