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Chen SJ, Li SJ, Hong HM, Hwang HF, Lin MR. Effects of Age, Sex, and Postconcussive Symptoms on Domain-Specific Quality of Life a Year After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E225-E236. [PMID: 38032833 DOI: 10.1097/htr.0000000000000916] [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: 12/02/2023]
Abstract
OBJECTIVE To identify the factors influencing longitudinal changes in patients' scores across 6 domains of the Quality of Life after Brain Injury (QOLIBRI) instrument 1 year after mild traumatic brain injury (mTBI). DESIGN This was a longitudinal cohort study. PARTICIPANTS AND SETTING Eligible patients with a new diagnosis of mTBI were recruited from the outpatient clinics of the neurosurgery departments of 3 teaching hospitals in Taipei City, Taiwan. In total, 672 patients participated in the baseline assessment. Postinjury follow-up was conducted at 6 and 12 months. MAIN OUTCOME MEASURE Six domains of the 37-item QOLIBRI: Cognition, Self, Daily Life and Autonomy, Social Relationships, Emotions, and Physical Problems. RESULTS Linear mixed-effects analyses revealed that, among patients younger than 60 years, the scores of the Cognition, Self, Daily Life and Autonomy, and Social Relationships domains significantly increased 6 months after injury; furthermore, their scores of the Cognition, Self, and Daily Life and Autonomy significantly increased 12 months after injury. By contrast, among patients 60 years and older, the scores of these domains reduced from baseline to 6 and 12 months. No significant sex-based difference was observed in the changes in scores of any QOLIBRI domain. At 6 and 12 months post-injury, the scores of the Cognition, Emotions, and Physical Problems domains were significantly higher for patients with postconcussive symptoms than for those without these symptoms. CONCLUSIONS Although multiple characteristics of patients significantly affected their baseline scores on the 6 domains of the QOLIBRI, only age and postconcussive symptoms were significantly associated with longitudinal changes in their scores 6 and 12 months after mTBI.
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Affiliation(s)
- Sy-Jou Chen
- Author Affiliations: Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (Dr Chen); Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan (Drs Chen and Lin); Departments of Emergency Medicine (Dr Li) and Nursing (Ms Hong), Taipei Medical University Hospital, Taipei, Taiwan; Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan (Dr Hwang); and Programs in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan (Dr Lin)
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Robertson MK, McLoughlin J. The role of the physiotherapist in concussion. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:2013. [PMID: 38725965 PMCID: PMC11079349 DOI: 10.4102/sajp.v80i1.2013] [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: 11/01/2023] [Accepted: 01/31/2024] [Indexed: 05/12/2024] Open
Abstract
In the last decade, concussion research has exploded in multiple fields of scientific research. This has helped to clarify what causes, influences, and perpetuates human concussion, and displays the integral role physiotherapists play in concussion management. In this article we discuss the latest research relevant to the key role of physiotherapy in concussion management. A narrative review of the literature on concussion was conducted. The current review analyses how concussion has influenced physiotherapy in several categories: assessment, treatment, management, research rigour and building the profile of the profession. Scientific concussion research has largely converged in support of the role of physiotherapists utilising specific components including: (1) autonomic, (2) cervicogenic, (3) vestibulo-ocular and (4) psychological approaches to management. Latest research supports the critical role of physiotherapy in concussion care in the assessment, management, and prevention of concussion with scope for further interdisciplinary collaborations. Clinical implications Concussion is complex. A basic mental health, Vestibular Ocular Motor Screening (VOMS) and four key components relating to concussion management (autonomic, cervicogenic, vestibular oculomotor, and psychological approaches to management) should be included in the undergraduate and postgraduate curriculum. This will aid clinical physiotherapists to support their patients. A call to advance more intradisciplinary physiotherapy teamwork should be encouraged as valuable knowledge sharing is potentially lost within the framework of 'specialisation'. If needed, the skills of a greater interdisciplinary team are imperative to facilitate patient management and recovery from this multi-faceted injury.
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Affiliation(s)
| | - James McLoughlin
- College of Nursing and Health Sciences, Faculty of Physiotherapy, Flinders University, Adelaide, Australia
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Cairncross M, Ledoux AA, Greenberg J, Silverberg ND. A Cross-Sectional Investigation of Trait Mindfulness, Concussion Symptom Severity, and Quality of Life in Adults with Persisting Symptoms Postconcussion. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38563801 DOI: 10.1089/jicm.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Individual differences in mindfulness may impact quality of life after concussion. In a cross-sectional analysis, the moderating effect of mindfulness was tested on the association between symptom severity and quality of life in adults with persisting postconcussion symptoms (N = 85). Mindfulness and symptom severity were independently associated with quality of life; however, mindfulness did not moderate this association. "Nonreactivity" was independently associated with quality of life; however, it was not a significant moderator. Taking a nonreactive stance, or allowing experiences to come and go without effort to change them, may be relevant to quality-of-life outcomes after concussion.
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Affiliation(s)
- Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Andrée-Anne Ledoux
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
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Bales NJ, Perera DC, Foerster R, Poirier L, Ducis K. Analysis of a novel virtual pediatric concussion clinic in a rural setting. Childs Nerv Syst 2024; 40:1199-1205. [PMID: 38015249 DOI: 10.1007/s00381-023-06231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Children and adolescents who sustain concussion in rural communities are lost to follow-up after initial evaluation more often than their urban counterparts. Thus, this study aims to determine the feasibility and accessibility of a novel virtual pediatric concussion clinic at a rural academic hospital. METHODS Data regarding patients referred to a virtual concussion clinic at a rural Pediatric Level 2 Trauma Center over a 16-month period was prospectively collected. Patients experiencing concussive symptoms were referred to the pediatric neurosurgery clinical registered nurse and received a phone call following an injury. Referrals to therapy were made based on symptoms reported. RESULTS Data from 44 patients was collected: 9 did not follow-up in concussion clinic despite leaving a voicemail. Forty-three were referred from the emergency department. The median time from referral placed to completing a virtual follow-up was 4.5 days. Among the referrals, 3 (8.6%) were to pediatric neurology, 10 (28.6%) to occupational therapy (OT), 6 (17.1%) to physical therapy (PT), 4 (11.4%) to speech-language pathology (SLP), and 25 (71.4%) did not receive referrals as their symptoms had abated. Patients followed with pediatric neurology post-injury for an average of 75.9 days, OT for an average of 52.7 days, and PT for an average of 2.3 days. CONCLUSION This is a feasible model to follow patients and place referrals for additional therapeutic services in a rural community. With 79.5% of patients completing a follow-up, the clinic demonstrates easy accessibility and reliable adherence.
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Affiliation(s)
- Natalie J Bales
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, USA.
| | - Dinukie-Chantal Perera
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, USA
| | - Ruth Foerster
- Division of Neurosurgery at The University of Vermont Medical Center, Burlington, VT, USA
| | - Leanne Poirier
- Division of Neurosurgery at The University of Vermont Medical Center, Burlington, VT, USA
| | - Katrina Ducis
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, USA
- Division of Neurosurgery at The University of Vermont Medical Center, Burlington, VT, USA
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Kersivien C, Doumit A, Gascoigne M, Wearne TA. The protective role of resilience in the reporting of post-concussive symptoms within a non-clinical sample. Clin Neuropsychol 2024; 38:668-682. [PMID: 37731324 DOI: 10.1080/13854046.2023.2256949] [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: 02/15/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
Objective: Despite being common following a brain injury, post-concussive symptoms (PCS) are highly prevalent in healthy and non-concussed individuals. Psychosocial factors likely subserve the maintenance of symptoms, and numerous studies have identified prominent risk factors associated with post-concussive symptom reporting (e.g. history of depression). However, few studies have investigated protective factors in this context. The aim of the current study was to examine the relationship between resilience and PCS, and to identify the factors subserving resilience within this relationship. Method: Healthy and non-concussed participants (n = 283, Mage = 22.70 years) completed questionnaires examining PCS (Rivermead Post-Concussion Symptom Questionnaire) and resilience (Resilience Scale for Adults), together with a screener of background demographic/clinical factors. Results: Resilience negatively predicted PCS above and beyond the effect of demographic and clinical factors previously implicated in the reporting of PCS. Interestingly, heightened "perception of self" was the resilience factor uniquely associated with PCS symptoms. The final model accounted for 33% of the variance in PCS. Overall, female gender, a history of headaches, and diagnoses of ADHD and depression, and reduced "perception of self" were all predictive of greater PCS (ps < .05). Conclusion: Resilience, particularly perception of self, is a positive protective factor in the reporting of PCS. These findings highlight the importance of early identification of less resilient individuals following trauma-such as an mTBI and provide a potential rationale for the incorporation of resilience-based rehabilitation programs into the recovery process, particularly those that promote greater self-efficacy and self-competency.
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Affiliation(s)
| | - Adam Doumit
- School of Psychology, Western Sydney University, Sydney, Australia
| | | | - Travis A Wearne
- School of Psychology, Western Sydney University, Sydney, Australia
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Weightman MM, King LA, Fino PC, Dibble LE, Pelo R, Michielutti PG, Richard H, Parrington L, Lester ME, Hoppes CW. Reconsidering Vestibular/Ocular Motor Screening Cutoff Scores for Concussion. Mil Med 2024; 189:e714-e720. [PMID: 37856171 DOI: 10.1093/milmed/usad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Vestibular/Ocular Motor Screening (VOMS) is often part of a comprehensive evaluation to identify acute mild traumatic brain injury. Most of the reports describe the use of the VOMS in adolescents/young adults and not in older adults or military service members. The purpose of this study was to describe VOMS findings in healthy civilians and active duty military service members up to the age of 50 years. MATERIALS AND METHODS Seventy-seven healthy civilians between 18 and 50 years of age (22 males, age 31.8 [9.0] years) participated across three sites in addition to 40 healthy active duty service members (25 males, age 27.5 [4.9] years) from one site. Demographics, Neurobehavioral Symptom Inventory scores, mean near point convergence (NPC) distance, and Total Symptom Change (TSS) scores from the VOMS were evaluated. RESULTS For civilians, the group mean NPC distance was 4.98 (3.8) cm. For military service members, the group mean NPC distance was 6.17 (4.57) cm. For civilians, the mean TSS was 1.2 (2.3) with 53.2% reporting 0 TSS, 27.3% reporting one TSS, and 19.5% reporting two or more TSS. For military service members, the mean TSS was 0.20 (0.72) with 92.5% reporting 0 TSS, 0% reporting one TSS, and 7.5% reporting two or more TSS. Age did not correlate with the mean NPC distance and TSS in healthy civilians and active duty military service members. CONCLUSIONS Reconsideration of the Military Acute Concussion Evaluation, Version 2 cutoff value for abnormal mean NPC distance may be warranted to improve diagnostic accuracy in both civilian and military adult populations. Similarly, re-evaluating criteria for interpreting the TSS results of the VOMS, specifically in civilians, may be warranted.
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Affiliation(s)
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Peter C Fino
- Department of Health & Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Ryan Pelo
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Holly Richard
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Mark E Lester
- Department of Physical Therapy, University of Texas-Rio Grande Valley, Edinburg, TX 78539, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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Bowman TG, Thibault R, Radack BM, Davis A, Elam P. Clinical outcomes for various benign paroxysmal positional vertigo (BPPV) diagnoses in adolescents and young adults with recent concussions. Phys Ther Sport 2024; 65:90-94. [PMID: 38096715 DOI: 10.1016/j.ptsp.2023.12.004] [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: 09/04/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Determine how positive BPPV findings in adolescents and young adults following concussion impacted the total number of treatments required and time until discharge. SETTING Outpatient physical therapy clinic. PARTICIPANTS 167 individuals who were diagnosed with concussion or brain injury. DESIGN Retrospective chart review. MAIN MEASURES Total number of treatments and days until discharge were compared for various BPPV diagnoses (anterior canal, posterior canal, horizontal canal, and combination) and for individuals with and without BPPV. RESULTS Fifty-one out of 167 cases (30.54%) were diagnosed with BPPV. The total number of treatments provided was statistically different across BPPV diagnoses (P = .004). However, days until discharge were not statistically different between BPPV diagnoses (P = .28). There was no significant difference between time to discharge between those with BPPV (median = 21 days, range = 7-126) and those without (median = 28 days, range = 7-84 days; P = .23, r = 0.09). CONCLUSION To optimize outcomes, including symptom resolution and return to sport and/or work, early identification of BPPV and subsequent intervention should be prioritized for individuals who have concussion symptoms that suggest vestibular dysfunction.
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Affiliation(s)
- Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, 1501 Lakeside Dr, Lynchburg VA, 24501, USA.
| | - Rachel Thibault
- Rehab Associates of Central Virginia, 3211 Forest Brook Rd, Lynchburg, VA, 24501, USA
| | - Benjamin M Radack
- School of Physical Therapy, University of Lynchburg, 300 Monticello Ave, Ste A, Lynchburg, VA, 24501, USA
| | - Anissa Davis
- School of Physical Therapy, University of Lynchburg, 300 Monticello Avenue, Suite A, Lynchburg, VA, 24501, USA
| | - Penelope Elam
- School of Physical Therapy, University of Lynchburg, 300 Monticello Avenue, Suite A, Lynchburg, VA, 24501, USA
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Jensen KL, Wachner LG, Storm van den Brekel J, Hardis H, Smaakjær P, Hansen MV, Turn J, Rasmussen RS. Multidisciplinary interventions increase weekly working hours and quality of life in persons with post-concussion syndrome. Neurol Res 2023; 45:926-935. [PMID: 37590325 DOI: 10.1080/01616412.2023.2247302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To improve labor market attachment, general health and quality of life in persons suffering from post-concussion syndrome. Labor market attachment often changes after mTBI, and especially in persons suffering from post-concussion syndrome, and constitutes a huge societal burden. METHODS Eighty-two adults with persistent post-concussion syndrome participated in this single-center and uncontrolled interventional efficacy open-label investigation. The primary endpoint was to increase weekly working hours. Outcome measures ranged from self-reported cognitive symptoms to objective performance testing. Multidisciplinary interventions were used to reduce symptoms of fatigue, stress, pain, oculomotor malfunction, and sensitivity to both sound and light. RESULTS Workhours improved from median 0 to 6 hours (p = 0.00002). Several significant improvements were observed in quality of life measured by the SF-36. General fatigue measured by the MFI-20 was reduced (p < 0.0001), and symptoms of depression were reduced (p < 0.0001). The COPM results were improved for task completion satisfaction and for ability to perform a task (p < 0.0001). Reading speed, and performances in the Groffman Visual Tracing Test and the King-Devick Test, all improved (p < 0.01). The intervention did not reduce perception of pain intensity (p = 0.11). CONCLUSION After the intervention, participants increased weekly workhours and improved in many aspects of life - including quality of life, performance in everyday activities, fatigue and depression. Perception of pain intensity was not improved.
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Affiliation(s)
- Katrine L Jensen
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Lone G Wachner
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | | | - Helle Hardis
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Peter Smaakjær
- Department of Vision, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Mette V Hansen
- Department of Hearing, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Janette Turn
- Department of Hearing, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Rune S Rasmussen
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
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Martens G, Khosravi MH, Lejeune N, Kaux JF, Thibaut A. Gender Specificities in Sleep Disturbances following Mild Traumatic Brain Injury: A Preliminary Study. Brain Sci 2023; 13:brainsci13020323. [PMID: 36831865 PMCID: PMC9954746 DOI: 10.3390/brainsci13020323] [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: 12/01/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, can lead to persistent cognitive and functional symptoms that impede quality of life to a varying extent. This condition is referred to as post-concussive syndrome (PCS). Sleep disturbances are part of it but their distribution among different genders remains scarcely investigated. This pilot cross-sectional anonymous web-based survey interviewed volunteer 18-55 years old participants with a recent (i.e., less than 5 years) reported history of mTBI. Questionnaires related to persistent post-concussive symptoms (PPCS; Rivermead post-concussion symptoms questionnaire), sleep quality (Pittsburgh Sleep Quality Index) and daytime sleepiness (Epworth Sleepiness Scale) were administered as part of the survey. Ninety-one participants' responses were analysed (61 female; 30 male); 43% of them suffered from post-concussive syndrome, 60% reported poor sleep quality and 34% experienced excessive daytime sleepiness. The proportion of PPCS was significantly higher in female participants as compared to males (female: 57%; male: 13%; Fisher's exact test p < 0.001). Excessive daytime sleepiness was also significantly more present in females (female: 44%; male: 13%; p < 0.001) whereas poor sleep quality was present in similar proportions between females and males (female: 66%; male: 50%; p = 0.176). Even though based on a relatively small sample, these findings highlight important gender differences that should be accounted for in PPCS medical care and management.
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Affiliation(s)
- Géraldine Martens
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Physical and Rehabilitation Medicine and Sport Traumatology Department, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
- Correspondence:
| | | | - Nicolas Lejeune
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Saint-Luc Hospital Group, CHN William Lennox, 1340 Ottignies, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine and Sport Traumatology Department, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
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Sheeba S, Cavaleri R, Summers S, Browne C. Effectiveness of non-pharmacological treatments for vestibular and oculomotor dysfunction in patients with persistent post-concussive symptoms: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e066634. [PMID: 36609322 PMCID: PMC9827270 DOI: 10.1136/bmjopen-2022-066634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Concussion is a form of mild traumatic brain injury that disrupts brain function. Although symptoms are mostly transient, recovery can be delayed and result in persistent postconcussive symptoms (PPCS). Vestibular and oculomotor dysfunction are among the most debilitating impairments associated with PPCS. However, pharmacological interventions for these impairments are associated with deleterious side effects. Accordingly, increasing research has examined the utility of non-pharmacological interventions for PPCS. The aim of this review is to synthesise and evaluate the effectiveness of non-pharmacological interventions for the treatment of vestibular and oculomotor dysfunction for patients with PPCS. METHODS AND ANALYSIS Systematic searches of MEDLINE, PubMed, Web of Science and Scopus will identify randomised controlled trials employing non-pharmacological treatments for vestibular and/or oculomotor dysfunction for PPCS. Such interventions may include, but are not limited to, vestibular rehabilitation, optokinetic stimulation and vestibulo-ocular reflex exercises. Assessments of oculomotor function will include versional eye movements, vergence eye movements, visual-fixation movements and accommodation response. Assessments of vestibular function will include the Fukuda Step test, functional balance tests, force displacement tests, and subjective reports of balance disruption or vertigo. Where appropriate, meta-analyses of standardised mean differences will be conducted using a random effects model for continuous outcomes. For dichotomous outcomes (improved vs not improved following treatment), effects will be expressed as relative risk. The impact of heterogeneity will be calculated using the I2 statistic. The Physiotherapy Evidence Database scale will be used to determine the methodological quality of individual studies and Grading of Recommendations, Assessment, Development and Evaluations used to assess the certainty and quality of evidence for each outcome. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021254720.
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Affiliation(s)
- Stella Sheeba
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cherylea Browne
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Translational Neuroscience Facility, UNSW Sydney, Sydney, New South Wales, Australia
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Fure SCR, Howe EI, Andelic N, Brunborg C, Olsen A, Rike PO, Spjelkavik Ø, Enehaug H, Røe C, Løvstad M. Workplace Factors Associated With Return to Work After Mild-to-Moderate Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E1-E9. [PMID: 35293367 DOI: 10.1097/htr.0000000000000772] [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 Sociodemographic and injury-related predictors for return to work (RTW) after mild-to-moderate traumatic brain injury (TBI) have been extensively explored. However, there is a knowledge gap regarding work-related predictors of RTW. The main aim of this study was to explore work-related predictors of work participation 6 and 12 months after mild-to-moderate TBI. SETTING Data were collected at baseline 8 to 12 weeks after injury, and 3, 6, and 12 months after baseline, at a specialized TBI rehabilitation outpatient clinic at Oslo University Hospital, Oslo, Norway. PARTICIPANTS Eligible patients had suffered a mild-to-moderate TBI 8 to 12 weeks previously, were employed 50% or more at time of injury, were between 18 and 60 years of age, and sick listed 50% or more at time of inclusion due to symptoms of TBI (based on the Rivermead Post-Concussion Symptoms Questionnaire). In total, 116 patients were included in a randomized controlled trial, of whom 113 were included in the 1-year analysis. DESIGN Patients were originally included in a randomized controlled trial. There were no between-group differences in RTW after 1 year. Thus, the participants were evaluated as one cohort in this study. MAIN MEASURES The primary outcome measure was work participation 1 year after study inclusion. Work-related predictors were chosen on the basis of previous research and expert opinion and entered into a multivariable linear regression model. The model controlled for sociodemographic and injury-related factors. RESULTS The best-fitting model explained 25% of variation in work participation at 1 year. Significant predictors were predictability, quantitative demands and rewards (recognition) at the workplace, private or public employment, symptom burden at baseline, and sex. CONCLUSION In this study, several work-related predictors outperformed some of the established sociodemographic and injury-related predictors of RTW after TBI, thus stressing the need for further focus and research on amendable predictors of RTW after mild-to-moderate TBI.
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Affiliation(s)
- Silje Christine Reistad Fure
- Department of Physical Medicine and Rehabilitation (Drs Fure, Howe, Andelic, and Røe), and Oslo Centre for Biostatistics and Epidemiology, Research Support Services (Ms Brunborg), Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society (Drs Fure, Andelic, and Røe), Institute of Clinical Medicine, Faculty of Medicine (Drs Howe and Røe), and Department of Psychology (Dr Løvstad), University of Oslo, Oslo, Norway; Department of Psychology, Norwegian University of Technology and Science, Trondheim, Norway (Dr Olsen); Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway (Dr Olsen); Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway (Drs Rike and Løvstad); Work Research Institute, Oslo Metropolitan University, Oslo, Norway (Mr Spjelkavik and Dr Enehaug)
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Lambert M, Sheldrake E, Deneault AA, Wheeler A, Burke M, Scratch S. Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis. JAMA Netw Open 2022; 5:e2248453. [PMID: 36574246 PMCID: PMC9857135 DOI: 10.1001/jamanetworkopen.2022.48453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Approximately 15% to 30% of individuals with a history of concussion present with persistent postconcussion symptoms (PPCS). Individuals with PPCS are at greater risk of experiencing depressive symptoms. OBJECTIVE To synthesize the association between depressive symptoms and PPCS in children, adolescents, and adults via meta-analysis and to investigate potential moderators of that association. DATA SOURCES Systematic search of Ovid Medline, CINAHL, PsycInfo, and Embase from 1995 to January 2022 was performed. Additionally, references from included studies were hand-searched to ensure relevant articles were captured in the search. STUDY SELECTION Studies that involved participants who experienced PPCS and quantified depressive symptoms were included. The definition of PPCS was limited to physician-diagnosed or self-reported concussion, with symptoms lasting for a minimum of 4 weeks postinjury. Two authors independently screened all articles to determine study eligibility. DATA EXTRACTION AND SYNTHESIS Study characteristics were extracted independently by 2 trained investigators. Study data were meta-analyzed using a random-effects meta-analysis. EXPOSURE PPCS. MAIN OUTCOMES AND MEASURES The the primary outcome was depressive symptoms. RESULTS Data were extracted from 18 studies with a total of 9101 participants. Of the 18 studies, all were cohort studies, and 13 (72%) comprised adult populations. The mean (SD) time since concussion was 21.3 (18.7) weeks. After accounting for potential publication bias, the random-effects meta-analysis found a significant positive association between PPCS and depressive symptoms, (odds ratio, 4.56; 95% CI, 2.82-7.37; P < .001). There were no significant moderators, likely due to the small number of studies included. CONCLUSIONS AND RELEVANCE In this meta-analysis, experiencing PPCS was associated with a higher risk of experiencing depressive symptoms. There are several important clinical and health policy implications of the findings. Most notably, the development of strategies for effective prevention and earlier intervention to optimize mental health recovery following a concussion should be supported.
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Affiliation(s)
- Maude Lambert
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Bloorview Research Institute, Toronto, Ontario, Canada
| | - Elena Sheldrake
- Bloorview Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | | | - Anne Wheeler
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Burke
- Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Shannon Scratch
- Bloorview Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Zeldovich M, Bockhop F, Covic A, Cunitz K, Polinder S, Haagsma JA, von Steinbuechel N. Reference Values for the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) from General Population Samples in the United Kingdom, Italy, and The Netherlands. J Clin Med 2022; 11:jcm11164658. [PMID: 36012895 PMCID: PMC9410233 DOI: 10.3390/jcm11164658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
After traumatic brain injury (TBI), individuals may experience short- or long-term health burdens, often referred to as post-concussion symptoms (PCS). The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is one of the commonly used instruments to assess self-reported PCS. To date, no reference values for RPQ have been provided, although they are crucial for clinical practice when evaluating a patient’s health status relative to a comparable healthy population. Therefore, the aim of this study is to provide reference values for the United Kingdom, the Netherlands, and Italy. A total of 11,759 individuals (50.3% women) from representative general population samples participated in an online survey (4646 individuals from the UK, 3564 from the Netherlands, and 3549 from Italy). The factorial structure of the RPQ was examined using confirmatory factor analysis (CFA), and results from the general population samples were compared with those from respective TBI samples recruited within the international CENTER-TBI study using multigroup CFA. Reference values were stratified by sex, health status, age, and education using percentiles. The three-factorial model outperformed the one-factorial structure. The general population samples were largely comparable to the corresponding TBI samples, except for items such as dizziness, vision, and sensory sensitivity, which can be considered more TBI-specific. Because of the significant differences between the general population samples, we provided reference values for the total score and for the somatic, emotional, and cognitive scales for each country separately. The reference values provided can now be used in clinical practice and research. Future studies should obtain stratified reference values for other countries and languages to improve accuracy in the diagnosis and treatment of symptom burden after TBI.
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Affiliation(s)
- Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
- Correspondence:
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Katrin Cunitz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
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Callahan C, Bloom J, Fonseca J, Ramsey K, DeMaio V, Deichmeister M, Register-Mihalik J. Presence of persistent parent reported emotional and behavioral-related concussion symptoms is associated with lower health-related quality of life in adolescent athletes. J Neurotrauma 2022; 39:1214-1221. [PMID: 35481782 DOI: 10.1089/neu.2021.0398] [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: 11/12/2022] Open
Abstract
Persistent concussion symptoms in adolescents are associated with lower health-related quality of life (HRQOL). However, the association between persistent emotional and behavioral-related concussion symptoms (EBS) and HRQOL is unknown. This study was a prospective cohort of adolescent athletes presenting to a concussion clinic within three days post-concussion and completing a one-month follow up. The independent variable in these analyses was parent reported EBS symptom presence grouped as: 1) no EBS; 2) EBS present at pre-concussion levels; and 3) EBS worse than pre-concussion. EBS included the following concussion symptoms: feeling irritable, depressed, frustrated/impatient, restless, reduced tolerance to stress/emotion, poor concentration, and fear of permanent symptoms. Dependent variables were parent reported psychosocial, physical, and total HRQOL. Separate multivariable linear regression models controlling for age, sex, and concussion history were used to assess the association between EBS and HRQOL. Estimated adjusted mean differences (MD) and 95% confidence intervals (CI) were used to assess associations; MDs with a 95%CI excluding 0.0 were considered statistically significant. Overall, n=245 presented to the study clinic three days post-concussion and completed the one-month follow-up (Mage=14.28±2.09 years, 59.02% male, 90.64% Caucasian, 31.84% with concussion history). At one-month post-concussion, adolescents with pre-concussion EBS levels had significantly lower psychosocial, physical, and total HRQOL than those with no EBS. Additionally, those with EBS worse than pre-concussion had significantly lower psychosocial, physical, and total HRQOL than those with no EBS and EBS at pre-concussion levels. These findings highlight the importance of HRQOL assessments and that targeted interventions may be needed for those with EBS at one-month post-concussion to improve HRQOL.
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Affiliation(s)
- Christine Callahan
- The University of North Carolina at Chapel Hill, 2331, Exercise and Sports Science, 2207 Stallings-Evans Sports Medicine Complex Campus Box 8700, Chapel Hill, North Carolina, United States, 27599;
| | - Josh Bloom
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Janna Fonseca
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Kristen Ramsey
- Carolina Family Practice & Sports Medicine, Cary, North Carolina, United States;
| | - Valerie DeMaio
- The University of North Carolina at Chapel Hill, 2331, Department of Emergency Medicine, Chapel Hill, North Carolina, United States;
| | - Margaret Deichmeister
- University of North Carolina at Chapel Hill School of Medicine, 6797, Chapel Hill, North Carolina, United States;
| | - Johna Register-Mihalik
- University of North Carolina at Chapel Hill, 2331, Department of Exercise and Sport Science, Chapel Hill, North Carolina, United States, 27515;
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