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Modeling the Structure of Acute Sport-Related Concussion Symptoms: A Bifactor Approach

Published online by Cambridge University Press:  06 August 2018

Lindsay D. Nelson ,
Mark D. Kramer ,
Christopher J. Patrick  and
Michael A. McCrea
Lindsay D. Nelson*
Affiliation:
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
Mark D. Kramer
Affiliation:
Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
Christopher J. Patrick
Affiliation:
Department of Psychology, Florida State University, Tallahassee, Florida
Michael A. McCrea
Affiliation:
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
*
Correspondence and reprint requests to: Lindsay Nelson, 8701 West Watertown Plank Road, Milwaukee, WI. E-mail: linelson@mcw.edu
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Abstract

Objectives: Concussions cause diverse symptoms that are often measured through a single symptom severity score. Researchers have postulated distinct dimensions of concussion symptoms, raising the possibility that total scores may not accurately represent their multidimensional nature. This study examined to what degree concussion symptoms, assessed by the Sport Concussion Assessment Tool 3 (SCAT3), reflect a unidimensional versus multidimensional construct to inform how the SCAT3 should be scored and advance efforts to identify distinct phenotypes of concussion. Methods: Data were aggregated across two prospective studies of sport-related concussion, yielding 219 high school and college athletes in the acute (<48 hr) post-injury period. Item-level ratings on the SCAT3 checklist were analyzed through exploratory and confirmatory factor analyses. We specified higher-order and bifactor models and compared their fit, interpretability, and external correlates. Results: The best-fitting model was a five-factor bifactor model that included a general factor on which all items loaded and four specific factors reflecting emotional symptoms, torpor, sensory sensitivities, and headache symptoms. The bifactor model demonstrated better discriminant validity than the counterpart higher-order model, in which the factors were highly correlated (r=.55–.91). Conclusions: The SCAT3 contains items that appear unidimensional, suggesting that it is appropriate to quantify concussion symptoms with total scores. However, evidence of multidimensionality was revealed using bifactor modeling. Additional work is needed to clarify the nature of factors identified by this model, explicate their clinical and research utility, and determine to what degree the model applies to other stages of injury recovery and patient subgroups. (JINS, 2018, 24, 793–804)

Keywords

Head injuryConcussionSportsExploratory factor analysisConfirmatory factor analysisBifactor modelHierarchical modelHigher-order factor modelPsychometric propertiesClinical phenotypes
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 24 , Issue 8 , September 2018 , pp. 793 - 804
Copyright
Copyright © The International Neuropsychological Society 2018 

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References

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