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Kelly LA, Caccese JB, Jain D, Master CL, Lempke L, Memmini AK, Buckley TA, Clugston JR, Mozel A, Eckner JT, Susmarski A, Ermer E, Cameron KL, Chrisman S, Pasquina P, Broglio SP, McAllister TW, McCrea M, Esopenko C. Sex Differences Across Concussion Characteristics in US Service Academy Cadets: A CARE Consortium Study. Sports Med 2024:10.1007/s40279-024-02068-3. [PMID: 38995598 DOI: 10.1007/s40279-024-02068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To describe sex differences in concussion characteristics in US Service Academy cadets. DESIGN Descriptive epidemiology study. SETTING Four US service academies. PARTICIPANTS 2209 cadets (n = 867 females, n = 1342 males). INDEPENDENT VARIABLE Sex. OUTCOME MEASURES Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. MAIN RESULTS Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43-2.10] and intramurals (IPR of 1.53, 95% CI 1.02-2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58-0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60-0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09-1.38), LOC (IPR of 1.67, 95% CI 1.17-2.37), PTA (IPR of 1.94, 95% CI 1.43-2.62), and RGA (IPR of 2.14, 95% CI 1.38-3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00-2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. CONCLUSIONS A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries.
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Affiliation(s)
- Louise A Kelly
- Department of Exercise Science, California Lutheran University, #3400, 60 W. Olsen Road, Thousand Oaks, CA, 91360, USA.
| | - J B Caccese
- College of Medicine School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - D Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C L Master
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - L Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - A K Memmini
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - T A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - J R Clugston
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - A Mozel
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J T Eckner
- Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Susmarski
- Medical Associates Clinic, Loras College, Dubuque, IA, USA
| | - E Ermer
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - K L Cameron
- Orthopaedic and Sports Medicine, United States Military Academy, West Point, NY, 10996, USA
| | - S Chrisman
- Division of Adolescence Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - P Pasquina
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - S P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - T W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - C Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Caccese JB, Master CL, Buckley TA, Chrisman SPD, Clugston JR, Eckner JT, Ermer E, Harcum S, Hunt TN, Jain D, Kelly LA, Langford TD, Lempke LB, McDevitt J, Memmini AK, Mozel AE, Perkins SM, Putukian M, Roby PR, Susmarski A, Broglio SP, McAllister TW, McCrea M, Pasquina PF, Esopenko C. Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study. Sports Med 2024; 54:1707-1721. [PMID: 38133787 DOI: 10.1007/s40279-023-01982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. METHODS National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24-48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale. RESULTS Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24-48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5-70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6-49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1-2.9; male athletes, mean = 4.1, 95% CI 1.5-10.9). CONCLUSIONS Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | | | | | | | | | | | - Elsa Ermer
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stacey Harcum
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Divya Jain
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Anne E Mozel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan M Perkins
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | | | | | - Paul F Pasquina
- Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA
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Weightman MM, King LA, Fino PC, Dibble LE, Pelo R, Michielutti PG, Richard H, Parrington L, Lester ME, Hoppes CW. Reconsidering Vestibular/Ocular Motor Screening Cutoff Scores for Concussion. Mil Med 2024; 189:e714-e720. [PMID: 37856171 DOI: 10.1093/milmed/usad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Vestibular/Ocular Motor Screening (VOMS) is often part of a comprehensive evaluation to identify acute mild traumatic brain injury. Most of the reports describe the use of the VOMS in adolescents/young adults and not in older adults or military service members. The purpose of this study was to describe VOMS findings in healthy civilians and active duty military service members up to the age of 50 years. MATERIALS AND METHODS Seventy-seven healthy civilians between 18 and 50 years of age (22 males, age 31.8 [9.0] years) participated across three sites in addition to 40 healthy active duty service members (25 males, age 27.5 [4.9] years) from one site. Demographics, Neurobehavioral Symptom Inventory scores, mean near point convergence (NPC) distance, and Total Symptom Change (TSS) scores from the VOMS were evaluated. RESULTS For civilians, the group mean NPC distance was 4.98 (3.8) cm. For military service members, the group mean NPC distance was 6.17 (4.57) cm. For civilians, the mean TSS was 1.2 (2.3) with 53.2% reporting 0 TSS, 27.3% reporting one TSS, and 19.5% reporting two or more TSS. For military service members, the mean TSS was 0.20 (0.72) with 92.5% reporting 0 TSS, 0% reporting one TSS, and 7.5% reporting two or more TSS. Age did not correlate with the mean NPC distance and TSS in healthy civilians and active duty military service members. CONCLUSIONS Reconsideration of the Military Acute Concussion Evaluation, Version 2 cutoff value for abnormal mean NPC distance may be warranted to improve diagnostic accuracy in both civilian and military adult populations. Similarly, re-evaluating criteria for interpreting the TSS results of the VOMS, specifically in civilians, may be warranted.
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Affiliation(s)
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Peter C Fino
- Department of Health & Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Ryan Pelo
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Holly Richard
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Mark E Lester
- Department of Physical Therapy, University of Texas-Rio Grande Valley, Edinburg, TX 78539, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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Cheever KM, Dewig D, Nedimyer AK, Register-Mihalik JK, Kossman MK. Determinants of Intention to Disclose Musculoskeletal Injury in Adolescent Athletes. J Athl Train 2024; 59:121-129. [PMID: 37459391 PMCID: PMC10895395 DOI: 10.4085/1062-6050-0093.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
CONTEXT Although research indicates that the key to minimizing the effect of musculoskeletal injury, improving care, and mitigating long-term effects is to improve early injury care seeking, little is known about barriers to early musculoskeletal injury disclosure and care seeking. OBJECTIVE To identify which determinants predicted sport-related musculoskeletal (MSK) injury disclosure by adolescent athletes. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS A total of 564 adolescent athletes (58% male, age = 15.81 ± 1.8 years). MAIN OUTCOME MEASURE(S) Online survey exploring determinants of age, gender, race, socioeconomic status, injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding MSK injury disclosure, intention to disclose MSK injury, and actual behavior of disclosing MSK injury. RESULTS Of the respondents, 457 (80.2%) reported having sustained ≥1 (mean = 3.2 ± 2.2; range = 1-10) MSK injuries related to sport. Those who endorsed having experienced an MSK injury disclosed not reporting or purposefully hiding 77% of their suspected MSK injuries. Several factors influenced a high intention to disclose MSK injury. Specifically, for each unit increase in total MSK injury knowledge (Exp[β] = 1.061, β=0.054, P = .020, 95% CI = 1.031, 1.221) and attitude (Exp[β] = 1.070, β = 0.064, P < .001, 95% CI = 1.027, 1.115) score, 6% and 7% increases in the likelihood of a high intention to disclose an MSK injury, respectively, were observed. Moreover, for each unit increase in the social norm score (Exp[β] = 1.178, β=0.164, P < .001, 95% CI = 1.119, 1.241), an 18% increase in the likelihood of a high intention to disclose an MSK injury was noted. CONCLUSIONS Designing interventions geared toward increasing the knowledge of signs and symptoms of MSK injury, improving attitudes surrounding disclosure, and better understanding the social context of disclosing MSK injuries may improve MSK injury disclosure behavior and reduce the associated social and economic burdens of these injuries.
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Affiliation(s)
- Kelly Martell Cheever
- Applied Biomechanics Laboratory, Department of Kinesiology, University of Texas at San Antonio
| | - Derek Dewig
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown
| | - Aliza K. Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg
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Burger JW, Andersen LS, Joska JA. Baseline concussion assessments can identify mental disorders: SCAT-5 and other screening tools in South African club rugby. PHYSICIAN SPORTSMED 2023; 51:472-481. [PMID: 36217827 DOI: 10.1080/00913847.2022.2134977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Although mental health screenings are not routinely conducted in rugby, the Sport Concussion Assessment Tool - Fifth Edition (SCAT-5) is widely performed and measures affective, cognitive, sleep, and physical symptoms. This study investigated the psychometric properties of the SCAT-5 to explore its potential as a mental health screening tool. METHODS During preseason for the 2021 Western Province Super League A in South Africa, clinicians conducted mental health assessments of 71 adult male rugby union players. The SCAT-5 Symptom Evaluation, Baron Depression Screener for Athletes (BDSA), Athlete Psychological Strain Questionnaire (APSQ), Center for Epidemiologic Studies-Depression (CES-D), and Generalized Anxiety Disorder-7 (GAD-7) were compared to each other and to fully structured diagnostic interviews by mental health professionals using the Mini International Neuropsychiatric Interview (MINI) 7.0.2. RESULTS Lifetime MINI-defined mental disorders were common, being identified in 33.8% (95% CI 22.79-46.17%). Only 4.29% of participants had a previous diagnosis. Exploratory Factor Analysis indicated a mental health construct of depression/anxiety being measured by the SCAT-5. The SCAT-5 had strong internal consistency (α = 0.94) and showed moderate convergent validity with the CES-D (r = 0.34; p = 0.008) and GAD-7 (r = 0.49; p < 0.0001). The area under the curve for the ability of the SCAT-5 to identify current disorders was 0.87 (p = 0.003), on par with the CES-D and GAD-7. CONCLUSION Since the SCAT-5 has the potential to identify depression and anxiety, it may allow mental health screening without the need for additional measures. Follow-up studies should further explore its discriminative ability in larger samples.
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Affiliation(s)
- James W Burger
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
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Cheever K, Nedimyer AK, Dewig D, Register-Mihalik JK, Kossman MK. The Identification and Comparison of Factors Affecting Musculoskeletal and Concussion Injury Disclosure. J Athl Train 2023; 58:563-572. [PMID: 36252227 PMCID: PMC10496445 DOI: 10.4085/1062-6050-0291.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Despite the increased risk of musculoskeletal (MSK) injury after a concussion, little is known about the determinants of such a risk. Moreover, the authors of previous reports of increased risk of MSK injury after a concussion have neglected to account for the high level of undisclosed concussions. OBJECTIVE To explore the association between the intention to disclose a possible concussion and the intention to disclose an MSK injury. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS One hundred seven National Collegiate Athletic Association Division I athletes (females = 79%, age = 19.4 ± 1.4 years). MAIN OUTCOME MEASURE(S) Online survey exploring determinants such as injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding concussive and MSK injury disclosure. RESULTS A significant association between high intention to disclose a concussion and high intention to disclose an MSK injury (χ2 = 19.276, P < .001, Cramer V = 0.482) was observed. Spearman rank correlations suggested no correlation between concussion nondisclosure (25%) and MSK injury nondisclosure (52%). Multivariate binomial regressions indicated that perceived social norms were the strongest determinant (β = 1.365, P = .002) of high intention to disclose concussion, while attitudes toward MSK injury (β = 1.067, P = .005) and perceived social norms (β = 1.099, P = .013) were the strongest determinants of high intention to report MSK injury. CONCLUSIONS Individuals with high intention to report concussion symptoms also demonstrated high intention to report MSK injury. Strong positive associations were seen between known determinants of intention to disclose concussion and adapted versions of those same determinant domains in intention to disclose MSK injury. As those with high intention to disclose concussion also displayed high intention to disclose MSK injury, intention to disclose injuries generally may play a role in explaining the increase in MSK injury after a concussion.
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Affiliation(s)
- Kelly Cheever
- Applied Biomechanics Laboratory, Department of Kinesiology, University of Texas at San Antonio
| | - Aliza K. Nedimyer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill
| | - Derek Dewig
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill
- STAR Heel Performance Laboratory, University of North Carolina at Chapel Hill
- Motion Science Institute, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg
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Hunzinger KJ, Cameron KL, Roach MH, Jackson JC, McGinty GT, Robb JB, Susmarski AJ, Estevez CA, Broglio SP, McAllister TW, McCrea M, Pasquina PF, Buckley TA. Baseline concussion assessment performance by sex in military service academy rugby players: findings from the CARE Consortium. BMJ Mil Health 2023:e002358. [PMID: 36804739 DOI: 10.1136/military-2023-002358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Normative student-athlete concussion assessment data may not be appropriate for service academy members (SAMs), particularly rugby players, because of the uniqueness of their academic/military training environment. Having accurate baseline data for this population is important because of their high risk for concussion and frequent lack of assigned sports medicine professional. The primary purpose of this study was to characterise baseline performance on a concussion assessment battery, with secondary purpose to determine effect of sex and concussion history on these measures among SAM rugby players. METHODS 601 rugby-playing SAMs (19.3±1.5 years, 37.9% female) completed baseline concussion assessments: the Sport Concussion Assessment Tool (SCAT) Symptom and Symptom Severity Checklist, Standard Assessment of Concussion (SAC) and a neuropsychological test (either ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) or ANAM (Automated Neuropsychological Assessment Metrics)). Groups were compared using an independent samples t-test or Mann-Whitney U test. A 2 (sex) × 2 (concussion history) ANOVA was conducted to determine the effects of sex and concussion history on outcomes. RESULTS Women reported greater SCAT total symptoms (3.3 vs 2.8, p<0.001, r=0.143) and symptom severities (5.7 vs 4.3, p<0.001, r=0.139), and performed worse on ImPACT Visual Memory (79.3 vs 82.6, p=0.002, r=0.144) than men. Women performed better than men on SAC (28.0 vs 27.7, p=0.03, r=0.088), ImPACT Reaction Time Composite (0.59 vs 0.61, p=0.04, r=0.092) and ANAM Code Substitution Delayed (64.3 vs 61.5, p=0.04, d=0.433). Individuals with a history of concussion reported lower ImPACT Symptom Severity (2.6 vs 4.2, p=0.02, r=0.110). There was no interaction between concussion history and sex on outcomes. CONCLUSIONS These findings provide reference data for SAM rugby players on baseline assessments and to help in clinical decision-making when managing sports-related concussion in absence of baseline data.
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Affiliation(s)
- Katherine J Hunzinger
- Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - K L Cameron
- Keller Army Community Hospital, West Point, New York, USA
| | - M H Roach
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Research & Surveillance Division, Fort Bragg, North Carolina, USA
- Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - J C Jackson
- United States Air Force Academy, USAF Academy, Colorado, USA
| | - G T McGinty
- United States Air Force Academy, USAF Academy, Colorado, USA
| | - J B Robb
- 10th Medical Group, United States Air Force Academy, USAF Academy, Colorado, USA
| | - A J Susmarski
- Orthopedic Sports Medicine, United States Naval Academy, Annapolis, Maryland, USA
| | - C A Estevez
- Physical Therapy, United States Coast Guard Academy, New London, Connecticut, USA
| | - S P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - T W McAllister
- Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - M McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - P F Pasquina
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - T A Buckley
- Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
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Buckley TA, Chandran A, Mauntel TC, Kerr ZY, Brown DW, Boltz AJ, Herman DC, Hall EE, Lynall RC. Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes. Am J Sports Med 2023; 51:511-519. [PMID: 36255302 DOI: 10.1177/03635465221125155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. PURPOSE To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). STUDY DESIGN Descriptive epidemiology study. METHODS Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non-time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports. RESULTS A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [ORAdj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (ORAdj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports. CONCLUSION First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football.
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Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.,Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention Inc, Indianapolis, Indiana, USA
| | - Timothy C Mauntel
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Derek W Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel C Herman
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Davis, California, USA
| | - Eric E Hall
- Department of Exercise Science, Elon University, Elon, North Carolina, USA
| | - Robert C Lynall
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
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Karr JE, Zuccato BG, Ingram EO, McAuley TL, Merker B, Abeare CA. The Post-Concussion Symptom Scale: Normative Data for Adolescent Student-Athletes Stratified by Gender and Preexisting Conditions. Am J Sports Med 2023; 51:225-236. [PMID: 36427014 DOI: 10.1177/03635465221131987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Post-Concussion Symptom Scale (PCSS) is a self-report questionnaire measuring symptoms that commonly occur after a concussion; however, these symptoms are nonspecific and can be related to co-occurring orthopaedic injuries (eg, cervical strain) or patient characteristics and preexisting conditions, even in the absence of a recent injury. As such, clinicians may have difficulty determining whether symptom elevations are attributable to a recent concussion as opposed to a confounding injury or a preexisting condition, which may be especially difficult when preinjury baseline symptom data are unavailable. PURPOSE This study aimed to further validate the 4-factor model of the PCSS (ie, cognitive, sleep-arousal, physical, and affective symptoms) with adolescent student-athletes and provide normative reference data for each factor and the total score, stratified by gender and preexisting health conditions. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Participants were 9358 adolescent student-athletes who completed the PCSS during a preseason baseline evaluation (mean age, 14.9 years; SD, 1.3 years [range, 13-18 years]; 49.3% boys). The 4-factor model of the PCSS was tested for the full sample and separately for boys and girls using confirmatory factor analysis. Symptom severity percentiles were created for the PCSS total score and each factor, stratified by gender and preexisting conditions (ie, attention-deficit/hyperactivity disorder, mental health history, headache/migraine history, learning disability/dyslexia, academic problems, and concussion history). RESULTS The 4-factor model of the PCSS replicated in the full sample (comparative fit index [CFI] = 0.959) and in both gender groups (boys: CFI = 0.961; girls: CFI = 0.960). The total PCSS score at the 84th percentile varied by preexisting conditions as follows: healthy participants = 8, attention-deficit/hyperactivity disorder = 18, mental health history = 26, headache/migraine history = 18, learning disability = 19, and academic problems = 17. On all PCSS subscales, participants with a mental health history had the highest scores, and high scores were associated with having >1 preexisting condition. Girls had higher scores than boys for each stratification. CONCLUSION The 4-factor model of the PCSS replicates for adolescent student-athletes. Gender, number of preexisting conditions, and mental health history are important factors to account for when interpreting PCSS symptom severity. The normative data provided herein could assist clinicians in determining whether an adolescent student-athlete is presenting with persistent postconcussion symptoms or a typical symptom experience based on their gender and personal health history.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Brandon G Zuccato
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Eric O Ingram
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Tara L McAuley
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Bradley Merker
- Department of Behavioral Health, Henry Ford Health System, Detroit, Michigan, USA
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10
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Test-Retest Reliability and Efficacy of Individual Symptoms in Concussion Management. Clin J Sport Med 2023; 33:52-60. [PMID: 36599360 DOI: 10.1097/jsm.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/06/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE (1) To determine test-retest reliability of individual Sport Concussion Assessment Tool-Third Edition (SCAT-3) symptom scores and symptom severity scores, (2) to examine the specificity/sensitivity of individual SCAT-3 symptom severity scores acutely (24-48 hours) postconcussion, and (3) to develop a model of symptoms best able to differentiate concussed from nonconcussed student athletes and cadets. DESIGN Prospective, longitudinal, and cross-sectional. SETTING Twenty-six civilian schools and 3 US service academies. PARTICIPANTS Collegiate student athletes (n = 5519) and cadets (n = 5359) from the National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education Consortium, including 290 student athletes and 205 cadets, assessed 24 to 48 hours postconcussion. INDEPENDENT VARIABLES Concussed and nonconcussed student athlete and cadet groups. MAIN OUTCOME MEASURES Sport Concussion Assessment Tool-Third Edition individual symptom severity scores, total symptom scores, and symptom severity scores. RESULTS Results indicated poor test-retest reliability across all symptom scores (intraclass correlation coefficient = 0.029-0.331), but several individual symptoms had excellent predictive capability in discriminating concussed from nonconcussed participants (eg, headache, pressure in the head, and don't feel right had area under the curve >0.8, sensitivity >70%, and specificity >85%) regardless of baseline testing. These symptoms were consistent with Chi-square Automatic Interaction Detector classification trees with the highest mean probability. CONCLUSIONS Findings support the excellent diagnostic accuracy of honest symptom reporting, notwithstanding the known limitations in symptom underreporting, and suggest that there may be added value in examining individual symptoms rather than total symptom scores and symptom severity scores alone. Finally, findings suggest that baseline testing is not necessary for interpreting postconcussion symptom scores.
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11
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Moody JN, Hayes JP, Buckley TA, Schmidt JD, Broglio SP, McAllister TW, McCrea M, Pasquina PF, Caccese JB. Age of First Concussion and Cognitive, Psychological, and Physical Outcomes in NCAA Collegiate Student Athletes. Sports Med 2022; 52:2759-2773. [PMID: 35794432 PMCID: PMC9833421 DOI: 10.1007/s40279-022-01719-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Concussions are common among youth athletes and could disrupt critical neurodevelopment. This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and symptoms commonly associated with concussion in healthy collegiate men and women student athletes. METHODS Participants included 4267 collegiate athletes from various contact, limited-contact, and non-contact sports (1818 women and 2449 men) who completed baseline assessments as part of the Concussion Assessment, Research and Education (CARE) Consortium. Psychological distress was assessed with the Brief Symptom Inventory 18; neurocognitive performance was assessed with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); symptoms commonly associated with concussion were assessed with the ImPACT Post-Concussion Symptom Scale; postural stability was assessed with the Balance Error Scoring System. Generalized linear models were used to examine the effects of AFC on clinical outcomes separately in men and women. RESULTS Later AFC was associated with lower global (Exp(B) = 0.96, P = 0.001) and somatic (Exp(B) = 0.96, P = 0.002) psychological distress on the Brief Symptom Inventory 18 and faster ImPACT reaction time (B = - 0.003, P = 0.001) in women. AFC was not associated with any clinical outcomes in men. CONCLUSION Younger AFC was associated with some differences in psychological distress and reaction time among women but not men; however, these results are likely not clinically meaningful. Sociodemographic disparities, pre-existing conditions, and sport type may impact clinical and cognitive outcomes in collegiate athletes more than concussion history. Future work should examine the relationship between AFC and lifespan-related outcomes.
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Affiliation(s)
- Jena N Moody
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Jasmeet P Hayes
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA
| | - Thomas A Buckley
- Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | | | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul F Pasquina
- Uniformed Services University of the Health Science and Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jaclyn B Caccese
- Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA.
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W 10th Ave, Columbus, OH, USA.
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12
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Brett BL, Nelson LD, Meier TB. The Association Between Concussion History and Increased Symptom Severity Reporting Is Independent of Common Medical Comorbidities, Personality Factors, and Sleep Quality in Collegiate Athletes. J Head Trauma Rehabil 2022; 37:E258-E267. [PMID: 34570026 PMCID: PMC8940748 DOI: 10.1097/htr.0000000000000724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We investigated the degree to which the association between history of concussion with psychological distress and general symptom severity is independent of several factors commonly associated with elevated symptom severity. We also examined whether symptom severity endorsement was associated with concussion injury specifically or response to injury in general. SETTING Academic medical center. PARTICIPANTS Collegiate athletes ( N = 106; age: M = 21.37 ± 1.69 years; 33 female) were enrolled on the basis of strict medical/psychiatric exclusion criteria. DESIGN Cross-sectional single-visit study. Comprehensive assessment, including semistructured interviews to retrospectively diagnose the number of previous concussions, was completed. Single-predictor and stepwise regression models were fit to examine the predictive value of prior concussion and orthopedic injuries on symptom severity, both individually and controlling for confounding factors. MAIN OUTCOME MEASURES Psychological distress was operationalized as Brief Symptom Inventory-18 Global Severity Index (BSI-GSI) ratings; concussion-related symptom severity was measured using the Sport Concussion Assessment Tool. RESULTS Controlling for baseline factors associated with the symptom outcomes (agreeableness, neuroticism, negative emotionality, and sleep quality), concussion history was significantly associated with psychological distress ( B = 1.25 [0.55]; P = .025, Δ R2 = 0.034) and concussion-like symptom severity ( B = 0.22 [0.08]; P = .005, Δ R2 = 0.064) and accounted for a statistically significant amount of unique variance in symptom outcomes. Orthopedic injury history was not individually predictive of psychological distress ( B = -0.06 [0.53]; P = .905) or general symptom severity ( B = 0.06 [0.08]; P = .427) and did not explain the relationship between concussion history and symptom outcomes. CONCLUSIONS Concussion history is associated with subtle elevations in symptom severity in collegiate-aged athletes; this relationship is independent of medical, lifestyle (ie, sleep), and personality factors. Furthermore, this relationship is associated with brain injury (ie, concussion) and is not a general response to injury history.
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Affiliation(s)
- Benjamin L Brett
- Departments of Neurosurgery and Neurology (Drs Brett and Nelson) and Neurosurgery, Biomedical Engineering, and Cell Biology, Neurobiology, and Anatomy (Dr Meier), Medical College of Wisconsin, Milwaukee
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Brett BL, Bryant AM, España LY, Mayer AR, Meier TB. Investigating the overlapping associations of prior concussion, default mode connectivity, and executive function-based symptoms. Brain Imaging Behav 2022; 16:1275-1283. [PMID: 34989980 PMCID: PMC9107488 DOI: 10.1007/s11682-021-00617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/02/2022]
Abstract
Growing evidence suggests that younger athletes with greater concussion history are more likely to endorse greater subjective cognitive (e.g., executive function) symptoms, but not perform worse on objective cognitive testing. We sought to identify biological correlates of elevated cognitive symptoms in 100 healthy, collegiate-aged athletes with varying degrees of concussion history. Associations between concussion history with subjectively-rated executive function were assessed with generalized linear models. Using resting state fMRI, we examined associations between concussion history and between-and within-network connectivity across three networks integral to executive function; default mode network (DMN), frontoparietal network (FPN), and ventral attention network (VAN). Relationships of between-and within-network connectivity with subjective executive function were assessed. Although the large majority of participants did not report clinically relevant levels of executive difficulties, there was a significant association between concussion history and higher behavioral regulation-related symptoms; B = .04[.01, .07], p = .011. A significant elevation in total within-network connectivity was observed among those with a greater concussion history, B = .02[.002, .03], p = .028, which was primarily driven by a positive association between concussion history and within DMN connectivity, B = .02[.004, .04], p = .014. Higher behavioral regulation-related symptoms were associated with greater total within-network connectivity, B = 0.57[0.18, 0.96], p = .005, and increased within-network connectivity for the DMN, B = .49[.12, .86], p = .010). The current study identified a distinct biological correlate, increased within-DMN connectivity, which was associated with both a greater history of concussion and greater behavioral regulation symptoms. Future studies are required to determine the degree to which these changes associated with concussion history may evolve toward objective cognitive decline over the lifespan.
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Affiliation(s)
- Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Bryant
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lezlie Y España
- Department of Neurosurgery, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.
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14
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Aderman MJ, Brett BL, Malvasi SR, McGinty G, Jackson JC, Svoboda SJ, McCrea M, Broglio SP, McAllister TW, Pasquina PF, Cameron KL, Houston MN. Association Between Symptom Burden at Initiation of a Graduated Return to Activity Protocol and Time to Return to Unrestricted Activity After Concussion in Service Academy Cadets. Am J Sports Med 2022; 50:823-833. [PMID: 35006034 DOI: 10.1177/03635465211067551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current consensus and position statements recommend that concussed patients be asymptomatic upon the initiation of the graduated return to activity (RTA) protocol. However, a significant number of concussed patients are beginning their RTA protocols while endorsing symptoms. PURPOSE To characterize symptom endorsement at the beginning of the RTA protocol and examine the association between symptom endorsement and RTA protocol duration in service academy cadets. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective cohort study was conducted with cadets at 3 US service academies. Postconcussion symptom inventories were recorded upon the initiation of an RTA protocol. The Sport Concussion Assessment Tool Symptom Inventory was used to classify participants into 3 groups (0 symptoms, 1 symptom, and ≥2 symptoms) upon the initiation of the RTA protocol. The primary outcome of interest was RTA protocol duration. Kaplan-Meier survival estimates were calculated to estimate RTA protocol duration by symptom endorsement, sex, varsity status, academic break, and time to graduated RTA initiation. Univariate and multivariable Cox proportional hazards models were used to estimate the association between symptom endorsement at the initiation of the RTA protocol and RTA protocol duration (α < .05). RESULTS Data were analyzed from 966 concussed cadets (36% women). Headache (42%) and faintness/dizziness (44%) were the most commonly endorsed symptoms on the Sport Concussion Assessment Tool-Third Edition and the Brief Symptom Inventory-18, respectively. Univariate results revealed a significant association between endorsing ≥2 symptoms and RTA protocol duration. In the multivariable model, endorsing ≥2 symptoms maintained a statistically significant association with RTA protocol duration. Significant associations were observed between RTA protocol duration and nonvarsity status (27% longer), women (15% longer), academic breaks (70% longer), and time to the initiation of the RTA protocol (1.1% longer daily incremental increase) after controlling for covariates. CONCLUSION Symptom endorsement at the initiation of an RTA protocol was associated with RTA protocol duration. Cadets who had returned to preinjury baseline symptom burden or improved from baseline symptom burden and endorsed ≥2 symptoms at the initiation of the RTA protocol took longer to RTA.
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Affiliation(s)
| | | | | | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, Colorado, USA
| | | | | | | | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Paul F Pasquina
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kenneth L Cameron
- Keller Army Hospital, West Point, New York, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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15
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Houston MN, Bookbinder HA, Roach SP, Ross JD, Aderman MJ, Peck KY, Malvasi SR, Svoboda SJ, Cameron KL. Reference Values for the Headache Impact Test-6 Questionnaire. Arch Phys Med Rehabil 2021; 102:2369-2376. [PMID: 34175274 DOI: 10.1016/j.apmr.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/03/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine reference values for the Headache Impact Test-6 (HIT-6) in a young, physically active cohort and to examine the influence of sex, concussion history, headache history, and competitive sport level on HIT-6 scores. DESIGN Cross-sectional. SETTING United States Service Academy. PARTICIPANTS United States Service Academy cadets (N=2678) completed an HIT-6 questionnaire as part of their annual concussion baseline assessment. Cadets with a recent concussion were excluded from baseline testing. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Reference values were calculated and stratified by sex, concussion history, headache history, and competitive sport level. Mann-Whitney U and Kruskal-Wallis tests were used to examine the effect of sex, concussion history, headache history, and competitive sport level on HIT-6 scores (P<.05). RESULTS Of the 3599 cadets baselined, 2687 cadets (23% female) agreed to participate in the study and completed the HIT-6. Female participants reported significantly worse HIT-6 scores compared with male participants both with (P<.001) and without (P<.001) a concussion history. In both sexes, participants with a headache history reported worse scores than those with no headache/concussion history and a concussion history (all P<.005). Female cadets who participated in intramural athletics reported worse HIT-6 scores at baseline than female intercollegiate athletes (P=.003). CONCLUSIONS This is the first study to stratify HIT-6 data by sex, concussion history, headache history, and sport level in a collegiate population at risk for concussions. Sex and headache history appear to influence HIT-6 scores and should be given special consideration when interpreting health-related quality of life deficits due to headache.
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Affiliation(s)
- Megan N Houston
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY.
| | - Haley A Bookbinder
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | | | - Jeremy D Ross
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | - Michael J Aderman
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | | | - Steven R Malvasi
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
| | | | - Kenneth L Cameron
- Department of Orthopaedic Research, Keller Army Community Hospital, West Point, NY
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Teasing apart trauma: neural oscillations differentiate individual cases of mild traumatic brain injury from post-traumatic stress disorder even when symptoms overlap. Transl Psychiatry 2021; 11:345. [PMID: 34088901 PMCID: PMC8178364 DOI: 10.1038/s41398-021-01467-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 01/21/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent and closely related disorders. Affected individuals often exhibit substantially overlapping symptomatology - a major challenge for differential diagnosis in both military and civilian contexts. According to our symptom assessment, the PTSD group exhibited comparable levels of concussion symptoms and severity to the mTBI group. An objective and reliable system to uncover the key neural signatures differentiating these disorders would be an important step towards translational and applied clinical use. Here we explore use of MEG (magnetoencephalography)-multivariate statistical learning analysis in identifying the neural features for differential PTSD/mTBI characterisation. Resting state MEG-derived regional neural activity and coherence (or functional connectivity) across seven canonical neural oscillation frequencies (delta to high gamma) were used. The selected features were consistent and largely confirmatory with previously established neurophysiological markers for the two disorders. For regional power from theta, alpha and high gamma bands, the amygdala, hippocampus and temporal areas were identified. In line with regional activity, additional connections within the occipital, parietal and temporal regions were selected across a number of frequency bands. This study is the first to employ MEG-derived neural features to reliably and differentially stratify the two disorders in a multi-group context. The features from alpha and beta bands exhibited the best classification performance, even in cases where distinction by concussion symptom profiles alone were extremely difficult. We demonstrate the potential of using 'invisible' neural indices of brain functioning to understand and differentiate these debilitating conditions.
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