Primary and Secondary Risk Factors Associated With Concussion Symptom Clusters in Collegiate Athletes: Results From the NCAA-DoD Grand Alliance CARE Consortium

Reliable Change Indices for the Serial Administration of the Concussion Clinical Profiles Screening Tool

CONTEXT

The Concussion Clinical Profiles Screening Tool (CP Screen) self-report concussion symptom inventory is often administered at weekly intervals. However, 1-week reliable change indices (RCIs) for clinical cutoffs and the test-retest reliability of the CP Screen are unknown.

OBJECTIVE

To document RCI cutoff scores and 1-week test-retest reliability for each profile and modifier of the CP Screen for men and women.

DESIGN

Case series.

SETTING

A large US university.

PATIENTS OR OTHER PARTICIPANTS

One hundred seventy-three healthy college students.

MAIN OUTCOME MEASURE(S)

Participants completed 2 administrations of the CP Screen 7 days apart. The CP Screen items yielded 5 clinical profiles and 2 modifiers. Spearman ρ coefficients (rs), intraclass correlation coefficients (ICCs), single measures, and unbiased estimates of reliability (UERs) were used to assess test-retest reliability. Wilcoxon signed-rank tests assessed differences across time. Reliable change index values and cutoff scores are provided at 90%/95% CIs. All analyses were performed for the total sample and separately for men and women.

RESULTS

Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for men were as follows: ocular, vestibular >2/>4; anxiety/mood, cognitive/fatigue, and migraine >3/>3; sleep >4/>6; and neck >2/>2. Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for women were as follows: anxiety/mood ≥2/≥4; cognitive/fatigue, migraine, ocular, vestibular, and sleep ≥3/≥3; and neck ≥1/≥1. Correlations for the CP Screen ranged from 0.51 (migraine) to 0.79 (anxiety/mood) for the total sample, from 0.48 (migraine) to 0.84 (vestibular) for men, and from 0.51 (migraine) to 0.77 (ocular) for women. Test-retest indices for each profile and modifier were moderate to good for the total sample (ICC, 0.64-0.82; UER, 0.79-0.90), men (ICC, 0.60-0.87; UER, 0.76-0.94), and women (ICC, 0.64-0.80; UER, 0.78-0.89).

CONCLUSION

The CP Screen is reliable and stable across a 1-week interval, and established RCIs for men and women can help identify meaningful change throughout recovery.

Conservative Management of Acute Sports-Related Concussions: A Narrative Review

This review explores the application of the conservative management model for pain to sports-related concussions (SRCs), framing concussions as a distinct form of pain syndrome with a pathophysiological foundation in central sensitization. Drawing parallels with proven pain management models, we underscore the significance of a proactive approach to concussion management. Recognizing concussions as a pain syndrome allows for the tailoring of interventions in alignment with conservative principles. This review first covers the epidemiology and controversies surrounding prolonged concussion recovery and persistent post-concussion symptoms (PPCS). Next, the pathophysiology of concussions is presented within the central sensitization framework, emphasizing the need for early intervention to mitigate the neuroplastic changes that lead to heightened pain sensitivity. Five components of the central sensitization process specific to concussion injuries are highlighted as targets for conservative interventions in the acute period: peripheral sensitization, cerebral metabolic dysfunction, neuroinflammation, glymphatic system dysfunction, and pain catastrophizing. These proactive interventions are emphasized as pivotal in accelerating concussion recovery and reducing the risk of prolonged symptoms and PPCS, in line with the philosophy of conservative management.

TBICoE approach to concussion rehabilitation in service members and veterans

BACKGROUND

Concussion, also known as mild traumatic brain injury (mTBI), is a condition with unique ties to military service. Service members (SMs) are inherently at a higher risk for concussive injuries due to the intense physical training environment and combat operational tempo required to serve. The Traumatic Brain Injury Center of Excellence (TBICoE) is the US Department of Defense authority on this condition and provides a thorough approach to management of concussion and associated symptom sequela.

OBJECTIVES

This article seeks to review the TBICoE approach to the management and rehabilitation of military SMs with mTBI, and highlight resources available to military medical providers.

METHODS

The authors reviewed evidence and TBICoE resources to provide this comprehensive overview of the TBICoE approach to management and rehabilitation of concussion in military SMs.

RESULTS

A progressive return to activity protocol in conjunction with symptom-guided management of common post-concussive sequelae, including headache, vestibular and oculomotor issues, sleep dysfunction, cognitive rehabilitation, and behavioral health comorbidities are essential for concussion management in the acute, post-acute and chronic phases of injury.

CONCLUSION

The TBICoE approach to the rehabilitation of military SMs is comprehensive, and includes initial management with a stepwise return to duty protocol and an objective return to duty screening. The mainstays of treatment for SMs with post-acute and chronic post-concussion symptoms are headache management, vestibular and oculomotor rehabilitation, sleep interventions, cognitive rehabilitation, and early intervention for behavioral health comorbidities. These evidence-based strategies may be applied in the treatment of SMs in the US and internationally.