The role of stress reactivity and pre-injury psychosocial vulnerability to psychological and physical health immediately after traumatic injury

The effects of paced breathing on psychological distress vulnerability and heart rate variability in adults sustaining traumatic injury

BACKGROUND

Traumatic physical injuries can lead to psychological distress and increased risk of psychiatric disorders, often reflected in dysregulated autonomic responses measurable through heart rate variability (HRV). Slow-paced breathing has shown potential in enhancing HRV, but its effectiveness in injured survivors remains unexplored. This study investigates the effect of slow-paced breathing on HRV among injured survivors compared to non-injured individuals and explores the influence of psychological distress and spontaneous respiratory rate on this effect.

METHODS

The study involved 120 injured individuals and 112 non-injured controls with similar age, sex, and education levels. Injured participants with minor-to-moderate injuries from traffic crashes were assessed 3-6 weeks post-injury. Psychological distress was defined as the risk of post-traumatic stress disorder and/or major depression. Physiological assessment (HRV) included a 2-min resting baseline and a 2-min slow-paced breathing session (6 breaths/min). Repeated measure MANCOVA assessed HRV changes between groups, while correlation analyses examined the relationship between these changes.

RESULTS

Injured survivors had significantly lower HRV than non-injured controls. Both groups showed notable HRV increases during slow-paced breathing. Among injured individuals, those with higher psychological distress exhibited greater HRV increases, particularly in parasympathetic activity and overall variability. Higher spontaneous respiratory rates were associated with greater HRV changes, especially in non-injured individuals.

CONCLUSION

Slow-paced breathing demonstrated significant physiological effects for injured survivors, particularly those with higher psychological distress, and supports its potential in improving stress regulation post-injury. Future research should examine the long-term effects of sustained breathing practice and clinical applicability in reducing psychological distress and disability post-injury.

Relationship between combat-related traumatic injury and ultrashort term heart rate variability in a UK military cohort: findings from the ADVANCE study

INTRODUCTION

Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk. The long-term impact of CRTI on heart rate variability (HRV)-a robust CVD risk marker-has not been explored. This study investigated the relationship between CRTI, the mechanism of injury and injury severity on HRV.

METHODS

This was an analysis of baseline data from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of UK servicemen with CRTI sustained during deployment (Afghanistan, 2003-2014) and an uninjured comparison group who were frequency matched to the injured group based on age, rank, deployment period and role in theatre. Root mean square of successive differences (RMSSD) was measured as a measure of ultrashort term HRV via <16 s continuous recording of the femoral arterial pulse waveform signal (Vicorder). Other measures included injury severity (New Injury Severity Scores (NISS)) and injury mechanism.

RESULTS

Overall, 862 participants aged 33.9±5.4 years were included, of whom 428 (49.6%) were injured and 434 (50.3%) were uninjured. The mean time from injury/deployment to assessment was 7.91±2.05 years. The median (IQR) NISS for those injured was 12 (6-27) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured (39.47 ms (27.77-59.77) vs 46.22 ms (31.14-67.84), p<0.001). Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), geometric mean ratio (GMR) was reported. CRTI was associated with a 13% lower RMSSD versus the uninjured group (GMR 0.87, 95% CI 0.80-0.94, p<0.001). A higher injury severity (NISS ≥25) (GMR 0.78, 95% CI 0.69-0.89, p<0.001) and blast injury (GMR 0.86, 95% CI 0.79-0.93, p<0.001) were also independently associated with lower RMSSD.

CONCLUSION

These results suggest an inverse association between CRTI, higher severity and blast injury with HRV. Longitudinal studies and examination of potential mediating factors in this CRTI-HRV relationship are needed.

Mental health impairment and recovery after a road traffic injury: where do we stand in Europe?

Individuals sustaining road traffic injuries (RTIs) have been shown to run an increased risk of impaired mental health over time and delayed recovery. It is often the case that mental health symptoms get less clinical attention among individuals sustaining RTIs and therefore psychological support tends to be delayed. Effective management of these aspects in a clinical setting is still challenging in Europe due to health systems' unpreparedness to predict the risk of poor mental health outcomes among survivors and appropriately intervene. Although a considerable amount of research is available in Australia, Canada and the US, the problem is still under-investigated in Europe. This paper reports on a review of the literature, which aims at identifying and presenting the latest research on the predisposing risk factors of poor mental health recovery among individuals sustaining an RTI in Europe. The review identified a huge mental health burden remaining long after the road traffic incident and a complex interplay of factors affecting mental health recovery after an RTI. Several challenges have been identified including the lack of a consistent definition for mental health recovery, the use of heterogeneous instruments and non-consistent epidemiological approaches and the lack of data collection mechanisms in Europe to capture the true impact of injuries. The paper concludes that existing efforts to fully understand the mental health outcomes of RTI patients remain inconsistent in Europe and offers evidence-based solutions to guide public health research and policy.

Hip fracture has profound psychosocial impacts: a systematic review of qualitative studies

BACKGROUND

Hip fracture is a common and serious traumatic injury for older adults characterised by poor outcomes.

OBJECTIVE

This systematic review aimed to synthesise qualitative evidence about the psychosocial impact of hip fracture on the people who sustain these injuries.

METHODS

Five databases were searched for qualitative studies reporting on the psychosocial impact of hip fracture, supplemented by reference list checking and citation tracking. Data were synthesised inductively and confidence in findings reported using the Confidence in the Evidence from Reviews of Qualitative research approach, taking account of methodological quality, coherence, relevance and adequacy.

RESULTS

Fifty-seven studies were included. Data were collected during the peri-operative period to >12 months post fracture from 919 participants with hip fracture (median age > 70 years in all but 3 studies), 130 carers and 297 clinicians. Hip fracture is a life altering event characterised by a sense of loss, prolonged negative emotions and fear of the future, exacerbated by negative attitudes of family, friends and clinicians. For some people after hip fracture there is, with time, acceptance of a new reality of not being able to do all the things they used to do. There was moderate to high confidence in these findings.

CONCLUSIONS

Hip fracture is a life altering event. Many people experience profound and prolonged psychosocial distress following a hip fracture, within a context of negative societal attitudes. Assessment and management of psychosocial distress during rehabilitation may improve outcomes for people after hip fracture.

The importance of self-regulation and mental health for effective recovery after traffic injuries: A comprehensive network analysis approach

OBJECTIVE

Traffic injuries significantly impact people's psychological, physical and social wellbeing, and involve complex self-regulation responses. Psychological impacts are seldom recognized and addressed holistically. This study employs network analysis to investigate the interconnectedness between different dimensions that influence mental health vulnerability and recovery after traffic injuries.

METHODS

120 adults with mild-to-moderate traffic injuries and 112 non-injured controls were recruited. The network investigation employed two main approaches. Four cross-sectional networks examined the interrelationships between self-regulation responses (cognitive and autonomic) and various health dimensions (psychological, physical, social) over time (1, 3, 6, 12 months). Three predictive networks explored influences of acute self-regulation responses (1 month) on long-term outcomes. Network analyses focused on between-group differences in overall connectivity and centrality measures (nodal strength).

RESULTS

An overall measure of psychological wellbeing consistently emerged as the most central (strongest) node in both groups' networks. Injured individuals showed higher overall connectivity and differences in the centrality of self-regulation nodes compared to controls, at 1-month and 12-months post-injury. These patterns were similarly observed in the predictive networks, including differences in cognitive and autonomic self-regulation influences.

CONCLUSIONS

Network analyses highlighted the crucial role of psychological health and self-regulation, in promoting optimal wellbeing and effective recovery. Post-traffic injury, increased connectivity indicated prolonged vulnerability for at least a year, underscoring the need of ongoing support beyond the initial improvements. A comprehensive approach that prioritizes psychological health and self-regulation through psychologically informed services, early psychological screening, and interventions promoting cognitive and autonomic self-regulation is crucial for mitigating morbidity and facilitating recovery.

TRIAL REGISTRATION

IMPRINT study, ACTRN 12616001445460.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis

Heart rate variability (HRV) is a non-invasive measure of autonomic function. The relationship between unselected long-term traumatic injury (TI) and HRV has not been investigated. This systematic review examines the impact of non-acute TI (>7 days post-injury) on standard HRV indices in adults. Four electronic databases (CINAHL, Medline, Scopus, and Web of Science) were searched. The quality of studies, risk of bias (RoB), and quality of evidence (QoE) were assessed using Axis, RoBANS and GRADE, respectively. Using the random-effects model, mean difference (MD) for root mean square of successive differences (RMSSD) and standard deviation of NN-intervals (SDNN), and standardized mean difference (SMD) for Low-frequency (LF): High-Frequency (HF) were pooled in RevMan guided by the heterogeneity score (I2). 2152 records were screened followed by full-text retrieval of 72 studies. 31 studies were assessed on the inclusion and exclusion criteria. Only four studies met the inclusion criteria. Three studies demonstrated a high RoB (mean RoBANS score 14.5±3.31) with a low QoE. TI was associated with a significantly higher resting heart rate. Meta-analysis of three cross-sectional studies demonstrated a statistically significant reduction in RMSSD (MD -8.45ms, 95%CI-12.78, -4.12, p<0.0001) and SDNN (MD -9.93ms, 95%CI-14.82, -5.03, p<0.0001) (low QoE) in participants with TI relative to the uninjured control. The pooled analysis of four studies showed a higher LF: HF ratio among injured versus uninjured (SMD 0.20, 95%CI 0.01-0.39, p<0.04) (very low QoE). Albeit low QoE, non-acute TI is associated with attenuated HRV indicating autonomic imbalance. The findings might explain greater cardiovascular risk following TI. Trial registration PROSPERO registration number: CRD: CRD42021298530.

A Preoperative Spinal Education intervention for spinal fusion surgery designed using the Rehabilitation Treatment Specification System is safe and could reduce hospital length of stay, normalize expectations, and reduce anxiety

Aims

Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS.

Methods

POSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests.

Results

In all, 65 (43%) patients (mean age 57.4 years (SD 18.2), 58.8% female) comprised the Attend-POSE, and 85 (57%) DNA-POSE (mean age 54.9 years (SD 15.8), 65.8% female). There were no significant between-group differences in age, sex, surgery type, complications, or readmission rates. Median LOS was statistically different across Pre-POSE (5 days ((interquartile range (IQR) 3 to 7)), Attend-POSE (3 (2 to 5)), and DNA-POSE (4 (3 to 7)), (p = 0.014). Pairwise comparisons showed statistically significant differences between Pre-POSE and Attend-POSE LOS (p = 0.011), but not between any other group comparison. In the Attend-POSE group, there was significant change toward greater surgical preparation, procedural familiarity, and less anxiety.

Conclusion

POSE was associated with a significant reduction in LOS for patients undergoing spinal fusion surgery. Patients reported being better prepared for, more familiar, and less anxious about their surgery. POSE did not affect complication or readmission rates, meaning its inclusion was safe. However, uptake (43%) was disappointing and future work should explore potential barriers and challenges to attending POSE. Cite this article: Bone Jt Open 2022;3(2):135–144.