Validation of the military concussion readiness inventory-dizziness and balance

The purpose of this study was to provide initial validation of the Military Concussion Readiness Inventory-Dizziness and Balance (MCRI-DB), the first military-specific patient self-report outcome measure to quantify dizziness and balance symptomology. Using retrospective data analysis, data was extracted from the Traumatic Brain Injury (TBI) Survey Portal, a repository of clinical outcome measures from U.S. military beneficiaries who receive care within the Defense Intrepid Network for TBI and Brain Health. The sample was randomly split into two groups for analysis. An exploratory factor analysis (EFA) with item reduction was completed on the MCRI-DB. Confirmatory factor analysis (CFA) was completed on the modified MCRI-DB. Finally, the modified MCRI-DB was tested for criterion-related validity against the Dizziness Handicap Inventory (DHI) and Neurobehavioral Symptom Inventory (NSI). Data from 553 service members was extracted from the TBI Survey Portal (Mean age = 37 +/- 8 yrs.; Males = 491, Females = 62; Army = 514). EFA was performed using Sample 1 data, starting with component extraction. One component was retained after parallel analysis and scree plot visualization. After determining the number of factors to retain, an iterative item reduction process began, with subsequent EFA after each of the seven rounds of item elimination. This process reduced the MCRI-DB from 68 items to 25 items. A follow-up CFA of the 25-item MCRI-DB was then completed using Sample 2 data, resulting in an acceptable model fit. Internal consistency for the 25-item MCRI-DB was good, Cronbach’s 𝛼 = 0.95. The 25-item MCRI-DB demonstrated strong correlation to the DHI (r = 0.77, p < 0.001) and NSI (n = 0.67, p < 0.001). Factor analysis and item reduction processes led to the creation of the 25-item MCRI-DB, demonstrating a streamlined survey process, reduced respondent burden, and improved data quality. The scale's one-factor solution aligns with recent literature on similar measures, boosting confidence in its ability to represent the construct of dizziness in military service members with a history of traumatic brain injury (TBI). The 25-item MCRI-DB may serve as an alternative self-reported dizziness outcome measure for military personnel. The MCRI-DB contains items that will aid in return-to-duty decision-making after mTBI.