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The length of time ARSOF members had to recall likely con- have better test-retest reliability, and more research is needed
tributed to the poor test-retest reliability. Questionnaires are all to confirm. Developing a blast exposure questionnaire with
self-report and rely on the participants’ ability to recall events less granularity and that accounts for different phases of train-
or experiences. Some questionnaires (such as the Quality of ing and deployment may result in better reliability for ARSOF
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Life After Brain Injury or Godin Leisure Activity Scale ) members.
only require the participant to recall the past week and display
strong test-retest reliability. Other scales, such as the Food Fre- Author Contributions
quency Questionnaire (FFQ), typically require recall over the DP, DW, and JH: conceptualization; DP, DW, and JH: meth-
last 12 months and show a range of test-retest reliability from odology; DP, CM, SW, and JH: investigation; ES: writing and
poor to good, with decreasing reliability when participants analysis; DP, DW, and JH: supervision, and CM: resources.
were asked to recall >12 months compared to <12 months.
36
The decrease in recall ability may be attributed to the level of Disclaimer
granularity/detail the FFQ requests. Our results support the The views expressed in this manuscript are those of the au-
granularity notion where items 1 and 2 only required partic- thors and do not necessarily represent the official policy or po-
ipants to answer yes/no and years exposed, respectively, and sition of the Defense Health Agency, Department of Defense/
displayed good-excellent test-retest reliability. As granularity Department of War, or any other U.S. government agency. This
increased (Items 3–6), there was a general decrease in reli- work was prepared under Contract HT0014-22-C-0016 with
ability. The exception to the decrease was item 6 in weapon DHA Contracting Office (NM-CD) HT0014 and, therefore, is
categories 2–3, which showed good test-retest reliability. It is defined as U.S. Government work under Title 17 U.S.C.§101.
unclear why item 6 in weapon categories 2–3 deviated from Per Title 17 U.S.C.§105, copyright protection is not available
the trend, but we postulated that because the weapon catego- for any work of the U.S. Government. For more information,
ries referred to “large arms,” using these types of weapons was please contact dha.TBICOEinfo@health.mil.
more unique, less frequent, and therefore had better recall.
37
Weapon categories 2–3, in general across all items, did have Disclosures
slightly better test-retest reliability than the other weapon cat- The authors have nothing to disclose.
egories, supporting the notion of uniqueness. Our exploration
of the data provides further support whereby item 6 (querying Funding
exposure for at least two consecutive days) exhibited ~20–30 No funding was received for this work.
points lower on a 0 (none or never) to 100 (all the time) scale
for weapon categories 2–3 compared to item 6 in all other References
weapon categories. 1. Rowland JA, Martindale SL. Considerations for the assessment
of blast exposure in service members and veterans. Front Neurol.
Limitations 2024;15:1383710. doi:10.3389/fneur.2024.1383710
This study is not without limitations, one of which is men- 2. Martindale SL, Ord AS, Rowland JA. Influence of blast exposure
tioned above in the discussion: small sample size. ARSOF are on cognitive functioning in combat veterans. Neuropsychology.
2020;34(7):735–743. doi:10.1037/neu0000672
highly specialized, meaning research with ARSOF generally 3. Martindale SL, Ord AS, Rule LG, Rowland JA. Effects of blast
has a low sample size, and our study is not abnormal for this exposure on psychiatric and health symptoms in combat veterans.
population. Small sample sizes are common in Special Forces J Psychiatr Res. 2021;143:189–195. doi:10.1016/j.jpsychires.
research 38,39 and may have directly caused the negative ICC 2021.09.021
values and 95% CIs, which are not typical during reliability 4. Lange RT, French LM, Bailie JM, et al. Clinical utility of PTSD,
testing. Negative ICCs occur when the within-group variability resilience, sleep, and blast as risk factors to predict poor neuro-
(i.e., variability at a single post-SFAUC time point) is greater behavioral functioning following traumatic brain injury: a lon-
than the between-group variability (i.e., variability between gitudinal study in U.S. military service members. Qual Life Res.
2022;31(8):2411–2422. doi:10.1007/s11136-022-03092-4
both post-SFAUC time points). 40,41 The differences in within- vs 5. Dickerson MR, Murphy SF, Urban MJ, White Z, VandeVord PJ.
between-group variability during ICC calculations commonly Chronic anxiety- and depression-like behaviors are associated
41
occur when sample sizes are small. Therefore, larger sample with glial-driven pathology following repeated blast induced neu-
sizes would be preferred for future research, but may not be rotrauma. Front Behav Neurosci. 2021;15:787475. doi:10.3389/
feasible given the specialty of ARSOF personnel. In our study fnbeh.2021.787475
specifically, the sample size was small for test-retest reliability 6. Elder GA, Stone JR, Ahlers ST. Effects of low-level blast exposure
on the nervous system: Is there really a controversy? Front Neu-
(n=13) because ARSOF members were performing other duties rol. 2014;5:269. doi:10.3389/fneur.2014.00269
and/or training and not available for repeat testing. 7. Song H, Konan LM, Cui J, et al. Nanometer ultrastructural brain
damage following low intensity primary blast wave exposure.
Neural Regen Res. 2018;13(9):1516–1519. doi:10.4103/1673-
Conclusion 5374.237110
8. Taber KH, Hurley RA, Haswell CC, et al. White matter compromise
In conclusion, the GBEV displayed moderate convergent va- in veterans exposed to primary blast forces. J Head Trauma Reha-
lidity (rho-range=0.595–0.672) but predominantly poor test- bil. 2015;30(1):E15–25. doi:10.1097/HTR.0000000000000030
retest reliability, which worsened with increased GBEV scores. 9. Robinson ME, Lindemer ER, Fonda JR, Milberg WP, McGlinchey
The latter may be potentially due to poor recall secondary RE, Salat DH. Close-range blast exposure is associated with al-
to greater blast exposure history, potentially because of their tered functional connectivity in veterans independent of concus-
mTBI history affecting memory, or the stage in their career, sion symptoms at time of exposure. Hum Brain Mapp. 2015;36
but an exact reason (i.e., memory effects vs career stage) is (3):911–922. doi:10.1002/hbm.22675
beyond the scope of the current study. Future researchers and 10. Belding JN, Englert RM, Fitzmaurice S, et al. Potential health and
performance effects of high-level and low-level blast: a scoping re-
clinicians should use caution when interpreting BETS results view of two decades of research. Front Neurol. 2021;12:628782.
for ARSOF members specifically. Conventional forces may doi:10.3389/fneur.2021.628782

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