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Cross-walk comparison of the DVBIC-TBICoE and LIMBIC-CENC combat-related concussion prospective longitudinal study datasets

Published:February 24, 2023DOI:https://doi.org/10.1016/j.apmr.2023.02.003
Cross-walk comparison of the DVBIC-TBICoE and LIMBIC-CENC combat-related concussion prospective longitudinal study datasets
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      ABSTRACT

      Objective

      To describe and compare cohorts between two large, longitudinal, federally-funded TBI studies of Service members and veterans across demographic, self-report, and neuropsychological variables.

      Design

      Analysis of data from the DVBIC-TBICoE and LIMBIC-CENC prospective longitudinal studies (PLS).

      Setting

      Recruitment locations spanning Department of Defense and Veterans Affairs hospitals across the U.S.

      Participants

      1,463 participants enrolled in the DVBIC-TBICoE study and divided among non-injured (NIC) (n=191), injured control (IC) (n=349), mild TBI (mTBI) (n=682), and (moderate-severe-penetrating TBI (smcTBI) (n=241) subgroups. 1,550 participants enrolled in the LIMBIC-CENC study and divided between IC (n=285) and mTBI (n=1,265) subgroups. IC and mTBI study groups were compared across demographic and military characteristics, self-reported symptoms, and neuropsychological test scores.

      Interventions

      None

      Main Outcome Measures

      Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-C), TBI Quality of Life (TBI-QOL), Test of Premorbid Functioning (TOPF), Wechsler Adult Intelligence Scale-IV (WAIS-IV) Visual Puzzles, Symbol Search, Coding, Letter-Number Sequencing, and Digit Span, Trail Making Test (TMT), Delis-Kaplan Executive Functioning System (DKEFS) Verbal Fluency, Letter Fluency, and Category Fluency, California Verbal Learning Test-II (CVLT-II), and Grooved Pegboard (GP).

      Results

      Compared to DVBIC-TBICoE, LIMBIC-CENC participants have higher enrollment age, education level, proportion of Black race, and time from injury as well as less combat deployments and are less likely to be married. The distribution of military service branches also differed. Further, symptom profiles differed between cohorts. LIMBIC-CENC participants endorsed higher posttraumatic stress disorder symptomatology. DVBIC-TBICoE study IC participants endorsed higher somatosensory and vestibular symptoms (medium effect sizes). Other symptom measure differences had very small effect sizes (≤0.2). Differences were found on many cognitive test results, but are difficult to interpret given the demographic differences and generally very small effect sizes.

      Conclusions

      The heavy use of NIH common data elements in both studies and collaboration with the DVBIC-TBICoE study team on development of the LIMBIC-CENC assessment battery enabled this comparative analysis. Results highlight unique differences in study cohorts, and adds perspective and interpretability for assimilating past and future findings.

      Key Words

      List of abbreviations:

      CENC (Chronic Effects of Neurotrauma Consortium), CVLT-II (California Verbal Learning Test-II), DKEFS (Delis-Kaplan Executive Functioning System), DoD (Department of Defense), DVBIC-TBICoE (Defense and Veterans Brain Injury Center - TBI Center of Excellence), IC (Injured Control), FITBIR (Federal Interagency TBI Research), GP (Grooved Pegboard), HHS (Health and Human Services), LIMBIC (Long-Term Impact of Military-Relevant Brain Injury Consortium), LIMBIC-CENC (Long-Term Impact of Military-Relevant Brain Injury Consortium – Chronic Effects of Neurotrauma Consortium), MSVT (Medical Symptom Validity Test), mTBI (Mild TBI), NIC (Non-Injured Control), NIH (National Institutes of Health), NIHTB-CB (NIH Toolbox Cognition Battery), NRAP (National Research Action Plan), NSI (Neurobehavioral Symptom Inventory), OEF/OIF/OND (Operation Iraqi Freedom, Operation Enduring Freedom, Operation New Dawn), OSU TBI-ID (Ohio State University TBI Identification), PCL-C (PTSD Checklist-Military Version), PLS (Prospective Longitudinal Studies), PTSD (Posttraumatic Stress Disorder), PVTs (Performance Validity Tests), SecDef (Secretary of Defense), smcTBI (Moderate-Severe-Penetrating TBI), TBI (Traumatic Brain Injury), TBI-QOL (TBI Quality of Life), TMT (Trail Making Test), TOPF (Test of Premorbid Functioning), USAF (Air Force), VCU rCDI (VCU Retrospective Concussion Diagnostic Interview), WAIS-IV (Wechsler Adult Intelligence Scale-IV), WCT (Advanced Clinical Solutions Word Choice Test)
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      Article info

      Publication history

      Accepted: February 9, 2023
      Received in revised form: February 8, 2023
      Received: August 25, 2021

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Study Support: The DVBIC-TBICoE study is supported by the Defense and Veterans Brain Injury Center (DVBIC) 15-Year Longitudinal TBI Study designed to respond to a Congressional mandate (Sec721 NDAA FY2007).

      The LIMBIC-CENC Study material is based upon work supported by the U.S. Army Medical Research and Materiel Command, from the U.S. Department of Veterans Affairs Long-term Impact of Military-related Brain Injury Consortium/Chronic Effects of Neurotrauma Consortium under Award No. 1I01CX002097-01 and the U.S Department of Defense under Award No. W81XWH-18-PH/TBIRP-LIMBIC. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the U.S. Government, the Department of the Army, Navy, Air Force, Department of Defense, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred.

      Conflicts of Interest: None

      Author Note: The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2023.02.003

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine

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