Les Misérables: The 'Miserable Minority' Following Mild Traumatic Brain Injury

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Is misinformation causing head injury patients to have a worse outcome?

For decades some researchers and attorneys have clung to a theory called the “miserable minority.” The essence of the theory is that 15% of those who suffer a mild head injury continue to have chronic symptomatic complaints. However, the 15% statistic is based on studies with significant methodological flaws. A 2012 study in The Clinical Neuropsychologisttitled "The 'Miserable Minority' Following Mild Traumatic Brain Injury: Who Are They and Do Meta-Analyses Hide Them?" demonstrates why the 15% number is wrong, and how it is harming patients. 

The 2012 article traces the 15% statistic to two frequently cited studies: one from 1979 by Rutherford, et al., and another from 1983 by McLean, et al. The 2012 study explains problems present in the sample used in the 1979 article. For instance, although 19 of the 131 patients in the sample reported symptoms one year after their head injury “10 of these 19 had symptoms at 1 year that they had not reported at 6 weeks. In addition, of the 19 who remained symptomatic at one year, 8 were involved in lawsuits, 6 had been suspected of malingering 6 weeks after their accident, and 5 of the 19 were both involved in lawsuits and suspected of malingering.” In short, bad sample in, bad data out. And as for the 1983 article, it only followed patients for one month after their head injury. For that reason, it hardly can stand as an authority on long-term recovery outcomes for concussion patients.

So how is this false statistic harming patients? The 2012 study notes that positive outcome feedback is essential so the medical provider does not inadvertently convince the patient that he or she will be injured for the rest of their life. For instance "simply having one’s attention called to a history of mTBI can negatively influence actual neuropsychological test performance, in the absence of an external incentive or evidence for malingering.” In short, it is imperative that individuals who suffer a mild head injury are given accurate information so they can maximize their recovery. The study went on to state, “misidentifying common daily cognitive, somatic, and affective phenomena, which covary with stress as ‘postconcussive,’ can reify these ‘symptoms’ and in someone prone to being excessively focused on bodily sensations may create a disorder where none would otherwise exist.” What all that science talk means is that the power of suggestion is great.