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Cairns K, Beaulieu-Bonneau S, Jomphe V, Lamontagne MÈ, de Guise É, Moore L, Savard J, Sirois MJ, Swaine B, Ouellet MC. Four-Year Trajectories of Symptoms and Quality of Life in Individuals Hospitalized After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2025; 106:358-365. [PMID: 39341441 DOI: 10.1016/j.apmr.2024.09.005] [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: 02/17/2024] [Revised: 08/31/2024] [Accepted: 09/12/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVES To (1) detect distinct trajectories of symptoms and quality of life (QoL) over the first 4 years after mild traumatic brain injury (mTBI); (2) assess the relationship between symptom trajectory membership and QoL trajectory membership; and (3) identify participant characteristics associated with QoL trajectory membership. DESIGN Prospective longitudinal cohort study. Assessments occurred at 4, 8, 12, 24, 36, and 48 months after mTBI. SETTING Recruitment occurred in Level 1 Trauma Centers; follow-up was completed in the community. PARTICIPANTS Participants were 143 adults (aged 18-65y) who sustained an mTBI and were hospitalized (≥24h) at a Level 1 Trauma Center. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Medical Outcomes Study Cognitive Functioning Scale, Quality of Life after Brain Injury questionnaire, presence/absence of headaches or dizziness. RESULTS Group-based trajectory modeling revealed relatively stable symptom and QoL trajectories over time. Considerable percentages of participants were classified in trajectories of clinically significant symptoms throughout the full follow-up period: 62% for subjective cognitive issues, 54% for fatigue, 44% for anxiety, 43% for insomnia, 27% for depression, 23% for headaches, and 17% for dizziness. Sixty-six percent of participants belonged to trajectories of persistently poor QoL. For all symptoms, trajectories of greater severity were associated with trajectories of poorer QoL. None of the sociodemographic or injury-related variables examined were associated with QoL trajectory membership. CONCLUSIONS A substantial proportion of individuals hospitalized after mTBI experiences clinically significant persistent symptoms ≤4 years after injury, and those with more severe symptoms have poorer QoL. Further research is required to better understand the factors leading to symptom persistence and poor QoL.
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Affiliation(s)
- Kathleen Cairns
- School of Psychology, Université Laval, Québec, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- School of Psychology, Université Laval, Québec, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, QC, Canada
| | - Valérie Jomphe
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, QC, Canada; CERVO Research Centre, Québec, QC, Canada
| | - Marie-Ève Lamontagne
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, QC, Canada; School of Rehabilitation Sciences, Université Laval, Québec, QC, Canada
| | - Élaine de Guise
- Department of Psychology, Université de Montréal, Montréal, QC, Canada; Research Institute of the McGill University Health Centre (RI‑MUHC), Montréal, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec, QC, Canada; Research Centre of the Centre hospitalier universitaire (CHU) de Québec-Université Laval, Québec, QC, Canada
| | - Josée Savard
- School of Psychology, Université Laval, Québec, QC, Canada; Research Centre of the Centre hospitalier universitaire (CHU) de Québec-Université Laval, Québec, QC, Canada
| | - Marie-Josée Sirois
- School of Rehabilitation Sciences, Université Laval, Québec, QC, Canada; Research Centre of the Centre hospitalier universitaire (CHU) de Québec-Université Laval, Québec, QC, Canada; Institute on Aging and Social Participation in Older Adults, Québec, QC, Canada; VITAM Centre for Research in Sustainable Health, Québec, QC, Canada
| | - Bonnie Swaine
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC, Canada; School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
| | - Marie-Christine Ouellet
- School of Psychology, Université Laval, Québec, QC, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, QC, Canada.
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Smejka T, Verberne D, Schepers J, Wolfs C, Schepers V, Ponds R, Van Heugten C. Trajectories of fatigue and related outcomes following mild acquired brain injury: a multivariate latent class growth analysis. J Rehabil Med 2024; 56:jrm32394. [PMID: 38506428 PMCID: PMC10985494 DOI: 10.2340/jrm.v56.32394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Fatigue is a common symptom following acquired brain injury although the severity and course differs for many individuals. This longitudinal study aimed to identify latent trajectory classes of fatigue and associated outcomes following mild brain injury. METHODS 204 adults with mild traumatic brain injury (159; 78%) or minor stroke (45; 22%) were assessed 4 times over 1 year. Subjective measures of fatigue, anxiety, depression, cognitive complaints and societal participation were collected. Multivariate Latent Class Growth Analysis identified classes of participants with similar longitudinal patterns. Demographic and injury characteristics were used to predict class membership. RESULTS Analysis revealed four classes. Class 1 (53%) had mild, decreasing fatigue with no other problems. Class 2 (29%) experienced high persistent fatigue, moderate cognitive complaints and societal participation problems. Class 3 (11%) had high persistent fatigue with anxiety, depression, cognitive complaints and participation problems. Class 4 (7%) experienced decreasing fatigue with anxiety and depression but no cognitive or participation problems. Women and older individuals were more likely to be in class 2. CONCLUSION Half the participants had a favourable outcome while the remaining classes were characterised by persistent fatigue with cognitive complaints (class 2), decreasing fatigue with mood problems (class 4) or fatigue with both cognitive and mood problems (class 3). Fatigue treatment should target combinations of problems in such individual trajectories after mild brain injury.
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Affiliation(s)
- Tom Smejka
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Centre, the Netherlands
| | - Daan Verberne
- Department of Neurorehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jan Schepers
- Department of Methodology and Statistics, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Claire Wolfs
- Limburg Brain Injury Centre, the Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Vera Schepers
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rudolf Ponds
- Limburg Brain Injury Centre, the Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Center, location VU, Amsterdam, the Netherlands
| | - Caroline Van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Centre, the Netherlands.
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Mäki K, Nybo T, Hietanen M, Huovinen A, Marinkovic I, Isokuortti H, Melkas S. Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. J Rehabil Med 2024; 56:jrm13438. [PMID: 38436399 PMCID: PMC10926572 DOI: 10.2340/jrm.v56.13438] [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: 06/01/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE To examine the associations between recent stressful life events and self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. DESIGN Observational cohort study. PARTICIPANTS Patients (aged 18-68 years) with mild traumatic brain injury (n = 99) or lower extremity orthopaedic injury (n = 34). METHODS Data on stressful life events and self-reported symptoms were collected 3 months post-injury. Stressful life events in the last 12 months were assessed as part of a structured interview using a checklist of 11 common life events, self-reported fatigue with Barrow Neurological Institute Fatigue Scale, and depressive symptoms with Beck Depression Inventory - Fast Screen. RESULTS Median number of stressful life events was 1 (range 0-7) in the mild traumatic brain injury group and 1.5 (range 0-6) in the orthopaedic injury group. The groups did not differ significantly in terms of fatigue or depressive symptoms. In the mild traumatic brain injury group, the total number of recent stressful life events correlated significantly with self-reported fatigue (rs = 0.270, p = 0.007) and depressive symptoms (rs = 0.271, p = 0.007). CONCLUSION Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. Clinicians should consider stressful life events when managing patients who experience these symptoms, as this may help identifying potential targets for intervention.
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Affiliation(s)
- Kaisa Mäki
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Taina Nybo
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Antti Huovinen
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Ivan Marinkovic
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Harri Isokuortti
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Khosdelazad S, Jorna LS, Rakers SE, Koffijberg R, Groen RJM, Spikman JM, Buunk AM. Long-term Course of Cognitive Functioning After Aneurysmal and Angiographically Negative Subarachnoid Hemorrhage. Neurosurgery 2023; 93:1235-1243. [PMID: 37272715 DOI: 10.1227/neu.0000000000002559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/17/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is a common consequence of subarachnoid hemorrhage (SAH), negatively affecting everyday functioning. This study is the first to investigate the long-term course of cognitive functioning after SAH and its associations with long-term well-being (ie, anxiety and depression), cognitive complaints, and return to work, separately for patients with aneurysmal SAH (aSAH) and angiographically negative SAH (anSAH) in a longitudinal design. METHODS Cognitive functioning was measured at 2 time points (T1: 3-6 months post-SAH; T2: 2-4 years post-SAH) in 58 patients with aSAH and 22 patients with anSAH with neuropsychological tests for (working) memory, psychomotor speed, and attention/executive functioning. Questionnaires were used to measure cognitive complaints and well-being at T1 and T2 and return to work at T2. RESULTS At T2, patients with aSAH only showed improvements in memory and on an executive functioning and psychomotor speed subtest, whereas in contrast, patients with anSAH had significantly poorer scores on tests for psychomotor speed. A significant amount of patients with aSAH and anSAH still reported cognitive complaints, anxiety, and depression in the chronic stage. Cognitive functioning was not significantly associated with cognitive complaints in both SAH groups. On the other hand, cognitive complaints were related to well-being at the long-term in both SAH groups. More cognitive complaints were also associated with more difficulties in return to work in patients with aSAH. CONCLUSION Patients with aSAH and anSAH have cognitive impairments at the subacute stage post-SAH, and these impairments persist into the chronic stage. Moreover, both SAH groups still reported decreased well-being in the chronic stage post-SAH, related to cognitive complaints but not to cognitive impairment. For clinical practice, an early neuropsychological assessment will already provide relevant information to estimate long-term cognitive impairment, but in addition, it is important to pay attention to psychological distress at the long-term.
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Affiliation(s)
- Sara Khosdelazad
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Lieke S Jorna
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Sandra E Rakers
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Ralf Koffijberg
- Department of Medical Psychology, Medical Center Leeuwarden, Leeuwarden , The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Jacoba M Spikman
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
| | - Anne M Buunk
- Department of Neurology, Unit Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen , The Netherlands
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Løke D, Andelic N, Helseth E, Vassend O, Andersson S, Ponsford JL, Tverdal C, Brunborg C, Løvstad M. Stability and Change in Biopsychosocial Factors Associated With Fatigue 6 and 12 Months After Traumatic Brain Injury: An Exploratory Multilevel Study. J Head Trauma Rehabil 2023; 38:E244-E253. [PMID: 36602267 DOI: 10.1097/htr.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To explore factors associated with stability and change in fatigue from 6 to 12 months following traumatic brain injury (TBI). SETTING Combined in- and outpatient acute care and postacute rehabilitation settings. PARTICIPANTS A total of 103 patients with confirmed intracranial injury were assessed 6 and/or 12 months following TBI. DESIGN A prospective observational study with repeated measures at 2 time points, analyzed with a hybrid mixed-effects model. MAIN MEASURES Primary outcomes were the fatigue factor derived from items from several fatigue patient-reported outcome measures (PROMs; Fatigue Severity Scale, Chalder Fatigue Scale, Giessen Subjective Complaints List-fatigue subscale, and Rivermead Post-Concussion Symptoms Questionnaire-fatigue item) Secondary outcomes were PROMs relating to pain, somatic and psychological distress, insomnia, sleepiness, personality traits, optimism, resilience, behavioral activation and inhibition, and loneliness, as well as neuropsychological measures. Demographic variables and injury severity characteristics were included as covariates. RESULTS In multilevel regression, female sex, years of education, and 3 factors related to injury severity, somatic vulnerability, and psychosocial robustness were all significantly associated with variation in fatigue between subjects, and explained 61% of the variance in fatigue that was due to stable between-subject differences. Fatigue levels declined significantly over time. Changes in pain severity, somatic symptom burden, psychological distress, and behavioral inhibition were positively associated with changes in fatigue, explaining 22% of the variance in fatigue within subjects. CONCLUSIONS The study demonstrated that several previously implicated factors show robust effects in distinguishing individuals with TBI on levels of fatigue, but only a few show additional within-subject associations across time. Pain severity, somatic symptom burden, psychological distress, and behavioral inhibition correlated with fatigue across time, implicating these factors as crucial targets for rehabilitation of patients with TBI who suffer from persistent fatigue.
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Affiliation(s)
- Daniel Løke
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway (Mr Løke and Dr Løvstad); Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway (Mr Løke and Drs Vassend, Andersson, and Løvstad); Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, and Institute of Health and Society, Center for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway (Dr Andelic); Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, Oslo, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway (Drs Helseth and Tverdal); Psychosomatic and CL Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway (Dr Andersson); Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia (Dr Ponsford); and Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway (Ms Brunborg)
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