SPECIAL SECTION: ORIGINAL ARTICLE The Predictive Validity of a Brief Inpatient Neuropsychologic Battery for Persons With Traumatic Brain Injury Robin A. Hanks, PhD, Scott R. Millis, PhD, Joseph H. Ricker, PhD, Joseph T. Giacino, PhD, Risa Nakese-Richardson, PhD, Alan B. Frol, PhD, Tom A. Novack, PhD, Kathleen Kalmar, PhD, Mark Sherer, PhD, Wayne A. Gordon, PhD ABSTRACT. Hanks RA, Millis SR, Ricker JH, Giacino JT, Nakese-Richardson R, Frol AB, Novack TA, Kalmar K, Sherer M, Gordon WA. The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain in- jury. Arch Phys Med Rehabil 2008;89:950-7. Objective: To examine the predictive validity of a brief neuropsychologic test battery consisting of the Galveston Ori- entation and Amnesia Test, the California Verbal Learning Test–II, Trail-Making Test (TMT), Symbol Digit Modalities Test, grooved pegboard, phonemic and categorical word gen- eration tasks, the Wechsler Test of Adult Reading (WTAR), and the Wisconsin Card Sorting Test– 64 relative to functional outcome at 1 year in persons with traumatic brain injury. Design: Inception cohort study. Follow-up period of 12 months. Setting: Seven Traumatic Brain Injury Model System cen- ters. Neuropsychologic testing was conducted during the acute inpatient rehabilitation stay and functional outcome measures were obtained at 1-year outpatient follow-up. Participants: Adults (N=174) who met criteria for admis- sion to inpatient brain injury rehabilitation. Interventions: Not applicable. Main Outcome Measures: FIM instrument, Disability Rat- ing Scale, Supervision Rating Scale, Satisfaction With Life Scale (SWLS), and Glasgow Outcome Scale-Extended. Results: Multiple regression analyses revealed that perfor- mance on the neuropsychologic test battery was predictive of outcome at 1 year postinjury for all outcome measures, except FIM motor scores and the SWLS. Cognitive performance using this battery was found to predict 1-year outcomes above and beyond functional variables and injury severity variables col- lected during inpatient rehabilitation, thereby indicating incre- mental validity for this test battery. Individual tests that were found to be significant predictors of 1-year outcomes included the WTAR and TMT part B. Conclusions: These findings support the clinical utility and ecological validity of this battery with respect to level of disability, functional independence, and supervision required. Key Words: Brain injuries; Neuropsychological tests; Out- comes assessment (health care); Psychometrics; Rehabilitation. © 2008 by the American Congress of Rehabilitation Medi- cine and the American Academy of Physical Medicine and Rehabilitation O UTCOME PREDICTION is one of the most important and challenging tasks faced by clinicians involved in acute inpatient traumatic brain injury (TBI) rehabilitation. Es- tablishing an accurate prognosis is essential for planning cur- rent rehabilitation goals, identifying appropriate postacute care needs, educating caretakers about long-term medical and psy- chosocial issues, and rationing financial resources. Neuropsy- chologic assessment is commonly conducted in association with other neurodiagnostic procedures (eg, neuroimaging stud- ies) and has been shown to predict functional outcome at various stages of recovery. 1 A number of empirical studies have examined the role of neuropsychologic test performance in the prediction of out- come after TBI. Hart at al 2 assessed 452 adults enrolled in the Traumatic Brain Injury Model Systems (TBIMS) at 1 year postinjury on a battery of neuropsychologic tests including the Galveston Orientation and Amnesia Test (GOAT), token test, Wechsler Memory Scale–Revised (WMS-R) (logical memory subtest), digit span, Trail-Making Test (TMT), grooved peg- board, Controlled Oral Word Association Test (COWAT), Visual Form Discrimination, Wechsler Adult Intelligence Scale–Revised (WAIS-R) (block design subtest), Rey Auditory Verbal Learning Test (RAVLT), Symbol Digit Modalities Test (SDMT), and Wisconsin Card Sorting Test (WCST). The pri- mary outcome measure was the level of supervision required after 1 year based on the Supervision Rating Scale (SRS). 3 Nearly all measures differentiated those needing supervision from those who did not on univariate analyses, however, only digits backward, COWAT, and WCST predicted those needing moderate versus heavy supervision. Using a similar test bat- tery, Ross et al 4 evaluated 59 patients enrolled in a TBIMS after resolution of posttraumatic amnesia (PTA). Although performance on no single measure was a significant predictor of psychosocial outcome on the Community Integration Ques- tionnaire, 5 scores on the RAVLT, and TMT, when used in combination with age, significantly predicted home, and social integration. Performance on neuropsychologic tests have also been shown to be significantly correlated with severity of functional disability 6 and return to work. 7,8 Neese et al 6 investigated the association between various neuropsychologic testing domains (ie, intellectual, academic, language, visuoperceptual, memory, executive functioning) and level of functioning on the Disabil- From Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI (Hanks, Millis); Rehabilitation Institute of Michigan, Detroit, MI (Hanks, Millis); Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA (Ricker); JFK Johnson Rehabilitation Insti- tute and New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ (Gi- acino, Kalmar); Methodist Rehabilitation Center, Jackson, MS (Nakese-Richardson); University of Mississippi Medical Center, Jackson, MS (Nakese-Richardson); De- partment of Physical Medicine and Rehabilitation, Baylor Institute for Rehabilitation, Dallas, TX (Frol); Spain Rehabilitation Center, Birmingham, AL (Novack); Memorial Hermann/TIRR, Houston, TX (Sherer); and Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY (Gordon). Supported by the National Institute on Disability and Rehabilitation Research (grant nos. H133A020501, H133A020502, H133A020509, H133A020514, H133A020515, H133A020518, H133A020526). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Reprint requests to Robin A. Hanks, PhD, ABCN, Rehabilitation Institute of Michigan, 261 Mack Blvd, Detroit, MI 48201, e-mail: rhanks@med.wayne.edu. 0003-9993/08/8905-00816$34.00/0 doi:10.1016/j.apmr.2008.01.011 950 Arch Phys Med Rehabil Vol 89, May 2008