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Mikolic A, Panenka WJ, Iverson GL, Cotton E, Burke MJ, Silverberg ND. Litigation, Performance Validity Testing, and Treatment Outcomes in Adults With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E153-E161. [PMID: 37773600 DOI: 10.1097/htr.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To investigate whether involvement in litigation and performance validity test (PVT) failure predict adherence to treatment and treatment outcomes in adults with persistent symptoms after mild traumatic brain injury (mTBI). SETTING Outpatient concussion clinics in British Columbia, Canada. Participants were assessed at intake (average 12.9 weeks postinjury) and again following 3 to 4 months of rehabilitation. PARTICIPANTS Adults who met the World Health Organization Neurotrauma Task Force definition of mTBI. Litigation status was known for 69 participants ( n = 21 reported litigation), and 62 participants completed a PVT ( n = 13 failed the Test of Memory Malingering) at clinic intake. DESIGN Secondary analysis of a clinical trial (ClinicalTrials.gov #NCT03972579). MAIN MEASURES Outcomes included number of completed sessions, homework adherence, symptoms (Rivermead Post Concussion Symptoms Questionnaire), disability ratings (World Health Organization Disability Assessment Schedule 2.0), and patient-rated global impression of change. RESULTS We did not observe substantial differences in session and homework adherence associated with litigation or PVT failure. Disability and postconcussion symptoms generally improved with treatment. Involvement in litigation was associated with a smaller improvement in outcomes, particularly disability ( B = 2.57, 95% confidence interval [CI] [0.25-4.89], P = .03) and patient-reported global impression of change (odds ratio [OR] = 4.19, 95% CI [1.40-12.57], P = .01). PVT failure was not associated with considerable differences in treatment outcomes. However, participants who failed the PVT had a higher rate of missing outcomes (31% vs 8%) and perceived somewhat less global improvement (OR = 3.47, 95% CI [0.86-14.04]; P = .08). CONCLUSION Adults with mTBI who are in litigation or who failed PVTs tend to adhere to and improve following treatment. However, involvement in litigation may be associated with attenuated improvements, and pretreatment PVT failure may predict lower engagement in the treatment process.
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Affiliation(s)
- Ana Mikolic
- Departments of Psychology (Drs Mikolic and Silverberg) and Psychiatry (Dr Panenka), The University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada (Drs Mikolic and Silverberg); British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada (Dr Panenka); BC Neuropsychiatry Program, Vancouver, British Columbia, Canada (Dr Panenka); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Iverson); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (Dr Iverson); Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts (Dr Iverson); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown (Dr Iverson); Departments of Psychiatry and Behavioral Sciences (Dr Cotton) and Neurology (Dr Cotton), Northwestern University, Chicago, Illinois; Neuropsychiatry Program, Department of Psychiatry and Division of Neurology and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (Dr Burke); and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada (Dr Burke)
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Faulkner JW, Whiting D, Theadom A, Snell DL, Roche M, Barker-Collo S. Valued living after mild traumatic brain injury: Characteristics and relationship with outcomes. Neuropsychol Rehabil 2024:1-17. [PMID: 38497571 DOI: 10.1080/09602011.2024.2328876] [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: 09/06/2023] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Psychological factors are strong predictors of mild traumatic brain injury (mTBI) recovery, consequently, psychological interventions can form part of an individual's rehabilitation. This may include enhancing valued living (VL), an approach that is effective in severe and mixed acquired brain injury samples. This study aimed to characterize VL in mTBI and explore its relationship with mTBI and mental health outcomes. 56 participants with a mTBI completed self-report measures before engaging in a psychological intervention. Pre-injury mental health and other demographic and injury-related variables, VL, post-concussion symptoms (PCS), functional disability, and stress, anxiety and depression were measured. A pre-injury mental health condition was significantly associated with VL. VL was uniquely associated with depression after mTBI (β = -0.08, p = .05), however, there was no relationship with PCS, functional disability, stress or anxiety (p > .05). Following mTBI individuals with a pre-injury mental health condition or who experience heightened depressive symptoms may benefit from a values-based intervention as part of their rehabilitation. Future research, however, is needed to examine the role of VL in mTBI recovery.
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Affiliation(s)
- Josh W Faulkner
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Diane Whiting
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Alice Theadom
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Maree Roche
- School of Management, Fellow NZ Psychological Society, Auckland University, Auckland, New Zealand
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Tarvonen-Schröder S, Koivisto M. World Health Organization Disability Assessment Schedule versus Functional Independence Measure in Traumatic Brain Injury. J Rehabil Med 2023; 55:jrm16274. [PMID: 38032144 DOI: 10.2340/jrm.v55.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE In patients with traumatic brain injury, to compare functioning measured using the 12-item patient and proxy World Health Organization Disability Assessment Schedule (WHODAS-12) with assessments made by professionals. PATIENTS AND METHODS At discharge from rehabilitation, 89 consecutive patients with traumatic brain injury (10 mild, 36 moderate, 43 severe) and their proxies completed the WHODAS-12. Professionals assessed functioning simultaneously using the WHO minimal generic set of domains of functioning and health and Functional Independence Measure (FIM). RESULTS From mild to severe traumatic brain injury, increasing disability was found in: sum, component and item scores of patient and proxy WHODAS, except for emotional functions in patients' ratings; in sum and item scores of the WHO minimal generic data-set, except for pain; and in FIM total score and sub-scores. The WHODAS participation component was more impaired than activities. Although proxies rated functioning more impaired than patients, the correlation between patient and proxy WHODAS was strong (0.74). The correlation between patient/proxy WHODAS and FIM was also strong (-0.56 and -0.78, respectively). Proxy WHODAS differentiated mild and moderate traumatic brain injury more accurately than the other assessments. CONCLUSION We recommend using the WHODAS-12 when planning patient- and family-oriented rehabilitation services after traumatic brain injury.
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Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital, Turku, Finland and Clinical Neurosciences, University of Turku, Turku, Finland; Finnish Institute for Health and Welfare, Finland.
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
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Hume CH, Mitra B, Wright BJ, Kinsella GJ. Mild Traumatic Brain Injury and Functional Outcome in Older Adults: Pain Interference But Not Cognition Mediates the Relationship Between Traumatic Injury and Functional Difficulties. J Head Trauma Rehabil 2023; 38:E278-E288. [PMID: 36602271 DOI: 10.1097/htr.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine functional status of older people 3 months after mild traumatic brain injury (mTBI) and identify whether pain interference or cognition mediates any relationship found between injury status and functional outcomes. SETTING Patients admitted to a Melbourne-based emergency department. PARTICIPANTS Older adults 65 years and older: 40 with mTBI, 66 with orthopedic injury without mTBI (TC), and 47 healthy controls (CC) without injury. DESIGN Observational cohort study. MAIN MEASURES Functional outcome was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and single- and dual-task conditions of the Timed-Up-and-Go task. Pain interference and cognitive performance at 3 months post-injury were examined as mediators of the relationship between injury status (injured vs noninjured) and functional outcome. RESULTS Patients with mTBI and/or orthopedic injury reported greater difficulties in overall functioning, including community participation, compared with noninjured older people (CC group). Both trauma groups walked slower than the CC group on the mobility task, but all groups were similar on the dual-task condition. Pain interference mediated the relationship between injury status and overall functioning [ b = 0.284; 95% CI = 0.057, 0.536), community participation ( b = 0.259; 95% CI = 0.051, 0.485), and mobility ( b = 0.116; 95% CI = 0.019, 0.247). However, cognition did not mediate the relationship between injury status and functional outcomes. CONCLUSIONS Three months after mild traumatic injury (with and without mTBI), patients 65 years and older had greater functional difficulties compared with noninjured peers. Pain interference, but not cognition, partially explained the impact of traumatic injury on functional outcomes. This highlights the importance of reducing pain interference for older patients after injury (including mTBI) to support better functional recovery.
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Affiliation(s)
- Camilla H Hume
- Melbourne Campus, La Trobe University, Bundoora, Australia (Ms Hume); Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, and National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia (Dr Mitra); and School of Psychology and Public Health, La Trobe University, Melbourne, Australia (Ms Hume and Drs Wright and Kinsella)
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5
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S. The influence of psychological flexibility on persistent post concussion symptoms and functional status after mild traumatic brain injury. Disabil Rehabil 2023; 45:1192-1201. [PMID: 35382660 DOI: 10.1080/09638288.2022.2055167] [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: 11/03/2022]
Abstract
PURPOSE This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes. METHOD Adults with mTBI (N = 147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N = 102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors. RESULTS The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury. CONCLUSION The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.Implications for RehabilitationPersistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI) can have a significant impact on wellbeing, functional status, and quality of life.In this study, psychological flexibility early in recovery, was associated with higher levels of psychological distress and more severe post-concussion symptoms six months later.Psychological flexibility at six months post-injury also mediated the relationship between psychological distress and functional disability.A context specific measure of psychological flexibility may predict poorer long-term outcomes following mTBI.
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Affiliation(s)
| | - Deborah L Snell
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
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Young CA, Ealing J, McDermott CJ, Williams TL, Al-Chalabi A, Majeed T, Talbot K, Harrower T, Faull C, Malaspina A, Annadale J, Mills RJ, Tennant A. Measuring disability in amyotrophic lateral sclerosis/motor neuron disease: the WHODAS 2.0-36, WHODAS 2.0-32, and WHODAS 2.0-12. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:63-70. [PMID: 35876069 DOI: 10.1080/21678421.2022.2102926] [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] [Received: 05/02/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 01/26/2023]
Abstract
Aim: To investigate whether the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) can provide interval level measurement of disability in Amyotrophic Lateral Sclerosis (ALS), allowing parametric analyses. Methods: Data on the WHODAS 12, 32, and 36-item versions, from 1120 patients studied at one or more time points, were fit to the Rasch model and comparisons made against ALSFRS-R, King's staging, and mortality. Trajectory modeling was undertaken for a newly diagnosed (≤6 months) cohort of 454 individuals. Results: Total scores for WHODAS 32 and 36-item versions can be converted to interval level measurement suitable for individual clinical use, and the 12-item WHODAS total for group use. The 36-item version is shown to be equivalent to the 32-item version. Expected correlations were seen with King's staging, ALSFRS-R, and EQ-5D-5L. Trajectory analysis of disability (WHODAS 2.0) showed three clearly demarcated groups with differences in King's staging, depressive symptomatology and mortality, but not age. Conclusions: The WHODAS 2.0 is a brief patient reported outcome measure which can be used to measure disability in ALS. Provided the patient answers all 36 (32 if not working) items, the conversion table produces an interval level estimate for parametric analyses. The different trajectories demonstrated from diagnosis support the concept of a prodromal period, and suggest the WHODAS 2.0 could be used for surveillance of at risk populations, such as those with genetic predisposition.
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Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - John Ealing
- Department of Neurology, Greater Manchester Centre for Clinical Neurosciences, Salford, UK
| | | | - Tim L Williams
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | - Tahir Majeed
- Department of Neurology, Lancashire Teaching Hospital, Preston, UK
| | - Kevin Talbot
- Department of Neurology, University of Oxford, Oxford, UK
| | | | | | | | - Joe Annadale
- Hywel Dda University Health Board, Wales, UK, and
| | - Roger J Mills
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Snell DL, Silverberg ND. Derivation of a minimal clinically important difference score for the WHODAS 2.0 in mild traumatic brain injury. NeuroRehabilitation 2022; 52:249-257. [PMID: 36565071 DOI: 10.3233/nre-220004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) treatment research is hindered by lack of clinically meaningful and responsive outcome measures. One promising measure is the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), although minimal clinically important differences (MCID) for have not been established. OBJECTIVE To estimate MCID for the WHODAS 2.0 for mTBI. METHODS We analysed two prospectively collected mTBI datasets (n = 225) attending adult outpatient clinics in British Columbia, Canada. Participants completed the 12-item WHODAS 2.0, Patient Global Impression of Change scale, and Rivermead Post-Concussion Symptoms Questionnaire. We used anchor- and distribution-based methods to explore MCIDs in WHODAS 2.0 scores. RESULTS For Study 1 (n = 131), the anchor and distribution-based approaches produced minimal change estimates ranging from 1.3 to 2.8 interval scores. For Study 2 (n = 94), the anchor and distribution-based approaches produced minimal change estimates from 2.2 to 3.2 interval scores. For certain subgroups based on age, sex, and post-concussion severity, minimal change estimates were slightly higher. CONCLUSION An MCID of 3.5 interval WHODAS 2.0 points would conservatively capture meaningful change in adults of varying age, sex, and post-concussion symptom severity. Such a uniform metric will assist future mTBI intervention studies to improve standards of care and evaluation of outcomes.
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Affiliation(s)
- Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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Faulkner JW, Snell DL, Theadom A. Psychological flexibility moderates the influence of fear avoidance on outcomes after mild traumatic brain injury. Brain Inj 2022; 36:991-999. [PMID: 35950285 DOI: 10.1080/02699052.2022.2109747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Psychological factors contribute to poorer long-term outcomes following mild traumatic brain injury (mTBI); however, the exact psychological mechanisms that underly this relationship are not well understood. This study examined the relationship between psychological flexibility, fear avoidance, and outcomes over the first 6 months after mTBI. METHOD Adults with mTBI-completed measures of psychological flexibility, fear avoidance, post-concussion symptoms, and functional status at baseline (<3 months post-injury; N = 152), and 3-month (N = 133) and 6-month follow-up (N = 102). A conceptually derived moderation-mediation analysis was used to test the mediating effect of fear avoidance on post-concussion symptoms and functional outcomes, and the moderating effects of psychological flexibility on fear avoidance. RESULTS Fear avoidance had a significant indirect effect on the relationship between post-concussion symptoms and functional status across all three time points. Psychological flexibility was found to significantly moderate these effects. Only low levels of psychological flexibility had a significant influence on the mediating effects of high fear avoidance on functional status at 6-month follow-up. CONCLUSIONS Psychological flexibility may influence mTBI recovery by exerting an influence on fear avoidance. These initial findings provide a potential theoretical explanation of how fear avoidance can become maladaptive with time after mTBI.
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Affiliation(s)
- Josh W Faulkner
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Deborah L Snell
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Northcote, Australia
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Silverberg ND, Otamendi T, Brasher PM, Brubacher JR, Li LC, Lizotte PP, Panenka WJ, Scheuermeyer FX, Archambault P. Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial. BMJ Open 2022; 12:e062527. [PMID: 35728892 PMCID: PMC9214410 DOI: 10.1136/bmjopen-2022-062527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mental health problems frequently interfere with recovery from mild traumatic brain injury (mTBI) but are under-recognised and undertreated. Consistent implementation of clinical practice guidelines for proactive detection and treatment of mental health complications after mTBI will require evidence-based knowledge translation strategies. This study aims to determine if a guideline implementation tool can reduce the risk of mental health complications following mTBI. If effective, our guideline implementation tool could be readily scaled up and/or adapted to other healthcare settings. METHODS AND ANALYSIS We will conduct a triple-blind cluster randomised trial to evaluate a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care. We will recruit 535 adults (aged 18-69 years) with mTBI from six emergency departments and two urgent care centres in the Greater Vancouver Area, Canada. Upon enrolment at 2 weeks post-injury, they will complete mental health symptom screening tools and designate a general practitioner (GP) or primary care clinic where they plan to seek follow-up care. Primary care clinics will be randomised into one of two arms. In the guideline implementation tool arm, GPs will receive actionable mental health screening test results tailored to their patient and their patients will receive written education about mental health problems after mTBI and treatment options. In the usual care control arm, GPs and their patients will receive generic information about mTBI. Patient participants will complete outcome measures remotely at 2, 12 and 26 weeks post-injury. The primary outcome is rate of new or worsened mood, anxiety or trauma-related disorder on the Mini International Neuropsychiatric Interview at 26 weeks. ETHICS AND DISSEMINATION Study procedures were approved by the University of British Columbia's research ethics board (H20-00562). The primary report for the trial results will be published in a peer-reviewed journal. Our knowledge user team members (patients, GPs, policymakers) will co-create a plan for public dissemination. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04704037).
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Thalia Otamendi
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Penelope Ma Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Patrick Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, Québec, Canada
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Faulkner JW, Snell DL, Shepherd D, Theadom A. Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury. J Psychosom Res 2021; 151:110664. [PMID: 34749069 DOI: 10.1016/j.jpsychores.2021.110664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. METHOD Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). RESULTS A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. CONCLUSIONS Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.
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Affiliation(s)
- Josh W Faulkner
- Massey University, PO Box 756, Wellington 6140, New Zealand.
| | - Deborah L Snell
- University of Otago Christchurch, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Daniel Shepherd
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
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Greenberg J, Singh T, Iverson GL, Silverberg ND, Macklin EA, Parker RA, Giacino JT, Yeh GY, Vranceanu AM. A Live Video Mind-Body Treatment to Prevent Persistent Symptoms Following Mild Traumatic Brain Injury: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25746. [PMID: 33443484 PMCID: PMC7843203 DOI: 10.2196/25746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Every year, approximately 42 million people sustain a mild traumatic brain injury (mTBI, also known as concussion), with particularly high rates among college-aged individuals. A substantial proportion of these people (44%-64%) develop persistent symptoms that are challenging to treat, costly, and associated with significant disability. Anxiety has emerged as a risk factor for progression from acute to persistent mTBI symptoms. Objective This study aims to develop, adapt, and establish the feasibility of the Toolkit for Optimal Recovery after Concussions (TOR-C), an innovative mind-body program aimed at preventing persistent symptoms among young adults with mTBI and comorbid anxiety. Here, we describe the proposed study design, methodology, measurement, and treatment manuals. Methods In phase 1, we will conduct individual, live video qualitative interviews (up to n=20) with college-aged individuals with mTBI and comorbid anxiety to inform adaptation of the intervention and study procedures. In phase 2, an open pilot of the live video TOR-C (n=5) with exit interviews will be conducted to explore the initial feasibility, acceptability, and credibility of the program and to refine the study procedures. Phase 3 will involve conducting a feasibility randomized controlled trial (N=50) of the TOR-C versus a health education control (Health Enhancement for Concussions; HE-C), both delivered via live video, to establish feasibility of recruitment procedures (screening, eligibility, and enrollment) and data collection; feasibility, credibility, and acceptability of the live video TOR-C and HE-C (adherence, retention, fidelity, and satisfaction) following prespecified benchmarks; and a signal of improvement in outcomes. Results Phase 1 of the study has been approved by the Massachusetts General Hospital Institutional Review Board. Study completion is anticipated by early 2025. Conclusions We will develop and test the first mind-body intervention focused on prevention of persistent symptoms following mTBI in young adults with comorbid anxiety problems. This will allow us to establish feasibility markers in postconcussive symptoms, anxiety, disability, and fear avoidance to inform a future efficacy trial of the TOR-C versus HE-C. International Registered Report Identifier (IRRID) PRR1-10.2196/25746
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Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanya Singh
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Charlestown, MA, United States.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Eric A Macklin
- Harvard Medical School, Boston, MA, United States.,Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Robert A Parker
- Harvard Medical School, Boston, MA, United States.,Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Joseph T Giacino
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Gloria Y Yeh
- Harvard Medical School, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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An item analysis according to the Rasch model of the German 12-item WHO Disability Assessment Schedule (WHODAS 2.0). Qual Life Res 2021; 30:2929-2938. [PMID: 34014444 PMCID: PMC8481170 DOI: 10.1007/s11136-021-02872-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The World Health Organization Disability Assessent Schedule 2.0 (WHODAS 2.0) assesses disability in individuals irrespective of their health condition. Previous studies validated the usefulness of the WHODAS 2.0 using classical test theory. This study is the first investigating the psychometric properties of the 12-items WHODAS 2.0 in patients with cancer using item analysis according to the Rasch model. METHODS In total, 350 cancer patients participated in the study. Rasch analysis of the 12-items version of the WHODAS 2.0 was conducted and included testing unidimensionality, local independence, and testing for differential item functioning (DIF) with regard to age, gender, type of cancer, presence of metastases, psycho-oncological support, and duration of disease. RESULTS After accounting for local dependence, which was mainly found across items of the same WHODAS domain, satisfactory overall fit to the Rasch model was established (χ2 = 36.14, p = 0.07) with good reliability (PSI = 0.82) and unidimensionality of the scale. DIF was found for gender (testlet 'Life activities') and age (testlet 'Getting around/Self-care'), but the size of DIF was not substantial. CONCLUSION Overall, the analysis results according to the Rasch model support the use of the WHODAS 2.0 12-item version as a measure of disability in cancer patients.
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