Kerala Brain Injury Questionnaire: Feasibility, Reliability, and Validation Study

Background: Mild traumatic brain injury (mTBI) can result in persistent neurological symptoms and signs and may contribute to late life cognitive decline. Yet, recognition of post-mTBI symptoms in older populations, especially in low-middle-income countries such as India, remains inadequate. Hence, there is a critical need to develop a screening tool to assess lifetime post-mTBI symptoms in India, which has a disproportionately high rate of TBI. Objective: To develop the Kerala Brain Injury Questionnaire (KBIQ) to assess post-mTBI (postconcussive) symptomatology. Methods: We examined the feasibility, reliability, and validity of the KBIQ, which assessed clinical symptoms possibly related to mTBI over the previous month in the Kerala Einstein Study (KES), based in Kerala state, India. Results: 682 KES participants (mean age 68.5 ± 5.7 years, 40.5% women, and 14.9% reported mTBI) without dementia completed the KBIQ. The KBIQ had high acceptability and response rates with no concerns raised during administration raised by participants or interviewers. The KBIQ demonstrated high internal consistency and good validity, as assessed by comparison to mTBI history. We used principal component analysis to determine that the KBIQ has a six-component structure. Conclusions: The KBIQ is a reliable and valid assessment of chronic postconcussive symptoms in older Indian adults. The KBIQ can be used by nonclinicians, making it suitable for widespread case detection in community settings and for prescreening individuals prior to clinic visits, helping clinicians identify potential undiagnosed health issues.