Author/s: John Mark Disorbio and Daniel Bruns
Publication year: 2002
Age Range: 18 years to 65 years old
Administration: Individual – 7 to 10 minutes
Scoring options: Q-global™ Scoring & Reporting, Q™ Local Software or PAD
Assessment of pain and functional levels and other psychological factors commonly associated with pain and rehabilitation patients.
A brief diagnostic tool well-suited for initial intake and outcomes measurement of patients with injuries.
The BBHI 2 test was developed specifically to help medical professionals assess the important mind/body connection for their patients and its impact on normal course of treatment and recovery. Derived from the well-researched, widely used BHI™ (Battery for Health Improvement) test, the shorter BBHI 2 instrument helps practitioners quickly evaluate for a number of psychomedical factors commonly seen in patients with injuries, such as pain, somatic, and functional complaints – as well as traditional psychological concerns such as depression, anxiety and patient defensiveness.
The information provided by the BBHI 2 test can help practitioners obtain a quick yet comprehensive overview of the patient to help in treatment planning and in determining whether the patient may need a more in-depth evaluation by a psychologist.
How to Use This Test
The BBHI 2 test can be used in a wide variety of settings, including:
- As part of the initial evaluation
- Throughout the course of treatment to track patient progress
- Before and after:
Multidisciplinary pain program
- To help medical evaluators provide reliable, objective information regarding:
Cases involving occupational and auto injuries
Social security and disability evaluations
Workers’ compensation cases
The BBHI2 assessment provides objective infomation and practical treatment strategies to medical professionals who treat injured patients in a variety of settings.
Taking only 7–10 minutes to administer, the BBHI 2 test:
- Provides a single instrument to help measure a variety of pain-related issues, including level of pain, functionality, and emotional distress.
- Uses a nationally standardized 0–10 pain scale, which assesses multiple dimensions of the pain experience, including level of pain in 10 body areas, pain tolerance, pain range, and peak pain.
- Efficiently assess patients to develop appropriate treatment plans and determine whether further psychological evaluation is needed.
- Includes validity checks. The Defensiveness Scale can help detect tendencies to minimize or magnify distress, while the inclusion of a validity item helps detect random responding.
- Helps practitioners meet assessment guidelines proposed by organizations such as the Counsel for the Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Pain Reference Groups
- Head Injury/Headache
- Neck Injury
- Upper Extremity Injury
- Back Injury
- Lower Extremity Injury
- Fake Good
- Fake Bad
Physical Symptom Scales
- Somatic Complaints
- Pain Complaints
- Functional Complaints
- Symptom Dependency
- Chronic Maladjustment
- Substance Abuse
- Family Dysfunction
- Survivor of Violence
- Doctor Dissatisfaction
- Job Dissatisfaction
Normed on a community sample of 725 individuals and a sample of 527 physical rehabilitation and chronic pain patients. The report compares the patient to both norm groups and uses the average physical rehabilitation/pain patient as a benchmark for interpretations and recommendations.
To provide further context for assessing the patient’s results, the BBHI 2 instrument also compares the patient, where appropriate, to 7 other reference groups in the reports:
- Head injury/Headache
- Neck injury
- Upper extremity injury
- Back injury
- Lower extremity injury
- Fake Good
- Fake Bad
Standard Report and Extended Reports
These reports present concise narrative statements about the patient’s responses, including a profile graph and Clinical Summary. There reports also feature Treatment Recommendations and a Patient Summary.
The Critical Items section highlights red flag indicators of clinical concerns:
- Suicide Ideation
- Pain Fixation
- Chemical Dependency
- Sleep Disorder
- Perceived Disability
- Compensation Focus
- Home Life Problems
- Satisfaction with Care
- Doctor Dissatisfaction
- Vegetative Depression
- Death Anxiety
- Random Responding
The Pain Complaint Item Responses capture your patient’s 0–10 pain ratings, similar to a VAS scale and also compares the patient’s reports to one of several possible reference groups.
The Extended Report includes amore in-depth Clinical Summary section, as well as Diagnostic Probabilities.
The Progress Report enables the clinician to monitor the patient’s progress over time through repeat administrations.
View a sample Standard Report.
View a sample annotated Standard Report.
View a sample Progress Report.
Scoring and/or Reporting Options
Q-global™ Web-based Administration, Scoring, and Reporting – Enables you to quickly assess and efficiently organize examinee information, generate scores, and produce accurate comprehensive reports all via the Web.
Q Local™ Scoring and Reporting Desktop Software – Enables you to score assessments, report results, and store and export data on your computer.
PAD (Patient Assessment Device) Hand-held Electronic Device – Administer the test on a portable, hand-held device. The PAD is placed on a docking station connected to a printer and a results report is printed immediately.
Using Psychological Evaluations to Improve Patient Care and Outcomes
Assessment and Treatment of Chronic Pain: A Physician’s Guide
Expanding the Horizon for Chronic Pain Patients: Advanced Spinal Cord Stimulation Technology Offers New Hope
Chronic Pain and Biopsychosocial Disorders
Case Study Articles
BBHI 2 Test: Information is Power: Practitioners Present Evidence-Based Results to Promote Use of Psychological Assessments with Workers Comp Patients(PDF – 172 KB)
BBHI™ 2 TEST – Companion Tests Provide Common Platform for Psychologists and Medical Practitioners in Evaluating Pain Patients (PDF – 142 KB)
BBHI™ 2 TEST – Physiatrist Uses BBHI 2 Test to Investigate the Underlying Causes of Patients’ Pain (PDF – 126 KB)
BBHI 2 Bibliography
Getting Started with the Q-global Training Series
View these brief training modules about Q-global:
Module 1: Gaining Access to Q-global
Module 2: Signing in and setting up your account
Module 3: Managing sub-accounts
Module 4: How to generate reports
BBHI™ 2 (Brief Battery for Health Improvement 2) Online Tutorials
This pre-recorded 20-30 minute session allows you to learn at your leisure. All you need is access to the Internet and the sound enabled on your computer. Please keep in mind that the session may take a few minutes to load.
These two tutorials will help you quickly gain an understanding of how to use the BBHI 2 test to efficiently assess for pain, function, depression, and other biopsychosocial issues that are commonly associated with pain and rehabilitation patients.
BBHI 2 Brief Tutorial: A brief overview that discusses what the test measures, how you can easily incorporate it into your office protocol, and insurance reimbursement. (16 minutes)
An In-Depth Look at the BBHI 2 Report: Thoroughly discusses the information available on the test’s results report and how you can use that information to better understand your patient’s level of pain and expectations from treatment. (10 minutes)
Frequently asked questions follow. Click on a question to see the response.
What is the BBHI 2 assessment designed to do?
The BBHI 2 assessment is designed to identify factors that may interfere with a patient’s normal course of recovery from an injury or chronic pain. The purpose of the BBHI 2 assessment is to provide relevant information and treatment recommendations to professionals who treat injured patients in a variety of settings, including physical rehabilitation, chronic pain, and general medicine.
When is it appropriate to use the BBHI 2 assessment?
The BBHI 2 assessment is intended to be used by a variety of clinicians and medical specialists, including anesthesiologists, neurologists, occupational therapists, physical therapists, surgeons, rehabilitation specialists, nurses, psychologists, psychiatrists, family physicians, multidisciplinary teams, and other healthcare providers involved in the treatment and care of injured patients. It is appropriate to use the BBHI 2 assessment with patients from 18 to 65 (inclusive) who are currently being treated for an injury or chronic pain. The test should not be used with patients who have serious cognitive impairment. The BBHI 2 assessment is also appropriate as a research instrument.
What are the benefits of having a test normed on rehabilitation/pain patients?
The benefit of having a test normed on rehabilitation/pain patients (rather than on community subjects) is that it reduces the chances of overpathologizing patients. The symptoms of the average patient, which are often labeled “extreme” or “highly problematic” on other tests, are appropriately labeled “average” on the BBHI 2 inventory. By comparing rehabilitation/pain patients to other rehabilitation/pain patients, the clinician or healthcare provider is able to assess which scale scores are elevated above what is normal or expected for the average rehabilitation/pain patient.
Can I administer just one of the BBHI 2 scales?
Yes. In fact, the BBHI 2 instrument is a modular assessment. It consists of four parts that can be administered individually if desired. Thus, if some of the BBHI 2 scales are not of interest to a caregiver, if time constraints prevent the administration of the entire BBHI 2, or if caregivers prefer to rely upon other instruments to assess certain factors, parts of the BBHI 2 assessment can be left blank. Unlike most psychological tests, the BBHI 2 assessment invalidates one scale at a time, rather than the whole test. As a result, even when entire scales are left blank, the BBHI 2 assessment still provides interpretable information.
Part I scores the Pain Complaints scale
Part II scores the Somatic Complaints scale
Part III scores the Defensiveness and Functional Complaints scales
Part IV scores the Depression and Anxiety scales
What are the BBHI 2 defaults?
If a Pain Diagnostic Category is not selected, it will default to a pain comparison for community norms. If none of the print option boxes are selected, a Standard Report will print. By default, you will NOT receive Item Responses or the Patient Summary.
If I score a Standard Report, can I print an Extended Report at no extra charge?
Yes. This is also the case if you print an Extended Report and would like to print a Standard Report.
How are the ratings and percentiles of each scale determined on the profile report?
The ratings are based on approximate percentile ranks. An extremely high or extremely low score suggests that the patient is in the highest or lowest 1% of the patient group.
A very high or very low score suggests that the patient is in the highest or lowest 5% of the patient group.
A high or low score suggests that the patient is in the highest or lowest 16% of the patient group, which means that he or she is more than one standard deviation away from the mean of the patient group.
A moderately high or moderately low score suggests that the patient is reporting a level of difficulties that is within normal limits for a patient but is more than one standard deviation away from the mean of “normal” nonpatients in the community.
What is the benefit of using the BBHI 2 Pain Scale?
The BBHI 2 Pain Complaints Scale is a double-normed scale, standardized on two national samples. One was a patient sample, and the other a community sample, and both of these samples were stratified to meet U.S. census data for gender, ethnicity, age, and level of education. The patient data was further subdivided into a chronic pain group, which comprised almost half of the sample, with the remainder being acute pain patients. The patients were also subdivided into diagnostic groups by their treating professionals. The pain diagnostic groups are divided into five groups: head injury/headache patients, neck injury patients, back injury patients, upper extremity injury patients, and lower extremity injury patients. These groups allow clinicians to make specific comparisons of their patients with a reference group of similarly diagnosed patients.
Q Local/BBHI 2 Starter Kit:
Includes BBHI 2 manual, answer sheets with test items and 10 Q Local administrations. (Does not include Q Local software.)