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Hetzer SM, Casagrande A, Qu’d D, Dobrozsi N, Bohnert J, Biguma V, Evanson NK, McGuire JL. Early Measures of TBI Severity Poorly Predict Later Individual Impairment in a Rat Fluid Percussion Model. Brain Sci 2023; 13:1230. [PMID: 37759831 PMCID: PMC10526292 DOI: 10.3390/brainsci13091230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Multiple measures of injury severity are suggested as common data elements in preclinical traumatic brain injury (TBI) research. The robustness of these measures in characterizing injury severity is unclear. In particular, it is not known how reliably they predict individual outcomes after experimental TBI. METHODS We assessed several commonly used measures of initial injury severity for their ability to predict chronic cognitive outcomes in a rat lateral fluid percussion (LFPI) model of TBI. At the time of injury, we assessed reflex righting time, neurologic severity scores, and 24 h weight loss. Sixty days after LFPI, we evaluated working memory using a spontaneous alternation T-maze task. RESULTS We found that righting time and weight loss had no correlation to chronic T-maze performance, while neurologic severity score correlated weakly. DISCUSSION Taken together, our results indicate that commonly used early measures of injury severity do not robustly predict longer-term outcomes. This finding parallels the uncertainty in predicting individual outcomes in TBI clinical populations.
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Affiliation(s)
- Shelby M. Hetzer
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Andrew Casagrande
- College of Arts and Sciences Interdisciplinary Program—Neuroscience, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Dima Qu’d
- Applied Pharmacology & Drug Toxicology Program, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Nicholas Dobrozsi
- College of Arts and Sciences Interdisciplinary Program—Neuroscience, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Judy Bohnert
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (J.B.); (J.L.M.)
| | - Victor Biguma
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Nathan K. Evanson
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Jennifer L. McGuire
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; (J.B.); (J.L.M.)
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Alim-Marvasti A, Kuleindiren N, Tiersen F, Johal M, Lin A, Selim H, Rifkin-Zybutz R, Mahmud M. Hierarchical clustering of prolonged post-concussive symptoms after 12 months: symptom-centric analysis and association with functional impairments. Brain Inj 2023; 37:317-328. [PMID: 36529935 PMCID: PMC10635586 DOI: 10.1080/02699052.2022.2158229] [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: 02/11/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Following a concussion, approximately 15% of individuals experience persistent symptoms that can lead to functional deficits. However, underlying symptom-clusters that persist beyond 12 months have not been adequately characterized, and their relevance to functional deficits are unclear. The aim of this study was to characterize the underlying clusters of prolonged post-concussive symptoms lasting more than 12 months, and to investigate their association with functional impairments. METHODS Although hierarchical clustering is ideally suited in evaluating subjective symptom severities, it has not been applied to the Rivermead Post-Concussion Questionnaire (RPQ). The RPQ and functional impairments questions were administered via a smartphone application to 445 individuals who self-reported prolonged post-concussive symptoms. Symptom-clusters were obtained using agglomerative hierarchical clustering, and their association with functional deficits were investigated with sensitivity analyses, and corrected for multiple comparisons. RESULTS Five symptom-clusters were identified: headache-related, sensitivity to light and sound, cognitive, mood-related, and sleep-fatigue. Individuals with more severe RPQ symptoms were more likely to report functional deficits (p < 0.0001). Whereas the headache and sensitivity clusters were associated with at most one impairment, at-least-mild sleeping difficulties and fatigue were associated with four, and moderate-to-severe cognitive difficulties with five (all p < 0.01). CONCLUSIONS Symptom-clusters may be clinically useful for functional outcome stratification for targeted rehabilitation therapies. Further studies are required to replicate these findings in other cohorts and questionnaires, and to ascertain the effects of symptomatic intervention on functional outcomes.
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Affiliation(s)
- Ali Alim-Marvasti
- Research Division, Mindset Technologies Ltd, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | | | | | - Monika Johal
- Research Division, Mindset Technologies Ltd, London, UK
- School of Medicine, Imperial College London, London, UK
| | - Aaron Lin
- Research Division, Mindset Technologies Ltd, London, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Hamzah Selim
- Research Division, Mindset Technologies Ltd, London, UK
| | | | - Mohammad Mahmud
- Research Division, Mindset Technologies Ltd, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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3
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Exploratory Examination of Knee Self-Efficacy in Individuals With a History of ACL Reconstruction and Sport-Related Concussion. J Sport Rehabil 2023; 32:177-182. [PMID: 36126946 DOI: 10.1123/jsr.2022-0086] [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: 03/02/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT Knee self-efficacy and injury-related fear are associated with poor self-reported knee function and decreased physical activity (PA) after ACL reconstruction (ACLR). Limited research has explored contextual factors that may influence psychological responses in this population, such as history of sport-related concussion (SRC). After SRC, individuals may experience increased negative emotions, such as sadness and nervousness. However, it is unknown how SRC history may influence knee-self efficacy and injury-related fear in individuals with ACLR. The purpose of this study was to compare knee self-efficacy and injury-related fear in individuals after ACLR who present with and without history of SRC. DESIGN Cross-sectional study. METHODS Forty participants ≥1 year postunilateral ACLR were separated by history of SRC (no SRC = 29, SRC = 11). The Knee Self-Efficacy Scale (KSES) and subscales measured certainty regarding performance of daily activities (KSES-ADL), sports/leisure activities (KSES-Sport), physical activities (KSES-PA), and future knee function (KSES-Future). The Tampa Scale of Kinesiophobia-11 measured injury-related fear. Mann-Whitney U tests were used to examine between-group differences. Hedges g effect sizes and 95% confidence interval were used to examine clinically meaningful group differences. RESULTS Individuals with a history of ACLR and SRC demonstrated worse KSES-PA (7.5 [5.3]) compared with those without a history of SRC (8.1 [6.1], P = .03). No other statistically significant differences were observed. A medium effect size was present for the KSES-PA (0.62), KSES-ADL (0.42), KSES-Present (ADL + PA + Sport) (0.48), KSES-Total (0.53), and Tampa Scale of Kinesiophobia-11 (0.61) but must be interpreted with caution as 95% confidence interval crossed 0. CONCLUSIONS This exploratory study indicated that individuals with a history of ACLR and SRC had worse knee self-efficacy for PA compared with those without history of SRC. Rehabilitation specialists should monitor knee self-efficacy deficits in the post-ACLR population and recognize the potential influence of cumulative injury history on rehabilitative outcomes.
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4
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Greenberg J, Kanaya MR, Bannon SM, McKinnon E, Iverson GL, Silverberg ND, Parker RA, Giacino JT, Yeh GY, Vranceanu AM. The Impact of a Recent Concussion on College-Aged Individuals with Co-Occurring Anxiety: A Qualitative Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031988. [PMID: 36767359 PMCID: PMC9915955 DOI: 10.3390/ijerph20031988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 05/25/2023]
Abstract
College-aged individuals with anxiety are vulnerable to developing persistent concussion symptoms, yet evidence-based treatments for this population are limited. Understanding these individuals' perspectives is critical for developing effective interventions. We conducted qualitative interviews with 17 college-aged individuals (18-24 years old) with a recent (≤10 weeks) concussion and at least mild anxiety (≥5 on the GAD-7 questionnaire) to understand the life impact of their concussion. We identified 5 themes: (1) disruption to daily activities (e.g., reduced participation in hobbies and physical activity); (2) disruption to relationships (e.g., reduced social engagement, feeling dismissed by others, stigma, and interpersonal friction); (3) disruptions in school/work (e.g., challenges participating due to light sensitivity, cognitive or sleep disturbance, and related emotional distress); (4) changes in view of the self (e.g., feeling "unlike oneself", duller, or more irritable), and (5) finding "silver linings" after the injury (e.g., increased motivation). Concussions impact the lives of college-aged individuals with co-occurring anxiety in a broad range of domains, many of which remain largely neglected in standard concussion clinical assessment and treatment. Assessing and addressing these issues has the potential to limit the negative impact of concussion, promote recovery, and potentially help prevent persistent concussion symptoms in this at-risk population.
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Affiliation(s)
- Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Millan R. Kanaya
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sarah M. Bannon
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Ellen McKinnon
- Dr. Robert Cantu Concussion Center, Emerson Hospital, Concord, MA 01742, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and The Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA 02129, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
| | - Noah D. Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC V5Z 1M9, Canada
| | - Robert A. Parker
- Harvard Medical School, Boston, MA 02115, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gloria Y. Yeh
- Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
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5
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Outlining the Invisible: Experiences and Perspectives Regarding Concussion Recovery, Return-to-Work, and Resource Gaps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138204. [PMID: 35805862 PMCID: PMC9266414 DOI: 10.3390/ijerph19138204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023]
Abstract
Appropriate supports and accommodations are necessary to ensure full concussion recovery and return-to-work (RTW). This research investigated barriers and facilitators to concussion recovery and RTW, and resource gaps reported by adults with concussion (‘workers’) and workplace and healthcare professionals (‘workplaces’). Semi-structured interviews and focus groups were conducted with workers (n = 31) and workplaces (n = 16) across British Columbia. Data were analyzed using inductive content analysis. Facilitators to workers’ concussion recovery and RTW included treatment, social support, and workplace and lifestyle modifications. To address barriers, both groups recommended: (a) widespread concussion and RTW education and training (b) standardized concussion recovery guidelines; (c) changing attitudes toward concussion; (d) mental health supports; and (e) increasing awareness that every concussion is unique. Findings can inform best practice for concussion recovery and RTW among professionals in workplaces, healthcare, occupational health and safety, and workers’ compensation boards.
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Varner CE, Thompson C, Wit K, Borgundvaag B, Houston R, McLeod S. A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury. Acad Emerg Med 2021; 28:493-501. [PMID: 33481332 DOI: 10.1111/acem.14215] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is a paucity of effective management strategies to prevent prolonged symptoms following mild traumatic brain injury (mTBI), and emerging evidence suggesting possible benefits of exercise. The objective of this trial was to determine whether adult patients presenting to the emergency department (ED) with a diagnosis of acute mTBI prescribed light exercise were less likely to develop persistent postconcussion symptoms (PCS). METHODS This was a randomized controlled trial conducted in three Canadian EDs. Consecutive, adult (18-64 years) ED patients with an mTBI sustained within the preceding 48 hours were eligible for enrollment. The intervention group received discharge instructions prescribing 30 minutes of daily light exercise, and the control group was given standard mTBI instructions advising gradual return to exercise following symptom resolution. The primary outcome was the proportion of patients with PCS at 30 days, defined as the presence of three or more symptoms on the Rivermead Post-concussion Symptoms Questionnaire (RPQ). RESULTS A total of 367 patients were enrolled (control group, n = 184; intervention, n = 183). Median age was 32 years and 201 (57.6%) were female. There was no difference in the proportion of patients with PCS at 30 days (control, 13.4% vs intervention, 14.6%; ∆1.2%, 95% confidence interval [CI] = -6.2 to 8.5). There were no differences in median change of RPQ scores, median number of return health care provider visits, median number of missed school or work days, or unplanned return ED visits within 30 days. Participants in the control group reported fewer minutes of light exercise at 7 days (30 vs 35; ∆5, 95% CI = 2 to 15). CONCLUSION In this trial of prescribed early light exercise for acute mTBI, there were no differences in recovery or health care utilization outcomes. Results suggest that early light exercise may be encouraged as tolerated at ED discharge following mTBI, but this guidance is not sufficient to prevent PCS.
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Affiliation(s)
- Catherine E. Varner
- Schwartz/Reisman Emergency Medicine Institute Sinai Health Toronto Ontario Canada
- Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| | - Cameron Thompson
- Schwartz/Reisman Emergency Medicine Institute Sinai Health Toronto Ontario Canada
| | - Kerstin Wit
- Department of Medicine McMaster University Hamilton Ontario Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute Sinai Health Toronto Ontario Canada
- Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| | - Reaves Houston
- Schwartz/Reisman Emergency Medicine Institute Sinai Health Toronto Ontario Canada
| | - Shelley McLeod
- Schwartz/Reisman Emergency Medicine Institute Sinai Health Toronto Ontario Canada
- Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
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7
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Varner C, Thompson C, de Wit K, Borgundvaag B, Houston R, McLeod S. Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department. CAN J EMERG MED 2021; 23:365-373. [PMID: 33555602 DOI: 10.1007/s43678-020-00076-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify risk factors associated with persistent concussion symptoms in adults presenting to the emergency department (ED) with acute mild traumatic brain injury (TBI). METHODS This was a secondary analysis of a randomized controlled trial conducted in three Canadian EDs whereby the intervention had no impact on recovery or healthcare utilization outcomes. Adult (18-64 years) patients with a mild TBI sustained within the preceding 48 h were eligible for enrollment. The primary outcome was the presence of persistent concussion symptoms at 30 days, defined as the presence of ≥ 3 symptoms on the Rivermead Post-concussion Symptoms Questionnaire. RESULTS Of the 241 patients who completed follow-up, median (IQR) age was 33 (25 to 50) years, and 147 (61.0%) were female. At 30 days, 49 (20.3%) had persistent concussion symptoms. Using multivariable logistic regression, headache at ED presentation (OR: 7.7; 95% CI 1.6 to 37.8), being under the influence of drugs or alcohol at the time of injury (OR: 5.9; 95% CI 1.8 to 19.4), the injury occurring via bike or motor vehicle collision (OR: 2.9; 95% CI 1.3 to 6.0), history of anxiety or depression (OR: 2.4; 95% CI 1.2 to 4.9), and numbness or tingling at ED presentation (OR: 2.4; 95% CI 1.1 to 5.2), were found to be independently associated with persistent concussion symptoms at 30 days. CONCLUSIONS Five variables were found to be significant predictors of persistent concussion symptoms. Although mild TBI is mostly a self-limited condition, patients with these risk factors should be considered high risk for developing persistent concussion symptoms and flagged for early outpatient follow-up.
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Affiliation(s)
- Catherine Varner
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada. .,Department of Family and Community Medicine, University of Toronto, 206-600 University Avenue, Toronto, ON, M5G 1X5, Canada. .,Sinai Health System, Toronto, ON, Canada.
| | - Cameron Thompson
- Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada.,Sinai Health System, Toronto, ON, Canada
| | - Kerstin de Wit
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Bjug Borgundvaag
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, 206-600 University Avenue, Toronto, ON, M5G 1X5, Canada.,Sinai Health System, Toronto, ON, Canada
| | - Reaves Houston
- Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada
| | - Shelley McLeod
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Schwartz/Reisman Emergency Medicine Institute, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, 206-600 University Avenue, Toronto, ON, M5G 1X5, Canada.,Sinai Health System, Toronto, ON, Canada
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8
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Vikane E, Frøyland K, Næss HL, Aßmus J, Skouen JS. Predictors for Psychological Distress 2 Months After Mild Traumatic Brain Injury. Front Neurol 2019; 10:639. [PMID: 31275230 PMCID: PMC6591371 DOI: 10.3389/fneur.2019.00639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/30/2019] [Indexed: 01/28/2023] Open
Abstract
Objective: To predict psychological distress at 2 months for patients with mild traumatic brain injury. Method: A prospective cohort study of 162 patients with mild traumatic brain injury (MTBI) admitted consecutively to an outpatient clinic at Haukeland University Hospital, Norway. Demographic data were obtained from Statistics Norway and injury characteristics were obtained from the hospital records. Sick leave data from the last year before the injury were obtained from The Norwegian Labor and Welfare Service. Self-report questionnaires were used to obtain history about earlier disease and symptom profiles. The Hospital Anxiety and Depression Scale (HAD) detecting states of depression and anxiety were used as the dependent variable in a stepwise linear regression. Pre-injury factors and injury-related factors were examined as potential predictors for HAD. Results: In the first steps we observed a significant association between HAD at 2 months and education, whiplash associated disorder (WAD), and earlier sick listed with a psychiatric diagnosis. In the final step there was an association only between HAD and self-reported anxiety and WAD. There were no associations between HAD and injury-characteristics like severity at Glasgow Coma Scale or intracranial injury. Conclusion: Patients with low education, earlier psychiatric diagnosis, self-reported earlier anxiety and WAD were more likely to develop a psychological distress after a MTBI. These findings should be taken into consideration when treating patients with MTBI.
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Affiliation(s)
- Eirik Vikane
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Kaia Frøyland
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Hanne Langseth Næss
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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9
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Auclair-Pilote J, Lalande D, Tinawi S, Feyz M, de Guise E. Satisfaction of basic psychological needs following a mild traumatic brain injury and relationships with post-concussion symptoms, anxiety, and depression. Disabil Rehabil 2019; 43:507-515. [PMID: 31230472 DOI: 10.1080/09638288.2019.1630858] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Self-determination theory proposes that the satisfaction of basic psychological needs (competence, autonomy, and relatedness) is essential to psychological well-being. This study aims to explore the acute impact of a mild traumatic brain injury on the perception of need satisfaction as well as to better understand which variables among post-concussion symptoms and mood are associated with the satisfaction of these psychological needs. MATERIAL AND METHODS A total of 179 adults with mild traumatic brain injury were included. The Basic Psychological Needs Satisfaction Scale (BPNS) was completed retrospectively to assess need satisfaction pre-injury and after the injury to assess need satisfaction post-injury. The Rivermead Post Concussion Symptoms Questionnaire as well as the Hospital Anxiety and Depression Scale were also completed post injury. RESULTS A significant difference between the perception of need satisfaction pre- and post- was found on the total BPNS score, with lower scores on the post-injury evaluation (less satisfaction). Moreover, higher levels of depression and anxiety were associated with less satisfaction. CONCLUSIONS These results suggest that sustaining a mild traumatic brain injury may have a negative impact on the satisfaction of competence, autonomy, and relatedness needs. To conclude, it is recommended that these concepts be included in psychological intervention programs following mild traumatic brain injury.Implications for rehabilitationA significant decrease in psychological need satisfaction is highlighted following mild traumatic brain injury.It is recommended that the needs of autonomy, competence, and relatedness in intervention programs following mild traumatic brain injury needs to be addressed.The more mild traumatic brain injury patients are anxious and depressed the more likely it is that they will present a diminished satisfaction of needs, expressed by a lower level of perception of their autonomy, competence, and relatedness. Thus, integrative intervention for anxiety as well as depression following mild traumatic brain injury is also recommended.
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Affiliation(s)
- Jennyfer Auclair-Pilote
- Department of Psychology, Université de Montréal, Montréal, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada
| | - Daniel Lalande
- Department of Psychology, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Simon Tinawi
- Traumatic Brain Injury Program, McGill University Health Center, Montréal, Canada
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Center, Montréal, Canada
| | - Elaine de Guise
- Department of Psychology, Université de Montréal, Montréal, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada.,Research Institute-McGill University Health Center, Montréal, Canada
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10
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Cogan AM, Haines CE, Devore MD, Lepore KM, Ryan M. Occupational Challenges in Military Service Members With Chronic Mild Traumatic Brain Injury. Am J Occup Ther 2019; 73:7303205040p1-7303205040p9. [PMID: 31120834 PMCID: PMC6533051 DOI: 10.5014/ajot.2019.027599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify the needs of military service members with chronic symptoms after mild traumatic brain injury (mTBI) that fall within the scope of occupational therapy practice. METHOD In this qualitative descriptive study, service members with a history of mTBI (N = 12) participated in semistructured interviews about their injury history, symptoms, daily routines, challenges, and plans. RESULTS Two main themes were identified: occupational changes and plans for the future. Occupational changes contains six subthemes: (1) rest and sleep, (2) activities of daily living and instrumental activities of daily living, (3) work, (4) social participation, (5) play and leisure, and (6) education. Plans for the future contains three subthemes: (1) supports, (2) barriers, and (3) fears. CONCLUSION Occupational therapists who work with this population should consider all areas of occupation, especially sleep, during assessment and treatment planning. Some clients may require additional support for preparing for civilian life.
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Affiliation(s)
- Alison M Cogan
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Christine E Haines
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Maria D Devore
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Karla M Lepore
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Margaret Ryan
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
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11
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Anderson JFI, Fitzgerald P. Associations between coping style, illness perceptions and self-reported symptoms after mild traumatic brain injury in prospectively studied pre-morbidly healthy individuals. Neuropsychol Rehabil 2018; 30:1115-1128. [PMID: 30560733 DOI: 10.1080/09602011.2018.1556706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigated whether coping style and/or illness perceptions are related to the severity of self-reported post-concussion syndrome (PCS) symptoms in the post-acute period after mild traumatic brain injury (mTBI). We hypothesised that reporting of early and late enduring-type PCS symptomatology (self-reported symptoms) would be significantly and negatively associated with: (a) an active "approach" coping style and (b) the belief that the injury would have negative consequences on the respondent's life. Using a prospective observational design we assessed 61 pre-morbidly healthy individuals who were admitted to hospital after an mTBI. Participants were assessed with measures of coping style and illness perception as well as PCS, depressive, anxiety and post-traumatic stress symptomatology. After controlling for current psychological distress, approach coping style significantly and independently predicted the severity of self-reported symptoms for early-type PCS symptomatology, but not late enduring-type PCS symptoms. The extent to which the respondent believed their symptoms were due to the mTBI significantly and independently predicted both early and late enduring-type PCS symptoms. This study indicates that different patterns of coping and illness perceptions are associated with early vs. late enduring types of PCS symptoms; this may have implications for the treatment of post-injury self-reported symptoms.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Psychology Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, Victoria, Australia.,Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Melbourne, Victoria, Australia
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Medvedev ON, Theadom A, Barker-Collo S, Feigin V. Distinguishing between enduring and dynamic concussion symptoms: applying Generalisability Theory to the Rivermead Post Concussion Symptoms Questionnaire (RPQ). PeerJ 2018; 6:e5676. [PMID: 30280043 PMCID: PMC6166625 DOI: 10.7717/peerj.5676] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background The Rivermead Post Concussion Symptoms Questionnaire (RPQ) is a widely-used, 16-item measure of concussion symptoms yet its ability to assess change in the symptom experience over time has come under criticism. We applied Generalisability theory to differentiate between dynamic and enduring aspects of post-concussion symptoms and to examine sources of measurement error in the RPQ. Materials and Methods Generalisability theory was applied using the longitudinal design with persons as the object of measurement. Patients with a traumatic brain injury (n = 145; aged ≥16 years) were assessed at three time occasions (1, 6 and 12 months post-injury) using the RPQ. Results The RPQ showed overall strong generalisability of scores (G = .98) across persons and occasions with a minor proportion of variance attributed to the dynamic aspect of symptoms reflected by interaction between person and occasion. Items measuring concentration, fatigue, restlessness and irritability reflected more dynamic patterns compared to more enduring patterns of sensitivity to noise, impatience, nausea and sleep disturbance. Conclusion The RPQ demonstrated strong reliability in assessing enduring post-concussion symptoms but its ability to assess dynamic symptoms is limited. Clinicians should exercise caution in use of the RPQ to track dynamic symptom change over time. Further investigation is necessary to enhance the RPQ's ability to assess dynamic symptoms and to address measurement error associated with individual items.
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Affiliation(s)
- Oleg N Medvedev
- School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Alice Theadom
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | | | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
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13
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Barker-Collo S, Theadom A, Starkey N, Kahan M, Jones K, Feigin V. Factor structure of the Rivermead Post-Concussion Symptoms Questionnaire over the first year following mild traumatic brain injury. Brain Inj 2018; 32:453-458. [PMID: 29355392 DOI: 10.1080/02699052.2018.1429659] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND We examined the factor structure of the Rivermead Post-Concussion Symptom Questionnaire (RPQ), the most commonly used measure of post-concussive symptoms, over the first year post-injury. METHOD Factor analysis (orthogonal rotation) was used to examine the RPQ items that form coherent subsets/factors within 2-weeks, and 1, 6, and 12-months post-mTBI in 527 adults (age >16 years). RESULTS At baseline, three factors accounted for 63.95% of the variance; factor 1 reflected cognitive and physiological disturbances; factor 2 included items reflecting mood, sleep, and nausea/vomiting; and factor 3 included visual/auditory disturbances, dizziness, and headaches. At 1 month, three factors were again extracted (63.26% variance). Factor 1 reflected cognitive and mood symptoms, factor 2 reflected mood with headache, nausea, and dizziness; and factor 3 reflected visual disturbances. Two factors were obtained at 6 and 12 months (63.7% and 63.38% of variance): factor 1 included mood/cognitive items, restlessness, sleep disturbance, and noise sensitivity; whereas, factor 2 included physiological symptoms. CONCLUSIONS The factor structure of the RPQ changes over time; however, it was relatively stable from 6 to 12-months post-injury. Subject to further evaluation, assessments conducted from 6 months could consider using these two factors as subscales. Changing the factor structure of RPQ before 6 months suggests that timing of assessment should be considered in applying these factors.
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Affiliation(s)
- Suzanne Barker-Collo
- a School of Psychology, Faculty of Sciences , University of Auckland , New Zealand
| | - Alice Theadom
- b National Institute for Stroke and Applied Neuroscience, School of Rehabilitation and Occupation Studies , AUT University , Auckland , New Zealand
| | - Nicola Starkey
- c School of Psychology, Faculty of Arts and Social Sciences , University of Waikato , Hamilton , New Zealand
| | - Michael Kahan
- d Waikato Occupational Services ltd , Hamilton , New Zealand
| | - Kelly Jones
- b National Institute for Stroke and Applied Neuroscience, School of Rehabilitation and Occupation Studies , AUT University , Auckland , New Zealand
| | - Valery Feigin
- b National Institute for Stroke and Applied Neuroscience, School of Rehabilitation and Occupation Studies , AUT University , Auckland , New Zealand
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14
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Buunk AM, Spikman JM, Veenstra WS, van Laar PJ, Metzemaekers JD, van Dijk JMC, Meiners LC, Groen RJ. Social cognition impairments after aneurysmal subarachnoid haemorrhage: Associations with deficits in interpersonal behaviour, apathy, and impaired self-awareness. Neuropsychologia 2017; 103:131-139. [DOI: 10.1016/j.neuropsychologia.2017.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 12/13/2022]
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15
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Vikane E, Hellstrøm T, Røe C, Bautz-Holter E, Aßmus J, Skouen JS. Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study. Brain Inj 2017; 31:475-484. [DOI: 10.1080/02699052.2017.1280852] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eirik Vikane
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erik Bautz-Holter
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Haller CS, Bosma CM, Kapur K, Zafonte R, Langer EJ. Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients’ relatives: a multilevel analysis. Qual Life Res 2016; 26:893-902. [DOI: 10.1007/s11136-016-1416-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 10/21/2022]
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17
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The diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. J Craniofac Surg 2014; 25:2105-8. [PMID: 25304144 DOI: 10.1097/scs.0000000000001050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The objective of this study was to investigate the diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. A total of 63 patients (45 men and 18 women; mean age of 43 years with a range from 20 to 72 years) who suffered from traumatic bifrontal contusions between January 2007 and December 2012 were inspected. The clinical and imaging results were studied for all patients, and we found that swelling of the mesencephalon and a downward shift of the bilateral red nucleus were significant signs of central brain herniation in the image of magnetic resonance imaging. All patients were given a simultaneous bilateral craniotomy for balanced decompressive surgery. The Glasgow Outcome Scale was used to monitor the patients during the follow-up period, which lasted from 6 to 52 months with a mean of 22 months. At the termination of the follow-up period, the following Glasgow Outcome Scale scores were obtained: 14 patients scored 5 points, 22 patients scored 4 points, 7 patients scored 3 points, 13 patients scored 2 points, and 7 patients scored 1 point. Therefore, our study suggested that an early magnetic resonance imaging scan could result in a more timely diagnosis of central brain herniation, and simultaneous bilateral craniotomy was found to be one of the best treatments for central brain herniation to improve patient outcomes.
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Yuh EL, Cooper SR, Mukherjee P, Yue JK, Lingsma HF, Gordon WA, Valadka AB, Okonkwo DO, Schnyer DM, Vassar MJ, Maas AIR, Manley GT. Diffusion tensor imaging for outcome prediction in mild traumatic brain injury: a TRACK-TBI study. J Neurotrauma 2014; 31:1457-77. [PMID: 24742275 DOI: 10.1089/neu.2013.3171] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated 3T diffusion tensor imaging (DTI) for white matter injury in 76 adult mild traumatic brain injury (mTBI) patients at the semiacute stage (11.2±3.3 days), employing both whole-brain voxel-wise and region-of-interest (ROI) approaches. The subgroup of 32 patients with any traumatic intracranial lesion on either day-of-injury computed tomography (CT) or semiacute magnetic resonance imaging (MRI) demonstrated reduced fractional anisotropy (FA) in numerous white matter tracts, compared to 50 control subjects. In contrast, 44 CT/MRI-negative mTBI patients demonstrated no significant difference in any DTI parameter, compared to controls. To determine the clinical relevance of DTI, we evaluated correlations between 3- and 6-month outcome and imaging, demographic/socioeconomic, and clinical predictors. Statistically significant univariable predictors of 3-month Glasgow Outcome Scale-Extended (GOS-E) included MRI evidence for contusion (odds ratio [OR] 4.9 per unit decrease in GOS-E; p=0.01), ≥1 ROI with severely reduced FA (OR, 3.9; p=0.005), neuropsychiatric history (OR, 3.3; p=0.02), age (OR, 1.07/year; p=0.002), and years of education (OR, 0.79/year; p=0.01). Significant predictors of 6-month GOS-E included ≥1 ROI with severely reduced FA (OR, 2.7; p=0.048), neuropsychiatric history (OR, 3.7; p=0.01), and years of education (OR, 0.82/year; p=0.03). For the subset of 37 patients lacking neuropsychiatric and substance abuse history, MRI surpassed all other predictors for both 3- and 6-month outcome prediction. This is the first study to compare DTI in individual mTBI patients to conventional imaging, clinical, and demographic/socioeconomic characteristics for outcome prediction. DTI demonstrated utility in an inclusive group of patients with heterogeneous backgrounds, as well as in a subset of patients without neuropsychiatric or substance abuse history.
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Affiliation(s)
- Esther L Yuh
- 1 Brain and Spinal Injury Center, University of California , San Francisco, California
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Cogan AM. Occupational needs and intervention strategies for military personnel with mild traumatic brain injury and persistent post-concussion symptoms: a review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2014; 34:150-9. [PMID: 24972412 DOI: 10.3928/15394492-20140617-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/06/2014] [Indexed: 11/20/2022]
Abstract
Mild traumatic brain injury (mTBI), also known as concussion, has been labeled the "signature injury" of the wars in Iraq and Afghanistan. A subset of military personnel with mTBI experience ongoing symptoms well beyond the normal recovery window. While much research has been dedicated to understanding the etiology and severity of the symptoms, very little has assessed how long-term symptoms impact participation in daily life. A scoping study of the occupational science and occupational therapy literature was conducted to ascertain the current state of research on the impact of mTBI on participation in daily life activities, as well as occupational therapy interventions for mTBI. Although the emphasis in this article is on military personnel with mTBI, studies on civilians with mTBI were included in the review as research with military populations is extremely limited. Based on the literature reviewed, the author suggests a role for occupational science research and occupational therapy practice in meeting the occupational needs of military service members with persistent symptoms after mTBI.
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Vikane E, Hellstrøm T, Røe C, Bautz-Holter E, Assmus J, Skouen JS. Missing a follow-up after mild traumatic brain injury--does it matter? Brain Inj 2014; 28:1374-80. [PMID: 24946256 DOI: 10.3109/02699052.2014.919532] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study sought to identify potential differing clinical characteristics between patients with a mild traumatic brain injury (MTBI) who attended a planned follow-up session and not. This study investigated whether clinical characteristics and attendance for a planned follow-up service 2-months after injury could be related to return-to-work (RTW) 1-year later. METHOD Prospective cohort study of 343 patients with MTBI admitted consecutively to the Department of Neurosurgery in 2009-2011. Demographic and clinical data were obtained from the hospital files and data about sick leave from The Norwegian Labour and Welfare Service. Patients were categorized into two groups according to their attendance. RESULTS One hundred and sixty-one (67%) patients attended (AG) and 80 (33%) did not (NAG) attend their follow-up appointments. The AG had significantly more frequently intracranial pathology on CT scan, had consumed less alcohol and were older. Logistic regression showed that follow-up attendance (OR = 16.89) and sick leave before injury (OR = 9.70) are unfavourably related to RTW at 12-months. Skull fracture and cause of injury had no influence of the outcome. CONCLUSION Not attending the follow-up has a favourable outcome after MBTI, indicating that these patients have a reduced need for medical and rehabilitation support for their brain injury.
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Affiliation(s)
- Eirik Vikane
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital , Bergen , Norway
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Sveen U, Andelic N, Bautz-Holter E, Røe C. Self-reported competency--validation of the Norwegian version of the patient competency rating scale for traumatic brain injury. Disabil Rehabil 2014; 37:239-46. [PMID: 24773117 DOI: 10.3109/09638288.2014.913706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the psychometric properties of the Norwegian version of the Patient Competency Rating Scale (PCRS) in patients with traumatic brain injury (TBI) at 12 months post-injury. METHODS Demographic and injury-related data were registered upon admission to the hospital in 148 TBI patients with mild, moderate, or severe TBI. At 12 months post-injury, competency in activities and global functioning were measured using the PCRS patient version and the Glasgow Outcome Scale-Extended (GOSE). Descriptive reliability statistics, factor analysis and Rasch modeling were applied to explore the psychometric properties of the PCRS. External validity was evaluated using the GOSE. RESULTS The PCRS can be divided into three subscales that reflect interpersonal/emotional, cognitive, and activities of daily living competency. The three-factor solution explained 56.6% of the variance in functioning. The internal consistency was very good, with a Cronbach's α of 0.95. Item 30, "controlling my laughter", did not load above 0.40 on any factors and did not fit the Rasch model. The external validity of the subscales was acceptable, with correlations between 0.50 and 0.52 with the GOSE. CONCLUSION The Norwegian version of the PCRS is reliable, has an acceptable construct and external validity, and can be recommended for use during the later phases of TBI.
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Affiliation(s)
- Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital , Oslo , Norway
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Zimmermann N, Pereira APAD, Fonseca RP. Brazilian Portuguese version of the Patient Competency Rating Scale (PCRS-R-BR): semantic adaptation and validity. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2014; 36:40-51. [DOI: 10.1590/2237-6089-2013-0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 11/26/2013] [Indexed: 11/22/2022]
Abstract
This study describes the adaptation of a revised Brazilian version of the Patient Competency Rating Scale (PCRS-R-BR), which focuses on executive, mnemonic, and attention functions. Evidence of content-based and external validity is also reported. The cross-cultural adaptation was conducted in five phases: 1) translations and back translations; 2) item analysis by authors; 3) classification by experts; 4) revisions and reformulations by authors; 5) pilot study with a sample of patients with mild and moderate/severe traumatic brain injury (TBI). Data were analyzed descriptively, and the PCRS-R-BR scores of groups with mild vs. moderate/severe TBI were compared using the Mann-Whitney test. Patients and their relatives were divided into groups and compared using repeated-measures analysis. The results of the PCRS-R-BR questionnaire for relatives and discrepancy scores of patients with moderate/severe TBI revealed significantly more impairment than that found in the group of patients with mild TBI. There were significant differences between item and total scores of both groups of patients and relatives. Results indicated a high level of item content agreement between experts. This study found initial evidence of PCRS-R-BR content-based and external validity when the questionnaire was applied to patients with mild and moderate/severe TBI and their relatives.
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Sandhaug M, Andelic N, Berntsen SA, Seiler S, Mygland A. Self and near relative ratings of functional level one year after traumatic brain injury. Disabil Rehabil 2011; 34:904-9. [PMID: 22148905 DOI: 10.3109/09638288.2011.626484] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To quantify traumatic brain injury (TBI) patients' perceptions of own function by the Patient Competency Rating Scale (PCRS) one year after injury, and to examine self-awareness of functional deficits by comparing PCRS ratings from patients (PCRS-P) and PCRS ratings from near relatives (PCRS-R), and to identify predictors of awareness deficits. METHOD A cohort of 50 severe (n = 33) and moderate (n = 17) TBI patients. Awareness of deficits was investigated by subtracting PCRS relative ratings from PCRS patient ratings. Predictors of PCRS ratings and differences were assessed by stepwise multiple regression analyses. RESULTS The average patient PCRS sum score was 122/150 (95% CI = 115; 129) as compared to a sum score of 117/150 (95% CI = 110; 125), given by their relatives (p = 0.93). The patients scored themselves slightly higher than their relatives in the domains of activities of daily living (ADL) and cognitive function (p < 0.001, p < 0.001). Regression analyses showed that Glasgow Coma Scale (GCS)score at admission to rehabilitation was the strongest predictor of patient PCRS (B = 3.314, p = 0.008). The strongest predictor of differences between patient and relative PCRS was GCS acute (B = -3.530, p = 0.001). CONCLUSIONS TBI patients demonstrated a slight "awareness gap" in ADL and cognitive function. Low GCS in the acute phase and high age were the strongest predictors of self- awareness deficits.
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Affiliation(s)
- Maria Sandhaug
- Faculty of Health and Sports, Agder University, Kristiansand, Norway.
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Vik-Mo EO, Reinlie S, Helseth E, Langmoen IA. Neurosurgery in Oslo. World Neurosurg 2011; 74:402-6. [PMID: 21492578 DOI: 10.1016/j.wneu.2010.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/12/2010] [Indexed: 11/18/2022]
Abstract
Neurosurgery in Oslo, Norway, was founded by the pioneer Vilhelm Magnus in the beginning of the 20th century. Through the contributions of important surgeons such as Arne Torkildsen, Kristian Kristiansen, and Helge Nornes, Norwegian neurosurgery has developed into an active clinical and technologically oriented surgical specialty. Since the unification of neurosurgical procedures in Oslo in January 2010 into one department, it is one of the largest neurosurgical departments in Europe with more than 4500 surgeries performed per year covering all aspects of neurosurgery. The department's scientific focus is on clinical studies, in close collaboration with supportive clinical departments; through interaction with basic science stem cell groups, an increasing effort is being made in translational cellular and molecular medicine.
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Lindén A, Lexell J, Larsson Lund M. Improvements of task performance in daily life after acquired brain injury using commonly available everyday technology. Disabil Rehabil Assist Technol 2010; 6:214-24. [DOI: 10.3109/17483107.2010.528142] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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