1
|
McKee C, Matthews M, Kontos AP, Rankin A, Bleakley C. The role of concussion history and biological sex on baseline concussion clinical profile symptoms in adolescent rugby players. Ir J Med Sci 2024; 193:2061-2069. [PMID: 38526765 DOI: 10.1007/s11845-024-03677-7] [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] [Received: 11/08/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Accurate concussion monitoring requires access to preinjury baseline data. This is particularly important in adolescent athletes who have a high risk of concussion and are prone to prolonged recovery. As Rugby Union is governed by similar laws for men and women, it is also an ideal population to rigorously examine the impact of biological sex on concussion symptoms. AIMS To evaluate self-reported concussion symptoms at baseline in adolescent rugby union players, and examine if subtype-specific symptoms are affected by concussion history and biological sex. METHODS Adolescent rugby union players aged 16-18 years were recruited during the 2022-2023 playing season. Participants completed a series of questionnaires covering post-concussion symptoms, concussion clinical profiles, anxiety, depression and fear avoidance behaviours. Independent variables of interest in analysis were biological sex and concussion history. RESULTS 149 participants (75% male) were included. 42% (63/149) reported at least one previous concussion (average time since concussion: 18.7 months, range 1-72). Adolescents with a concussion history reported significantly higher scores than those with no history, across two clinical profiles (ocular and sleep), concussion symptom severity, and depression, all based on medium effect sizes (SMD 0.3-0.5). Females had significantly higher scores across cognitive/fatigue, ocular and sleep clinical profiles, concussion symptoms, anxiety and depression, each with large effect sizes (SMD > 0.5). CONCLUSIONS Concussion history and sex are associated with higher baseline scores on specific concussion clinical profile, concussion symptom severity, and anxiety symptoms. These findings highlight the importance of considering baseline differences when interpreting post-injury clinical profile symptoms in adolescent rugby players. (Trial registration: ACTRN12622000931774).
Collapse
Affiliation(s)
- Connor McKee
- Faculty of Life and Health Sciences, Ulster University, York St., Belfast, BT15 1ED, Northern Ireland
| | - Mark Matthews
- Faculty of Life and Health Sciences, Ulster University, York St., Belfast, BT15 1ED, Northern Ireland
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alan Rankin
- Sports Institute of Northern Ireland, Belfast, Northern Ireland
- Sport Medicine NI LTD, Belfast, Northern Ireland
| | - Chris Bleakley
- Faculty of Life and Health Sciences, Ulster University, York St., Belfast, BT15 1ED, Northern Ireland.
| |
Collapse
|
2
|
Valovich McLeod TC, Snedden T, Halstead M, Wilson J, Master C, Grady M, Fazekas M, Santana J, Zaslow T, Miller S, Coel R, Howell DR. Influence of Personal and Injury-Related Factors Predicting Deficits in Quality of Life Domains Among Pediatric Athletes: Findings From the Sport Concussion Outcomes in Pediatrics Study. Clin J Sport Med 2023; 33:489-496. [PMID: 36858431 DOI: 10.1097/jsm.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To examine patient and injury factors that may predict quality of life (QoL) and symptom duration after concussion. DESIGN Prospective, longitudinal. SETTINGS Six children's hospital-based medical centers and 9 secondary school athletic training facilities. PATIENTS Pediatric patients (8-18 years) were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit for a diagnosis of sport-related concussion. INTERVENTIONS Patients completed a medical history, the Postconcussion Symptom Inventory (PCSI), and Patient-Reported Outcomes Measurement Information System Pediatric Profile-25 (PROMIS-PP). MAIN OUTCOME MEASURES Eight predictor variables [age, sex, assessment time, loss of consciousness, amnesia and history of concussion, migraines, or attention-deficit hyperactivity disorder or (ADHD)] were assessed using regression models constructed for each dependent variable. RESULTS A total of 244 patients (15.1 ± 2.1 years, 41% female) were enrolled (mean = 5 ± 3 days after concussion; range = 1-14 days). Female sex, later initial assessment, and presence of amnesia were associated with lower QoL scores on several domains, whereas loss of consciousness was associated with higher QoL for fatigue. A history of migraines was associated with lower peer relationship QoL. Patients who subsequently developed persisting symptoms had lower mobility scores and higher anxiety, depressive symptom, fatigue, and pain interference scores. CONCLUSIONS Female sex, later clinic presentation, and amnesia were associated with a lower QoL related to mobility, anxiety, depressive symptoms, fatigue, and pain interference. Interestingly, previous concussion and preinjury ADHD diagnosis did not negatively impact postinjury QoL at the initial visit. Future studies should assess the influence of these factors on QoL at later postinjury time points using a concussion-specific outcomes instrument.
Collapse
Affiliation(s)
| | | | | | - Julie Wilson
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Matthew Grady
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Tracy Zaslow
- Cedars-Sinai Kerlan Jobe Institute, Los Angeles, CA, USA
| | - Shane Miller
- Scottish Rite for Children, Dallas, TX, USA; and
| | - Rachel Coel
- Kapi'olani Medical Center for Women and Children, Honolulu, HI
| | - David R Howell
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
3
|
Consequences of Sport-Related Concussion on Health-Related Quality of Life in Adolescents: A Critically Appraised Topic. J Sport Rehabil 2023; 32:107-114. [PMID: 36220144 DOI: 10.1123/jsr.2022-0232] [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: 06/14/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
Abstract
CLINICAL SCENARIO Sport-related concussions (SRCs) are a prevalent and problematic injury occurring among adolescents participating in sports. Health-related quality of life (HRQoL) has been shown to be affected in a portion of adolescents recovering from SRCs, though the exact nature of the relationship has yet to be firmly established for this age group through the duration and completion of recovery. HRQoL can be a nebulous construct but is often described as multifaceted and demonstrates effects of an illness, injury, or condition on one's overall well-being, encompassing satisfaction and comfortability of physical, psychosocial, sleep, and cognitive attributes. CLINICAL QUESTION How do adolescents diagnosed with sport-related concussion perceive changes in health-related quality of life domain measures throughout recovery? SUMMARY OF KEY FINDINGS Four studies met the inclusion criteria, including 1 longitudinal prospective case series and 3 longitudinal prospective cohort studies. The literature indicated that adolescents who sustained an SRC reported an initial immediate decrease in overall HRQoL as well as domains including cognitive, physical, school, and sleep. This initial decrease was particularly notable in those with delayed recovery or those diagnosed with post-concussion syndrome. Despite the initial decrease, all participants of varying SRC recovery duration reportedly returned to healthy, normative levels of HRQoL upon recovery. CLINICAL BOTTOM LINE Adolescents reportedly experience initial decreases in various HRQoL domains immediately after SRC but appear to rebound to a healthy status upon recovery regardless of recovery duration. STRENGTH OF RECOMMENDATION Results of the review of 4 longitudinal studies established level B evidence.
Collapse
|
4
|
Eisenberg MT, Block AM, Ganapathy AK, Huckleby JM, Nepple JJ. PROMIS Utilization in Pediatric Orthopaedics: A Scoping Review. J Pediatr Orthop 2022; 42:521-531. [PMID: 35948527 DOI: 10.1097/bpo.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lack of a common patient-reported outcome metric used among the orthopaedic population is a problem that has been previously identified by the American Academy of Orthopaedic Surgeons. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institute of Health with the goal of creating a precise and efficient measurement tool for patient-reported symptoms, functioning, and health-related quality of life to be used in clinical research. A study summarizing its use in the pediatric orthopaedic population has not been previously performed. METHODS We performed a literature search of Ovid Medline, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from 2010 to August 2021. There were 1961 unique citations included after the removal of 1756 duplicates. After initial screening, 183 studies were screened under full-text review leaving a final number of 51 studies included in this scoping review. RESULTS Pediatric PROMIS studies were grouped by body part or sub-speciality: "Hand and Upper Extremity" (25.5%, n=13), "Sports" (23.5%, n=12), "Spine" (13.7%, n=7), "Trauma" (13.7%, n=7), "General Pediatric Orthopaedics" (11.8%, n=6), "Lower Extremity" (9.8%, n=5), and "Orthopaedic Oncology" (2%, n=1). An increase in studies utilizing PROMIS was seen throughout the study period with only 3 studies published from 2013 to 2016 to 39 in 2020 and 2021 alone. The 3 most frequently used pediatric PROMIS domains were Pain Interference (76.5%, n=39/51), Mobility (60.8%, n=31/51), and Upper Extremity (54.9%, n=28/51). 64.3% (n=9/14) of the included studies which reported on the floor effects of Pain Interference exhibited a significant floor effect. In all, 77.8% (n=7/9) of the included studies which reported on ceiling effects of Upper Extremity exhibited a significant ceiling effect. CONCLUSION The use of PROMIS increased significantly since the first publication in 2013 suggesting orthopaedic providers have increasingly utilized PROMIS in their day-to-day practice as an outcome measure. Ceiling and floor effects were prominent in several of the included domains (Pain Interference and Upper Extremity). Overall, PROMIS measures are efficient, reliable, and effective to use. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Matthew T Eisenberg
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | | | | | | |
Collapse
|
5
|
van Ierssel J, Pennock KF, Sampson M, Zemek R, Caron JG. Which psychosocial factors are associated with return to sport following concussion? A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:438-449. [PMID: 35017101 PMCID: PMC9338335 DOI: 10.1016/j.jshs.2022.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Psychosocial factors predict recurrent injury and return to preinjury level of performance following orthopedic injury but are poorly understood following concussion. Current management protocols prioritize physical measures of recovery. Therefore, the objective of this study was to describe the psychosocial factors associated with return to sport (RTS) and how they are measured in athletes who sustained a concussion. METHODS MEDLINE, Embase, APA PsycINFO, CINAHL, and SPORTDiscus were searched through February 2, 2021. Eligible studies included original peer-reviewed publications describing psychosocial factors associated with RTS following a diagnosed concussion. The primary outcome was scales or measures employed and/or key thematic concepts. RESULTS Of the 3615 studies identified, 10 quantitative cohort studies (Oxford Centre for Evidence-Based Medicine Level-3) representing 2032 athletes (85% male; high-school and collegiate collision/contact athletes) and 4 qualitative studies representing 66 athletes (74% male; 70% American football; aged 9-28 years) were included. We identified 3 overarching themes and 10 outcome measures related to psychosocial factors associated with RTS following concussion: (a) fear (e.g, of recurrent concussion, of RTS, of losing playing status); (b) emotional factors (e.g, depression, anxiety, perceived stress, mental health, disturbance mood); and (c) contextual factors (e.g, social support, pressure, sense of identity). CONCLUSION Although current medical clearance decisions prioritize physical measures of recovery, evidence suggests diverse psychosocial factors influence RTS following concussion. It remains unclear which psychosocial factors contribute to a successful RTS, including the influence of sex/gender and age. Future studies should evaluate the association of psychological readiness with physical measures of recovery at medical clearance, preinjury level of performance, and risk of recurrent concussion to support RTS clinical decision-making.
Collapse
Affiliation(s)
| | | | - Margaret Sampson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jeffrey G Caron
- Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada; Center for Interdisciplinary Research in Rehabilitation, Montreal, QC H3S 1M9, Canada
| |
Collapse
|
6
|
Shore J, Nalder E, Hutchison M, Reed N, Hunt A. Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development. JMIR Pediatr Parent 2022; 5:e34822. [PMID: 35377326 PMCID: PMC9016504 DOI: 10.2196/34822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. OBJECTIVE This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. METHODS The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. RESULTS Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. CONCLUSIONS The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.
Collapse
Affiliation(s)
- Josh Shore
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|