Evidence for the Factorial and Construct Validity of a Self-Report Concussion Symptoms Scale

Abstract

OBJECTIVE: To evaluate the factorial and construct validity of the Head Injury Scale (HIS) among a sample of male and female collegiate athletes. DESIGN AND SETTING: Using a cross-sectional design, we established the factorial validity of the HIS scale with confirmatory factor analysis and the construct validity of the HIS with Pearson product moment correlation analyses. Using an experimental design, we compared scores on the HIS between concussed and nonconcussed groups with a 2 (groups) x 5 (time) mixed-model analysis of variance. SUBJECTS: Participants (N = 279) in the cross-sectional analyses were predominately male (n = 223) collegiate athletes with a mean age of 19.49 +/- 1.63 years. Participants (N = 33) in the experimental analyses were concussed (n = 17) and nonconcussed control (n = 16) collegiate athletes with a mean age of 19.76 +/- 1.49 years. MEASUREMENTS: All participants completed baseline measures for the 16-item HIS, neuropsychological testing battery, and posturography. Concussed individuals and paired controls were evaluated on days 1, 2, 3, and 10 postinjury on the same testing battery. RESULTS: Confirmatory factor analysis indicated that a theoretically derived, 3-factor model provided a good but not excellent fit to the 16-item HIS. Hence, the 16-item HIS was modified on the basis of substantive arguments about item-content validity. The subsequent analysis indicated that the 3-factor model provided an excellent fit to the modified 9-item HIS. The 3 factors were best described by a single second-order factor: concussion symptoms. Scores from the 16-item HIS and 9-item HIS were strongly correlated, but there were few significant correlations between HIS scores and scores from the neuropsychological and balance measures. A significant group-by-day interaction was noted on both the 9-item HIS and 16-item HIS, with significant differences seen between groups on days 1 and 2 postconcussion. CONCLUSIONS: We provide evidence for the factorial and construct validity of the HIS among collegiate athletes. This scale might aid in return-to-play decisions by physicians and athletic trainers.

Figure 1

Theoretic measurement model for the Head Injury Scale.

Figure 2

Theoretic second-order measurement model for the Head Injury Scale.

Figure 3

Mean responses and standard error of the mean for injured and control groups using the 16-Item Head Injury Scale across testing days. *P ≤ .05.

Figure 4

Mean responses and standard error of the mean for injured and control groups using the 9-Item Head Injury Scale across testing days. *P ≤ .05.