title: Clinical utility of embedded performance validity tests on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) following mild traumatic brain injury.
abstract: This study evaluated the clinical utility of two embedded performance validity tests (PVTs) developed for the Repeatable Battery for the Assessment of Neuropsychological Status: the Effort Index (EI) and the Effort Scale (ES) in mild traumatic brain injury (TBI) patients. Participants were 250 military service members (94.0% male; Age: M = 28.4, SD = 7.6) evaluated following mild TBI on average 7.4 months (SD = 15.6) post-injury. Participants were divided into two groups based on their performance on the Test of Memory Malingering: PVT-Pass, n = 193; PVT-Fail, n = 57. For the EI, recommended cut-offs for extremely probable, highly probable, and probable poor effort were established. A cut-off score of >3 resulted in low sensitivity (.14), high specificity (.99) and positive predictive power (.94), and moderate negative predictive power (.68) and is recommended for identifying highly probable poor effort. For both the EI and ES, cut-offs for probable poor effort were identified; however, classification accuracy was not much improved relative to simply using the sum of the List Recognition and Digit Span raw scores to classify poor effort. It is acknowledged that the use of a different criterion would likely have resulted in different findings. Nevertheless, findings support the use of the EI and the ES as a "red flag" for possible poor effort in mild TBI patients, but suggest that, in most cases, additional PVTs would be required to accurately rule poor effort in or out.
authors.affiliation: a Defense and Veterans Brain Injury Center , Bethesda , Maryland , USA.|b National Intrepid Center of Excellence , Bethesda , Maryland , USA.|c Walter Reed National Military Medical Center , Bethesda , Maryland , USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Lippa
authors.affiliation: a Defense and Veterans Brain Injury Center , Bethesda , Maryland , USA.|b National Intrepid Center of Excellence , Bethesda , Maryland , USA.|c Walter Reed National Military Medical Center , Bethesda , Maryland , USA.|d University of British Columbia , Vancouver , British Columbia , Canada.
authors.forename: Rael T
authors.initials: RT
authors.lastname: Lange
authors.affiliation: c Walter Reed National Military Medical Center , Bethesda , Maryland , USA.|e United States Public Health Service , Rockville , Maryland , USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Bhagwat
authors.affiliation: a Defense and Veterans Brain Injury Center , Bethesda , Maryland , USA.|b National Intrepid Center of Excellence , Bethesda , Maryland , USA.|c Walter Reed National Military Medical Center , Bethesda , Maryland , USA.|f Center for Neuroscience and Regenerative Medicine , Bethesda , Maryland , USA.|g Uniformed Services University of the Health Sciences , Bethesda , Maryland , USA.
authors.forename: Louis M
authors.initials: LM
authors.lastname: French
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000150:complications* / Q000175:diagnosis; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008306:Malingering / Q000175:diagnosis* / Q000523:psychology; D008889:Military Personnel; D009483:Neuropsychological Tests; D011594:Psychometrics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Effort; mild traumatic brain injury; performance validity; repeatable battery for the assessment of neuropsychological status; response bias