The Patient Global Impression of Change as a complementary tool to account for neurobehavioral and mental health symptom improvement for patients with concussion.

ABSTRACT

PURPOSE: The purpose of this study was to determine the extent to which patient's perspective of symptom improvement, as indexed by the Patient Global Impression of Change (PGIC) survey, is associated with symptom improvement on common measures of neurobehavioral and mental health symptoms following concussion. MATERIALS AND METHODS: Data were from 449 US active duty service members receiving treatment in interdisciplinary programs for their concussion. PGIC rating (range = 1-7) was evaluated for compatibility in assessing improvement in or clinically-elevated neurobehavioral (using Neurobehavioral Symptom Inventory [NSI]) and mental health (using Post-traumatic Stress Disorder Checklist, DSM-5 [PCL-5] and Patient Health Questionnaire [PHQ-8]) symptoms. RESULTS: Higher PGIC scores were related to a higher prevalence of clinically-relevant decrease in NSI, PCL-5 or PHQ-8 scores. Participants with a PGIC rating of 3+ (vs.<3) were about 2.2 (CI = 1.4-3.5), 1.6 (CI = 1.1-1.3), and 2.7 (CI = 1.4-5.1) times more likely to report clinically-relevant decrease in NSI, PCL-5 and PHQ-8 symptoms, respectively. CONCLUSION: PGIC may help providers incorporate patients' perspectives on symptom improvement achieved during rehabilitation. An approach combining PGIC with surveys such as NSI, PCL-5 and PHQ-8 may provide a more comprehensive understanding of symptom improvement and realistic view of expectations for what would be deemed recovery to pre-injury symptom levels.

Concussion significantly impacts cognitive, physical and mental health, and active duty service members (SMs) are at high risk due to their occupation demands.The Patient Global Impression of Change (PGIC) assesses symptom improvement, as perceived by the patient, which may align better with usual/pre-injury level symptoms prior to injury compared to other common measures of neurobehavioral and mental health symptoms for concussion patients.A comprehensive approach in which PGIC is included in symptom assessment may provide a better understanding of symptom improvement and provide a more realistic view of expectations for what would be deemed recovery to usual/pre-injury level or improvement in symptoms.