Academic Journal
View in EDS

Kerala Brain Injury Questionnaire: Feasibility, Reliability, and Validation Study.

Bibliographic Details
Title: Kerala Brain Injury Questionnaire: Feasibility, Reliability, and Validation Study.
Authors: Ambrose AF; Department of Neurology, Renaissance School of Medicine, Stony Brook, NY, USA., Adhikari D; Department of Neurology, Albert Einstein College of Medicine, NY, USA., Kumar VGP; Institute of Neurosciences, Baby Memorial Hospital, Kozhikode, Kerala, India., Sigamani A; Institute of Neurosciences, Baby Memorial Hospital, Kozhikode, Kerala, India.; Carmel Research Consultancy Pvt Ltd, Bengaluru, Karnataka, India., Weiss E; Department of Neurology, Albert Einstein College of Medicine, NY, USA., Jin Y; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, NY, USA., Wang C; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, NY, USA., Ayers E; Department of Neurology, Renaissance School of Medicine, Stony Brook, NY, USA., Verghese J; Department of Neurology, Renaissance School of Medicine, Stony Brook, NY, USA.
Source: Neurology India [Neurol India] 2025 Nov 01; Vol. 73 (6), pp. 1193-1198. Date of Electronic Publication: 2025 Nov 11.
Publication Type: Journal Article; Validation Study
Language: English
Journal Info: Publisher: Medknow Publications Country of Publication: India NLM ID: 0042005 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1998-4022 (Electronic) Linking ISSN: 00283886 NLM ISO Abbreviation: Neurol India Subsets: MEDLINE
Imprint Name(s): Publication: Mumbai : Medknow Publications
Original Publication: Bombay : Neurological Society of India
MeSH Terms: Post-Concussion Syndrome*/diagnosis , Brain Concussion*/diagnosis , Brain Concussion*/complications, Humans ; India ; Female ; Male ; Reproducibility of Results ; Surveys and Questionnaires ; Aged ; Feasibility Studies ; Middle Aged
Abstract: Background: Mild traumatic brain injury (mTBI) can result in persistent neurological symptoms and signs and may contribute to late life cognitive decline. Yet, recognition of post-mTBI symptoms in older populations, especially in low-middle-income countries such as India, remains inadequate. Hence, there is a critical need to develop a screening tool to assess lifetime post-mTBI symptoms in India, which has a disproportionately high rate of TBI.
Objective: To develop the Kerala Brain Injury Questionnaire (KBIQ) to assess post-mTBI (postconcussive) symptomatology.
Methods: We examined the feasibility, reliability, and validity of the KBIQ, which assessed clinical symptoms possibly related to mTBI over the previous month in the Kerala Einstein Study (KES), based in Kerala state, India.
Results: 682 KES participants (mean age 68.5 ± 5.7 years, 40.5% women, and 14.9% reported mTBI) without dementia completed the KBIQ. The KBIQ had high acceptability and response rates with no concerns raised during administration raised by participants or interviewers. The KBIQ demonstrated high internal consistency and good validity, as assessed by comparison to mTBI history. We used principal component analysis to determine that the KBIQ has a six-component structure.
Conclusions: The KBIQ is a reliable and valid assessment of chronic postconcussive symptoms in older Indian adults. The KBIQ can be used by nonclinicians, making it suitable for widespread case detection in community settings and for prescreening individuals prior to clinic visits, helping clinicians identify potential undiagnosed health issues.
(Copyright © 2025 Neurology India, Neurological Society of India.)
References: Agrawal A, Munivenkatappa A, Shukla DP, Menon GR, Alogolu R, Galwankar S, et al. Traumatic brain injury related research in India: An overview of published literature. Int J Crit Illn Inj Sci 2016;6:65–9.
Dams-O’Connor K, Juengst SB, Bogner J, Chiaravalloti ND, Corrigan JD, Giacino JT, et al. Traumatic brain injury as a chronic disease: Insights from the United States Traumatic Brain Injury Model Systems Research Program. Lancet Neurol 2023;22:517–28.
Lefevre-Dognin C, Cogné M, Perdrieau V, Granger A, Heslot C, Azouvi P. Definition and epidemiology of mild traumatic brain injury. Neurochirurgie 2021;67:218–21.
Moore M, Sandsmark DK. Clinical updates in mild traumatic brain injury (Concussion). Neuroimaging Clin N Am 2023;33:271–8.
Nelson LD, Temkin NR, Dikmen S, Barber J, Giacino JT, Yuh E, et al. Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers: A transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study. JAMA Neurol 2019;76:1049–59.
Pozzato I, Meares S, Kifley A, Craig A, Gillett M, Vu KV, et al. Challenges in the acute identification of mild traumatic brain injuries: Results from an emergency department surveillance study. BMJ Open 2020;10:e034494.
Ruff RM, Iverson GL, Barth JT, Bush SS, Broshek DK. Recommendations for diagnosing a mild traumatic brain injury: A National Academy of Neuropsychology education paper. Arch Clin Neuropsychol 2009;24:3–10.
Graham A, Livingston G, Purnell L, Huntley J. Mild traumatic brain injuries and future risk of developing Alzheimer’s disease: Systematic review and meta-analysis. J Alzheimers Dis 2022;87:969–79.
Lennon MJ, Brooker H, Creese B, Thayanandan T, Rigney G, Aarsland D, et al. Lifetime traumatic brain injury and cognitive domain deficits in late life: The PROTECT-TBI cohort study. J Neurotrauma 2023;40:1423–35.
Schaffert J, Chiang HS, Fatima H, LoBue C, Hart J, Cullum CM. History of traumatic brain injury does not alter course of neurocognitive decline in older adults with and without cognitive impairment. Neuropsychology 2023;37:923–32.
Mavroudis I, Ciobica A, Bejenariu AC, Dobrin RP, Apostu M, Dobrin I, et al. Cognitive impairment following mild traumatic brain injury (mTBI): A review. Medicina (Kaunas) 2024;60:380.
Veerappan VR, Nagendra B, Thalluri P, Manda VS, Rao RN, Pattisapu JV. Reducing the neurotrauma burden in India-A national mobilization. World Neurosurg 2022;165:106–13.
Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 2002;24:24–8.
GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019;18:56–87.
National Statistical Office. Elderly in India 2021. New Delhi, India: Government of India; 2021 [updated 2021]. Available from: https://mospi.gov.in/sites/default/files/publication_reports/Elderly%20in%20India%202021.pdf . [Last accessed on 2025 Jan 15].
Sathyan S, Ayers E, Blumen H, Weiss EF, Adhikari D, Stimmel M, et al. Epidemiology of motoric cognitive risk syndrome in the Kerala Einstein study: Protocol for a prospective cohort study. JMIR Res Protoc 2023;12:e49933.
Silverberg ND, Iverson GL, Cogan A, Dams OCK, Delmonico R, Graf MJP, et al. The American congress of rehabilitation medicine diagnostic criteria for mild traumatic brain injury. Arch Phys Med Rehabil 2023;104:1343–55.
Verghese J, Noone ML, Johnson B, Ambrose AF, Wang C, Buschke H, et al. Picture-based memory impairment screen for dementia. J Am Geriatr Soc 2012;60:2116–20.
Corrigan JD, Bogner J. Initial reliability and validity of the Ohio State University TBI identification method. J Head Trauma Rehabil 2007;22:318–29.
Gardner RC, Rivera E, O’Grady M, Doherty C, Yaffe K, Corrigan JD, et al. Screening for lifetime history of traumatic brain injury among older American and Irish adults at risk for dementia: Development and validation of a web-based survey. J Alzheimers Dis 2020;74:699–711.
Horton L, Rhodes J, Menon DK, Maas AIR, Wilson L. Questionnaires vs interviews for the assessment of global functional outcomes after traumatic brain injury. JAMA Netw Open 2021;4:e2134121.
Dams-OʼConnor K, Cantor JB, Brown M, Dijkers MP, Spielman LA, Gordon WA. Screening for traumatic brain injury: Findings and public health implications. J Head Trauma Rehabil 2014;29:479–89.
King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The rivermead post concussion symptoms questionnaire: A measure of symptoms commonly experienced after head injury and its reliability. J Neurol 1995;242:587–92.
McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild traumatic brain injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One 2017;12:e0174847.
Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86–7.
Bogner JA, Whiteneck GG, MacDonald J, Juengst SB, Brown AW, Philippus AM, et al. Test-retest reliability of traumatic brain injury outcome measures: A traumatic brain injury model systems study. J Head Trauma Rehabil 2017;32:E1–16.
Schneider ALC, Peltz CB, Li Y, Bahorik A, Gardner RC, Yaffe K. Traumatic brain injury and long-term risk of stroke among US military veterans. Stroke 2023;54:2059–68.
Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in southern India. Int J Geriatr Psychiatry 2004;19:1188–94.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics 1988;44:837–45.
Ministry of Road Transport and Highways. Road accidents in India 2022 New Delhi, India 2022. Available from: https://morth.nic.in/sites/default/files/RA_2022_30_Oct.pdf . [Last accessed on 2025 Jan 15].
Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths-United States, 2007 and 2013. MMWR Surveill Summ 2017;66:1–16.
Quinn DK, Mayer AR, Master CL, Fann JR. Prolonged postconcussive symptoms. Am J Psychiatry 2018;175:103–11.
Langer LK, Alavinia SM, Lawrence DW, Munce SEP, Kam A, Tam A, et al. Prediction of risk of prolonged post-concussion symptoms: Derivation and validation of the TRICORDRR (Toronto Rehabilitation Institute Concussion Outcome Determination and Rehab Recommendations) score. PLoS Med 2021;18:e1003652.
Lau BC, Collins MW, Lovell MR. Sensitivity and specificity of subacute computerized neurocognitive testing and symptom evaluation in predicting outcomes after sports-related concussion. Am J Sports Med 2011;39:1209–16.
Zeldovich M, Bockhop F, Covic A, Cunitz K, Polinder S, Haagsma JA, et al. Reference values for the rivermead post-concussion symptoms questionnaire (RPQ) from general population samples in the United Kingdom, Italy, and The Netherlands. J Clin Med 2022;11:4658.
Potter S, Leigh E, Wade D, Fleminger S. The rivermead post concussion symptoms questionnaire: A confirmatory factor analysis. J Neurol 2006;253:1603–14.
Witteman C, Bolks L, Hutschemaekers G. Development of the illness perception questionnaire mental health. J Ment Health 2011;20:115–25.
Contributed Indexing: Keywords: Concussion; epidemiology; screening; traumatic brain injury
Entry Date(s): Date Created: 20251111 Date Completed: 20251113 Latest Revision: 20251128
Update Code: 20251128
DOI: 10.4103/neurol-india.Neurol-India-D-24-00864
PMID: 41215511
Database: MEDLINE
Description
ISSN:1998-4022
DOI:10.4103/neurol-india.Neurol-India-D-24-00864