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Chaurasiya A, Ranjan JK, Pandey N, Asthana HS. Hindi Adaptation and Psychometric Validation of Rivermead Post-Concussion Symptoms Questionnaire on Patients with Traumatic Brain Injury. Arch Clin Neuropsychol 2025:acaf039. [PMID: 40411127 DOI: 10.1093/arclin/acaf039] [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: 11/21/2024] [Revised: 04/10/2025] [Accepted: 04/25/2025] [Indexed: 05/26/2025] Open
Abstract
BACKGROUND The Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ) is a widely used tool for assessing the pattern and severity of post-head injury symptoms, and has been translated and validated in various languages. However, a Hindi version of this questionnaire is not yet available. Therefore, the present study aimed to adapt the RPCSQ into Hindi and examine its factorial structure along with its psychometric properties. METHOD The original English version of RPCSQ was adapted into Hindi by using the cross-cultural adaptation process. The final adapted Hindi version of RPCSQ (RPCSQ-H) was administered on traumatic brain injury (TBI) participants to assess its reliability, factor structure, discriminant validity, construct validity, and temporal stability of scale. RESULT The psychometric evaluation of the scale yielded an acceptable Cronbach's α coefficient of 0.768. The temporal stability of RPCSQ-H was significant at the acute stage, with test-retest coefficients of 0.713 and 0.615 after 7 days and 14 days, respectively. Additionally, the results supported a six-factor model of the RPCSQ-H with good convergent validity, factor reliability, and discriminant validity. CONCLUSION The RPCSQ-H demonstrates strong reliability and validity along with good psychometric to assess post-head injury symptoms in Hindi-speaking patients with TBI.
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Affiliation(s)
- Akanksha Chaurasiya
- Department of Psychology, Vasanta College for Women, Banaras Hindu University, Rajghat, Varanasi, Uttar Pradesh 221001, India
| | - Jay Kumar Ranjan
- Department of Psychology, Faculty of Social Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Nityanand Pandey
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Hari Shanker Asthana
- Department of Psychology, Faculty of Social Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
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Joseph CR. Assessing Mild Traumatic Brain Injury-Associated Blood-Brain Barrier (BBB) Damage and Restoration Using Late-Phase Perfusion Analysis by 3D ASL MRI: Implications for Predicting Progressive Brain Injury in a Focused Review. Int J Mol Sci 2024; 25:11522. [PMID: 39519073 PMCID: PMC11547134 DOI: 10.3390/ijms252111522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 10/09/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Abstract
Mild traumatic brain injury (mTBI) is a common occurrence around the world, associated with a variety of blunt force and torsion injuries affecting all age groups. Most never reach medical attention, and the identification of acute injury and later clearance to return to usual activities is relegated to clinical evaluation-particularly in sports injuries. Advanced structural imaging is rarely performed due to the usual absence of associated acute anatomic/hemorrhagic changes. This review targets physiologic imaging techniques available to identify subtle blood-brain barrier dysfunction and white matter tract shear injury and their association with chronic traumatic encephalopathy. These techniques provide needed objective measures to assure recovery from injury in those patients with persistent cognitive/emotional symptoms and in the face of repetitive mTBI.
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Affiliation(s)
- Charles R Joseph
- Department of Neurology and Internal Medicine, College of Osteopathic Medicine, Liberty University, Lynchburg, VA 24502, USA
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Theadom A, Chua J, Sintmaartensdyk A, Kara S, Barnes R, Macharg R, Leckey E, Mirza A. A supported primary health pathway for mild traumatic brain injury quality improvement report. J Prim Health Care 2024; 16:308-314. [PMID: 39321075 DOI: 10.1071/hc23131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/08/2024] [Indexed: 09/27/2024] Open
Abstract
Introduction Best-practice guidelines recommend that patients are followed-up to check if they have recovered following a mild traumatic brain injury (mTBI) and to refer to concussion services, if needed. However, in New Zealand, rates of follow-up are low and access to concussion services can be delayed. Aim We aimed to improve rates of follow-up and access to concussion services for mTBI patients aged ≥8 years by the implementation of a supported health pathway and test its success. Methods The pathway included a decision support tool, funded follow-up appointments, clinician training and a patient education resource. Sociodemographics, injury details and proportions of patients receiving a follow-up by type and time were extracted from the Accident Compensation Corporation (ACC) database between 18 May 22 and 30 June 23 and compared to national ACC data prior to implementation. Results Data were extracted for 220 patients, with a mean age of 31.5 years, 51.4% female and 21.4% Māori and Pacific. There was an increase in the proportion of patients receiving a follow-up from 36% pre-implementation to 56.8% post-implementation. Sixty-three patients (28.6%) accessed a concussion service post-implementation compared to 10% pre-implementation. Time to concussion service reduced from an average of 55 (s.d. = 65.4) to 37 days (29.5). Discussion Risk factor criteria within the decision support tool need to be weighted to improve specificity of referrals. Timing from injury to medical review in primary care needs to be considered. This quality improvement project provides preliminary evidence for implementation of a supported health care pathway for mTBI.
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Affiliation(s)
- A Theadom
- School of Clinical Sciences, Faculty of Health and Environmental Science, TBI Network, Auckland University of Technology, AR238, AUT North Campus, Auckland, New Zealand
| | - J Chua
- School of Clinical Sciences, Faculty of Health and Environmental Science, TBI Network, Auckland University of Technology, AR238, AUT North Campus, Auckland, New Zealand
| | | | - S Kara
- Axis Sports Medicine Specialists, Auckland, New Zealand; and ProCare, Auckland, New Zealand
| | - R Barnes
- Pegasus Health, Canterbury, New Zealand
| | - R Macharg
- WellSouth Primary Health Network, Dunedin, New Zealand
| | - E Leckey
- Pegasus Health, Canterbury, New Zealand
| | - A Mirza
- Manage My Health, Auckland, New Zealand
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Joseph CR, Lim JK, Grohol BN, Zivcevska M, Lencke J, Rich ED, Arrasmith CJ, Dorman IS, Clark BW, Love K, Ferry B, Rolfs ME. Identifying delay in glymphatic clearance of labeled protons post-acute head trauma utilizing 3D ASL MRI (arterial spin labeling): a pilot study. Sci Rep 2024; 14:6188. [PMID: 38485759 PMCID: PMC10940642 DOI: 10.1038/s41598-024-56236-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
This study correlated mild traumatic brain injury (mTBI) cognitive changes with ASL-MRI glymphatic clearance rates (GCRs) and recovery with GCR improvement. mTBI disrupts the blood brain barrier (BBB), reducing capillary mean transit time and GCRs. mTBI is clinically diagnosed utilizing history/examination findings with no physiologic biomarkers. 3D TGSE (turbo-gradient spin-echo) pulsed arterial spin-labeling 3T MRI with 7 long inversion times (TIs) assessed the signal clearance of labeled protons 2800-4000 ms postlabeling in bifrontal, bitemporal, and biparietal regions within 7 days of mTBI and once clinically cleared to resume activities. The Sport Concussion Assessment Tool Version 5 (SKAT5) and Brief Oculomotor/Vestibular Assessment evaluated injured athletes' cognitive function prior to MRIs. The pilot study demonstrated significant GCRs improvement (95% CI - 0.06 to - 0.03 acute phase; to CI-recovery CI 0.0772 to - 0.0497; P < 0.001 in frontal lobes; and parietal lobes (95% CI - 0.0584 to - 0.0251 acute; CI - 0.0727 to - 0.0392 recovery; P = 0.024) in 9 mTBI athletes (8 female, 1 male). Six age/activity-matched controls (4 females, 2 males) were also compared. mTBI disrupts the BBB, reducing GCR measured using the 3D ASL MRI technique. ASL MRI is a potential noninvasive biomarker of mTBI and subsequent recovery.
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Affiliation(s)
- Charles R Joseph
- Liberty University College of Osteopathic Medicine, Lynchburg, USA.
| | - Jubin Kang Lim
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Bryce N Grohol
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Marija Zivcevska
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Joshua Lencke
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Ethan Dean Rich
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | | | | | | | - Kim Love
- K. R. Love Quantitative Consulting and Collaboration, Athens, USA
| | - Ben Ferry
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Mark E Rolfs
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
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Kumar A, Kara S, van der Werf B, Fulcher M. Can the Buffalo Concussion Treadmill Test Be Used as a Prognostic Indicator for Patients With Sport-Related Mild Traumatic Brain Injury? Clin J Sport Med 2024; 34:91-96. [PMID: 37389465 DOI: 10.1097/jsm.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To establish whether time to exercise cessation using the Buffalo Concussion Treadmill Test (BCTT) protocol can be used as a prognostic indicator of recovery after sport-related mild traumatic brain injury (SR-mTBI). DESIGN Retrospective analysis of prospectively collected data. SETTING Specialist Concussion Clinic. PARTICIPANTS Three hundred and twenty one patients presenting between 2017 and 2019 who underwent BCTT for SR-mTBI. INTERVENTIONS Participants who remained symptomatic at a 2-week follow-up appointment after SR-mTBI underwent BCTT to develop a progressive subsymptom threshold exercise program with fortnightly follow-up until clinical recovery. MAIN OUTCOME MEASURES Clinical recovery was the primary outcome measure. RESULTS A total of 321 participants were eligible to participate in this study (mean age 22.94% and 46% female). The BCTT test duration was divided into 4-minute intervals and those who completed full 20 minutes. There was higher probability of clinical recovery in those who finished the entire 20-minute BCTT protocol compared with those who managed 17-<20 minutes (Hazard Ratio, HR 0.57), 13 to 16 minutes (HR 0.53), 9 to 12 minutes (HR 0.6), 5 to 8 minutes (HR 0.4), and 1 to 4 minutes (HR 0.7), respectively. Those seen earlier after injury ( P = 0.009), male patients ( P = 0.116), younger patients ( P = 0.0003), and those with physiological or cervical dominant ( P = 0.416) symptom clusters were more likely to achieve clinical recovery. Fifty percent of those who completed the full BCTT protocol achieved clinical recovery at day 19 post-injury. CONCLUSIONS The group completing full 20 minutes of BCTT achieved clinical recovery more quickly than those who did not complete full BCTT.
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Affiliation(s)
- Amitesh Kumar
- Axis Sports Medicine Specialists, Auckland, New Zealand
| | - Stephen Kara
- Axis Sports Medicine Specialists, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; and
| | - Mark Fulcher
- Axis Sports Medicine Specialists, Auckland, New Zealand
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Thielen H, Huenges Wajer IMC, Tuts N, Welkenhuyzen L, Lafosse C, Gillebert CR. The Multi-Modal Evaluation of Sensory Sensitivity (MESSY): Assessing a commonly missed symptom of acquired brain injury. Clin Neuropsychol 2024; 38:377-411. [PMID: 37291083 DOI: 10.1080/13854046.2023.2219024] [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: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
Objective: Sensory hypersensitivity is common after acquired brain injury. Since appropriate diagnostic tools are lacking, these complaints are overlooked by clinicians and available literature is limited to light and noise hypersensitivity after concussion. This study aimed to investigate the prevalence of sensory hypersensitivity in other modalities and after other types of brain injury. Method: We developed the Multi-Modal Evaluation of Sensory Sensitivity (MESSY), a patient-friendly questionnaire that assesses sensory sensitivity across multiple sensory modalities. 818 neurotypical adults (mean age = 49; 244 male) and 341 chronic acquired brain injury patients (including stroke, traumatic brain injury, and brain tumour patients) (mean age = 56; 126 male) completed the MESSY online. Results: The MESSY had a high validity and reliability in neurotypical adults. Post-injury sensory hypersensitivity (examined using open-ended questions) was reported by 76% of the stroke patients, 89% of the traumatic brain injury patients, and 82% of the brain tumour patients. These complaints occurred across all modalities with multisensory, visual, and auditory hypersensitivity being the most prevalent. Patients with post-injury sensory hypersensitivity reported a higher sensory sensitivity severity on the multiple-choice items of the MESSY as compared to neurotypical adults and acquired brain injury patients without post-injury sensory hypersensitivity (across all sensory modalities) (effect sizes (partial eta squared) ranged from .06 to .22). Conclusions: These results show that sensory hypersensitivity is prevalent after different types of acquired brain injury as well as across several sensory modalities. The MESSY can improve recognition of these symptoms and facilitate further research.
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Affiliation(s)
- Hella Thielen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Nora Tuts
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lies Welkenhuyzen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department Psychology, Hospital East-Limbourgh, Genk, Belgium
- TRACE, Centre for Translational Psychological Research (TRACE), Genk, Belgium
| | - Cristophe Lafosse
- Paramedical and Scientific Director, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Celine R Gillebert
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE, Centre for Translational Psychological Research (TRACE), Genk, Belgium
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Bastos Gottgtroy R, Hume PA, Theadom A. Describing the patient journey through healthcare pathways following mild traumatic brain injury in New Zealand using novel Graph analysis. Brain Inj 2023; 37:1294-1304. [PMID: 37403290 DOI: 10.1080/02699052.2023.2230878] [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: 12/15/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
AIM To identify treatment provider sequences and healthcare pathway characteristics and outcomes for people with mild traumatic brain injury (mTBI) in New Zealand. METHODS Total mTBI costs and key pathway characteristics were analysed using national healthcare data (patient's injury and services provided). Graph analysis produced sequences of treatment provider types for claims with more than one appointment and healthcare outcomes (costs and time to exit pathway) were compared. Key pathway characteristics' effect on healthcare outcomes were evaluated. RESULTS In two years, 55,494 accepted mTBI claims cost ACC USD$93,647,261 over four years. For claims with more than one appointment (36%), healthcare pathways had a median 49 days (IQR, 12-185). The 89 treatment provider types resulted in 3,396 different provider sequences of which 25% were General Practitioners only (GP), 13% Emergency Department to GP (ED-GP) and 5% GP to Concussion Service (GP-CS). Pathways with shorter time to exit and lower costs had correct mTBI diagnosis at initial appointment. Income maintenance comprised 52% of costs but only occurred for 20% claims. CONCLUSIONS Improving healthcare pathways for people with mTBI by investing in training of providers to enable correct mTBI diagnosis could yield longer term cost savings. Interventions to reduce income maintenance costs are recommended.
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Affiliation(s)
- Renata Bastos Gottgtroy
- Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
- Traumatic Brain Injury Network, Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
| | - Patria A Hume
- Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
- Traumatic Brain Injury Network, Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network, Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
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Marzolla MC, Wijenberg M, Stapert S, Hurks P, Schepers J, van Heugten C. Hypersensitivity to Noise and Light Over 1 Year After Mild Traumatic Brain Injury: A Longitudinal Study on Self-Reported Hypersensitivity and Its Influence on Long-Term Anxiety, Depression, and Quality of Life. J Head Trauma Rehabil 2023; 38:259-267. [PMID: 35997762 DOI: 10.1097/htr.0000000000000813] [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: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate (1) the prevalence of self-reported sensory hypersensitivity (noise [NS] and light [LS]) over 1 year after mild traumatic brain injury (mTBI) in adults and (2) the impact of NS and LS measured 2 weeks after injury on long-term outcomes 12 months postinjury, while controlling for postconcussion symptoms. SETTING Participants were recruited from 6 hospitals in the south of the Netherlands and were tested 4 times (2 weeks, 3 months, 6 months, and 12 months postinjury), using self-report questionnaires. PARTICIPANTS In total, 186 mTBI participants (diagnosed using WHO [World Health Organization]/EFNS [European Federation of Neurological Societies] criteria at the neurology/emergency department) and 181 participants with a minor orthopedic injury in their extremities (control group). DESIGN An observational, longitudinal, multicenter cohort study. MAIN MEASURES NS and LS items (Rivermead Post-Concussion Symptoms Questionnaire) were used as main outcome variables to determine sensory hypersensitivity symptoms. Additional outcomes included anxiety, depression, health-related quality of life (HRQoL), and life satisfaction. RESULTS There was an elevated prevalence of NS and LS between 2 weeks and 3 months after injury in the mTBI group compared with controls. Approximately 3% of mTBI patients had persistent hypersensitivity symptoms during the whole course of the study. At 12 months postinjury, the mTBI and control groups did not differ in the prevalence of persistent hypersensitivity symptoms. There was no evidence of a predictive value of hypersensitivity within 2 weeks postinjury on anxiety, depression, HRQoL, or life satisfaction, 12 months later after controlling for postconcussion symptoms. CONCLUSIONS These results not only confirm the presence of hypersensitivity symptoms after mTBI in the subacute stage but also provide assurance about the small size of the group that experiences persistent symptoms. Furthermore, there was no evidence that early NS and LS are uniquely associated with long-term emotional and quality-of-life outcomes, over and above general levels of postconcussion symptoms.
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Affiliation(s)
- Marilien C Marzolla
- Department of Neuropsychology and Psychopharmacology (Ms Marzolla and Drs Stapert, Hurks, and van Heugten), Section of Teaching and Innovation of Learning (Dr Wijenberg), and Department of Methodology and Statistics (Dr Schepers), Faculty of Psychology and Neuroscience, and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (Dr van Heugten), Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands (Ms Marzolla and Dr van Heugten); Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands (Dr Wijenberg); and Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (Dr Stapert)
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Déry J, de Guise É, Lamontagne ME. Identifying prioritization criteria for patients with mtbi waiting for multidisciplinary rehabilitation services: A Delphi study. Brain Inj 2023; 37:563-571. [PMID: 37114975 DOI: 10.1080/02699052.2023.2205662] [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: 04/29/2023]
Abstract
INTRODUCTION Rehabilitation service providers must take into account prognostic factors when making clinical decisions, which includes using these factors as prioritization criteria. The goal of this study was to establish consensus on patient prioritization criteria based on prognostic factors related to persistent symptoms for patients with mild traumatic brain injury (mTBI) waiting for outpatient specialized rehabilitation services. MATERIALS AND METHODS We conducted a Delphi survey involving clinicians, researchers, decision makers, and patients. Before the survey, we presented the results of an overview of systematic reviews summarizing the evidence on prognostic factors related to post-concussion symptoms. RESULTS After two rounds, the 17 experts reached consensus on the inclusion of 12 prioritization criteria: acute stress disorder, anxiety and depression, baseline mental and physical health, functional impacts and difficulties in performing daily habits after the trauma, motivation to receive services, multiple concussions, prior neurological problems, PTSD, quality of sleep, return to work failures, somatic complaints, suicidal ideation. CONCLUSION Healthcare stakeholders must consider a wide range of factors to guide clinical decision-making, including about access to care and patient prioritization. This study shows that the Delphi technique can be used to reach consensus on such decisions regarding patients with mTBI who are waiting for outpatient specialized rehabilitation services.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale,Québec, Canada
| | - Élaine de Guise
- Department of Psychology, Université de Montréal, Montréal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale,Québec, Canada
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Thielen H, Tuts N, Welkenhuyzen L, Huenges Wajer IMC, Lafosse C, Gillebert CR. Sensory sensitivity after acquired brain injury: A systematic review. J Neuropsychol 2023; 17:1-31. [PMID: 35773750 DOI: 10.1111/jnp.12284] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Patients with acquired brain injury frequently report experiencing sensory stimuli as abnormally under- (sensory hyposensitivity) or overwhelming (sensory hypersensitivity). Although they can negatively impact daily functioning, these symptoms are poorly understood. To provide an overview of the current evidence on atypical sensory sensitivity after acquired brain injury, we conducted a systematic literature review. The primary aim of the review was to investigate the behavioural and neural mechanisms that are associated with self-reported sensory sensitivity. Studies were included when they studied sensory sensitivity in acquired brain injury populations, and excluded when they were not written in English, consisted of non-empirical research, did not study human subjects, studied pain, related sensory sensitivity to peripheral injury or studied patients with a neurodegenerative disorder, meningitis, encephalitis or a brain tumour. The Web of Science, PubMed and Scopus databases were searched for appropriate studies. A qualitative synthesis of the results of the 81 studies that were included suggests that abnormal sensory thresholds and a reduced information processing speed are candidate behavioural mechanisms of atypical subjective sensory sensitivity after acquired brain injury. Furthermore, there was evidence for an association between subjective sensory sensitivity and structural grey or white matter abnormalities, and to functional abnormalities in sensory cortices. However, further research is needed to explore the causation of atypical sensory sensitivity. In addition, there is a need for the development of adequate diagnostic tools. This can significantly advance the quantity and quality of research on the prevalence, aetiology, prognosis and treatment of these symptoms.
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Affiliation(s)
- Hella Thielen
- Department Brain and Cognition, Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Nora Tuts
- Department Brain and Cognition, Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Lies Welkenhuyzen
- Department Brain and Cognition, Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium.,Department Psychology, Hospital East-Limbourgh, Genk, Belgium.,TRACE, Centre for Translational Psychological Research, KU Leuven - Hospital East-Limbourgh, Genk, Belgium
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Céline R Gillebert
- Department Brain and Cognition, Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium.,TRACE, Centre for Translational Psychological Research, KU Leuven - Hospital East-Limbourgh, Genk, Belgium
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Shaikh N, Tokhi Y, Hardaker N, Henshall K, Forch K, Fernando K, King D, Fulcher M, Jewell S, Bastos-Gottgtroy R, Hume P, Theadom A. Brain Injury Screening Tool (BIST): test-retest reliability in a community adult sample. BMJ Open 2022; 12:e057701. [PMID: 35922098 PMCID: PMC9352980 DOI: 10.1136/bmjopen-2021-057701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the test-retest reliability of the Brain Injury Screening Tool (BIST), which was designed to support the initial assessment of mild traumatic brain injury (mTBI) across a variety of contexts, including primary and secondary care. DESIGN Test-retest design over a 2-week period. SETTING Community based. PARTICIPANTS Sixty-eight adults (aged 18-58 years) who had not experienced an mTBI within the last 5 years and completed the BIST on two different occasions. MEASURES Participants were invited to complete the 15-item BIST symptom scale and the Depression, Anxiety and Stress Scale (DASS-21) online at two time-points (baseline and 2 weeks later). To account for large variations in mood affecting symptom reporting, change scores on the subscales of the DASS-21 were calculated, and outliers were removed from the analysis. RESULTS The BIST total symptom score and subscale scores (physical-emotional, cognitive and vestibular) demonstrated moderate to good test-retest reliability with intraclass correlation coefficients ranging between 0.51 and 0.83. There were no meaningful differences between symptom reporting on the total scale or subscales of the BIST between time1 and time2 at the p<0.05 level when calculated using related samples Wilcoxon signed-rank tests. CONCLUSION The BIST showed evidence of good stability of symptom reporting within a non-injured, community adult sample. This increases confidence that changes observed in symptom reporting in an injured sample are related to actual symptom change rather than measurement error and supports the use of the symptom scale to monitor recovery over time. Further research is needed to explore reliability of the BIST within those aged <16 years.
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Affiliation(s)
- Nusratnaaz Shaikh
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Yelda Tokhi
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Hardaker
- Accident Compensation Corporation, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Kevin Henshall
- Trauma Service, Counties Manukau Health, Auckland, New Zealand
| | - Katherine Forch
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Axis Sports Medicine, Auckland, New Zealand
| | | | - Doug King
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK
| | | | - Sam Jewell
- Wellington Sports Medicine, Wellington, New Zealand
| | - Renata Bastos-Gottgtroy
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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12
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Nanwa N, Wong V, Thompson AMS. Impact of Timing of Mental Health Interventions for Mild Traumatic Brain Injury Patients: A 10-year Matched Cohort Study of Workers' Compensation Claims. J Occup Environ Med 2022; 64:458-464. [PMID: 35761423 DOI: 10.1097/jom.0000000000002512] [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: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of timing of mental health interventions in workers' compensation claims for mild traumatic brain injury (MTBI). METHODS A 10-year matched retrospective cohort study of MTBI claims. Cases who started treatment within 3 months of the date of injury were hard matched to cases who started treatment more than 3 months after the date of injury. Outcomes were incremental cost difference and loss of earnings benefit duration 1 year after first intervention. RESULTS Seventeen percent (17%) of patients received mental health interventions. The early mental health intervention group had lower mean costs (incremental difference$1580 [95% CI: $5718 to $2085]) and shorter durations of disability (off loss of earnings) (59.2% versus 46.6%, NS). Sensitivity and stratified analyses demonstrated the same trend. CONCLUSIONS Early mental health interventions for MTBI patients may lead to reduced health care costs and shorter durations of disability.
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Affiliation(s)
- Natasha Nanwa
- From the Workplace Safety and Insurance Board, Ontario, Canada (Dr Nanwa, Dr Wong, Dr Thompson), Faculty of Medicine, University of Toronto, Ontario Canada (Dr Thompson), Dalla Lana School of Public Health, University of Toronto, Ontario, Canada (Dr Thompson)
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13
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Rauchman SH, Albert J, Pinkhasov A, Reiss AB. Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System. Neurol Int 2022; 14:453-470. [PMID: 35736619 PMCID: PMC9227114 DOI: 10.3390/neurolint14020038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.
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Affiliation(s)
- Steven H. Rauchman
- The Fresno Institute of Neuroscience, Fresno, CA 93730, USA
- Correspondence:
| | - Jacqueline Albert
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Allison B. Reiss
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
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14
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Martini DN, Wilhelm J, Lee L, Brumbach BH, Chesnutt J, Skorseth P, King LA. Exploring clinical and patient characteristics for rehabilitation referrals following a concussion: a retrospective analysis. Arch Rehabil Res Clin Transl 2022; 4:100183. [PMID: 35756984 PMCID: PMC9214303 DOI: 10.1016/j.arrct.2022.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To explore patterns of postconcussion care at a level 1 trauma center. Design Retrospective cohort study. Setting U.S. level 1 trauma center and local satellite units. Participants Patients of any age with a concussion diagnosis that reported to level 1 trauma center and local satellite units between 2016 and 2018 (N=2417). Intervention Not applicable. Main Outcome Measures Age, sex, point of entry, rehabilitation referrals, and pre-existing comorbidity diagnosis. Results Patient age (mean [SD]) significantly differed among points of entry, from youngest to oldest: 26.0 (14.0) years in sports medicine, 29.3 (23.0) years in the emergency department, 34.6 (23.6) years at primary care providers, and 46.0 (19.7) years at specialty care departments. Sex also significantly differed among points of entry; emergency departments reported more men (55.6%), whereas the other points of entry reported more women (59.3%-65.6%). Patients were more likely to receive a referral from sports medicine (odds ratio [OR]unadjusted=75.05, P<.001), primary care providers (ORunadjusted=7.98, P<.001), and specialty care departments (ORunadjusted=7.62, P<.001) than from the emergency department. Women were more likely to receive a referral (ORunadjusted=1.92, P<.0001), regardless of point of entry. Lastly, patients with a preexisting comorbidity were more likely (ORadjusted=2.12, P<.001) to get a rehabilitation referral than patients without a comorbidity. Conclusions Point of entry, age, sex, and preexisting comorbidities are associated with postconcussion care rehabilitation referral patterns. Improving concussion education dissemination across all entry points of a level 1 trauma center may standardize the postconcussion rehabilitation referral patterns, potentially improving the time to recovery from a concussion.
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15
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Faulkner JW, Snell DL, Shepherd D, Theadom A. Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury. J Psychosom Res 2021; 151:110664. [PMID: 34749069 DOI: 10.1016/j.jpsychores.2021.110664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. METHOD Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). RESULTS A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. CONCLUSIONS Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.
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Affiliation(s)
- Josh W Faulkner
- Massey University, PO Box 756, Wellington 6140, New Zealand.
| | - Deborah L Snell
- University of Otago Christchurch, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Daniel Shepherd
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
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16
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Shaikh N, Theadom A, Siegert R, Hardaker N, King D, Hume P. Rasch analysis of the Brain Injury Screening Tool (BIST) in mild traumatic brain injury. BMC Neurol 2021; 21:376. [PMID: 34587927 PMCID: PMC8479917 DOI: 10.1186/s12883-021-02410-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate the psychometric properties of the Brain Injury Screening Tool (BIST) symptom scale in a sample of people with a mild Traumatic Brain Injury (mTBI) through Rasch analysis, and to obtain an interval level measurement score for potential clinical use. Materials and methods Data were obtained from 114 adults aged over 16 years, who had experienced at least one mTBI in the past 10 years. Participants were recruited via social media, concussion clinics and sports organisations over a 4-month period between May and September 2020. Participants were asked to compete the symptom scale of the BIST tool via an anonymous online questionnaire. Internal construct validity, dimensionality, person separation index, and differential item functioning of the BIST were examined with Rasch analysis. Results BIST in its original form produced a satisfactory item-trait interaction, and good reliability, but was found to be multi-dimensional. Rasch analysis of the full scale with three domains as subtests resulted in acceptable model fit (χ2(6) =3.8, p > 0.05), with good reliability (Person Separation Index = 0.84), and uni-dimensionality. Differential Item Functioning (DIF) analysis displayed no significant DIF effects for sex or age revealing that people responded consistently and similarly to the individual BIST items based on severity of symptom burden. Conclusions The 15-item symptom scale of the BIST tool is a psychometrically sound measure of symptom burden following mTBI. The findings provide support for use of both total and sub scale scores for clinical use. Ordinal to interval score conversions are recommended for use when using the scores for research purposes in mTBI.
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Affiliation(s)
- Nusratnaaz Shaikh
- TBI Network, Auckland University of Technology, Auckland, New Zealand. .,School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand.,School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Siegert
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Hardaker
- Accident Compensation Corporation, Wellington, New Zealand.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Doug King
- TBI Network, Auckland University of Technology, Auckland, New Zealand.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand.,School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Patria Hume
- TBI Network, Auckland University of Technology, Auckland, New Zealand.,Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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17
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Shepherd D, Heinonen-Guzejev M, Heikkilä K, Landon J, Theadom A. Sensitivity to Noise Following a Mild Traumatic Brain Injury: A Longitudinal Study. J Head Trauma Rehabil 2021; 36:E289-E301. [PMID: 33656468 DOI: 10.1097/htr.0000000000000645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe changes in the prevalence and clinical correlates of noise sensitivity (NS) in mild traumatic brain injury (mTBI) across a 12-month period and to determine whether NS at an early stage of recovery has predictive value for later postconcussive symptoms. SETTING A mixed urban and rural region of New Zealand. PARTICIPANTS Data for 341 adults (201 males, 140 females; age range from 16 to 91 years) were extracted from a 1-year TBI incidence, and outcomes study was conducted in New Zealand. DESIGN Secondary analysis of data from a community-based, longitudinal population study of an mTBI incidence cohort collected within 1 week of injury (baseline) and at 1, 6, and 12 months postinjury. MAIN MEASURES Measures at baseline (within 2 weeks of the injury) and 1, 6, and 12 months included the Rivermead Post-concussion Symptoms Questionnaire and its NS item, the Hospital Depression and Anxiety Scale, and the computerized CNS-Vital Signs neurocognitive test. RESULTS NS progressively declined postinjury, from 45% at baseline to 28% at 12 months. In turn, NS showed itself as a significant predictor of future postconcussive symptoms. CONCLUSION Taken together with previous research, the findings of the current study indicate that NS may have clinical utility in flagging vulnerability to persistent postconcussive symptoms.
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Affiliation(s)
- Daniel Shepherd
- Department of Psychology, Auckland University of Technology, Auckland, New Zealand (Drs Shepherd, Landon, and Theadom); and Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland (Drs Heinonen-Guzejev and Heikkilä)
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18
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Theadom A, Hardaker N, Bray C, Siegert R, Henshall K, Forch K, Fernando K, King D, Fulcher M, Jewell S, Shaikh N, Bastos Gottgtroy R, Hume P. The Brain Injury Screening Tool (BIST): Tool development, factor structure and validity. PLoS One 2021; 16:e0246512. [PMID: 33539482 PMCID: PMC7861451 DOI: 10.1371/journal.pone.0246512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Currently health care pathways (the combination and order of services that a patient receives to manage their injury) following a mild traumatic brain injury vary considerably. Some clinicians lack confidence in injury recognition, management and knowing when to refer. A clinical expert group developed the Brain Injury Screening Tool (BIST) to provide guidance on health care pathways based on clinical indicators of poor recovery. The tool aims to facilitate access to specialist services (if required) to improve longer term prognosis. The tool was developed using a three-step process including: 1) domain mapping; 2) item development and 3) item testing and review. An online retrospective survey of 114 adults (>16 years) who had experienced a mild brain injury in the past 10 years was used to determine the initial psychometric properties of the 15-item symptom scale of the BIST. Participants were randomised to complete the BIST and one of two existing symptom scales; the Rivermead Post-concussion Symptom Questionnaire (RPQ) or the Sports Concussion Assessment Test (SCAT-5) symptom scale to determine concurrent validity. Participant responses to the BIST symptom scale items were used to determine scale reliability using Cronbach's alpha. A principal components analysis explored the underlying factor structure. Spearman's correlation coefficients determined concurrent validity with the RPQ and SCAT-5 symptom scales. The 15 items were found to require a reading age of 6-8 years old using readability statistics. High concurrent validity was shown against the RPQ (r = 0.91) and SCAT-5 (r = 0.90). The BIST total symptom scale (α = 0.94) and the three factors identified demonstrated excellent internal consistency: physical/emotional (α = 0.90), cognitive (α = 0.92) and vestibular-ocular (α = 0.80). This study provides evidence to support the utility, internal consistency, factor structure and concurrent validity of the BIST. Further research is warranted to determine the utility of the BIST scoring criteria and responsiveness to change in patients.
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Affiliation(s)
- Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- * E-mail:
| | - Natalie Hardaker
- Accident Compensation Corporation, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Charlotte Bray
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Siegert
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Kevin Henshall
- Trauma Service, Counties Manukau District Health Board, Auckland, New Zealand
| | - Katherine Forch
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Axis Sports Medicine, Auckland, New Zealand
| | | | - Doug King
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| | | | - Sam Jewell
- Wellington Sports Med, Wellington, New Zealand
| | - Nusratnaaz Shaikh
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Renata Bastos Gottgtroy
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology, Auckland, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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19
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O'Reilly M, Mahon S, Reid D, Hume P, Hardaker N, Theadom A. Knowledge, attitudes, and behavior toward concussion in adult cyclists. Brain Inj 2020; 34:1175-1182. [PMID: 32683900 DOI: 10.1080/02699052.2020.1793386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine knowledge, attitudes, and behavior toward concussion in cyclists and to identify predictors of concussion knowledge. METHODS Cycling organizations sent members a web link to online information about the study and a questionnaire. Anyone aged >16 years, living in New Zealand and engaged in a cycling activity was invited to participate. The 36-item questionnaire included sociodemographics, knowledge about concussion, helmet use, and personal concussion history. Data were collected between 15/05/19 and 30/06/19. A multiple linear regression model identified factors associated with levels of concussion knowledge. RESULTS The questionnaire was completed by 672 participants aged between 16 and 82 years (x̄ = 48.6 years). Knowledge of concussion was high. However, knowledge that helmets are not able to prevent concussion was low and time to return to sport after injury was variable. Knowledge did not always translate to seeking of medical attention or replacement of helmet behavior. Younger age and having sustained at least one prior concussion were associated with higher levels of concussion knowledge F(df = 3) = 8.81, p < .001. CONCLUSIONS Knowledge and attitudes toward concussion were positive. However, knowledge gaps and discrepancies between attitudes and behavior were identified. Consistent, clear messages are needed around return to sport timeframes.
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Affiliation(s)
- Maureen O'Reilly
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Duncan Reid
- Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology , Auckland, New Zealand.,Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Natalie Hardaker
- Injury Prevention, Accident and Compensation Corporation , Wellington, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology , Auckland, New Zealand
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20
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Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury: A 2-Year Prospective Study. Clin J Sport Med 2020; 30:96-101. [PMID: 32132366 DOI: 10.1097/jsm.0000000000000811] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe clinical recovery time and factors that might impact on recovery after a sports-related mild traumatic brain injury (SR-mTBI; concussion). DESIGN Prospective cohort study (level IV evidence). SETTING New Zealand Sports Concussion Clinic. PARTICIPANTS Eight hundred twenty-two patients presenting within 14 days of a SR-mTBI/concussion over a 2-year period. MAIN OUTCOME MEASURES Clinical recovery measured as number of days after injury. INTERVENTIONS METHODS Participants were assessed and managed using a standardized protocol consisting of relative rest followed by controlled cognitive and physical loading. A reassessment was performed 14 days after injury with initiation of an active rehabilitation program consisting of a subsymptom threshold exercise program ± cervicovestibular rehabilitation (if required) for participants who remained symptomatic. Participants were then assessed every 2 weeks until clinical recovery. RESULTS A total of 594 participants were eligible for analysis (mean age 20.2 ± 8.7 years, 77% males) and were grouped into 3 age cohorts: children (≤12 years), adolescents (13-18 years), and adults (≥19 years). Forty-five percent of participants showed clinical recovery within 14 days of injury, 77% by 4 weeks after injury, and 96% by 8 weeks after injury. There was no significant difference in recovery time between age groups. Prolonged recovery was more common in females (P = 0.001), participants with "concussion modifiers" (P = 0.001), and with increased time between injury and the initial appointment (P = 0.003). CONCLUSIONS This study challenges current perceptions that most people with a SR-mTBI (concussion) recover within 10 to 14 days and that age is a determinant of recovery rate. Active rehabilitation results in high recovery rates after SR-mTBI.
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The association between health-related quality of life and noise or light sensitivity in survivors of a mild traumatic brain injury. Qual Life Res 2019; 29:665-672. [PMID: 31667708 DOI: 10.1007/s11136-019-02346-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Sensory impairment is a common aftereffect of mild traumatic brain injury (TBI); however, their influence upon treatment outcomes and quality of life has yet to be investigated. This study sought to determine the effects of noise and light sensitivity upon the quality of life of individuals diagnosed with a TBI. METHODS A cross-sectional adult sample obtained from a longitudinal study (n = 293) provided measures of light and noise sensitivity and quality of life 12 months post injury. Sensitivities were taken from the Rivermead Post-concussion Symptoms Questionnaire, while quality of life was estimated using the Short-Form 36 health survey (SF-36). RESULTS Approximately 42% of participants reported ongoing difficulties with noise and light sensitivity. Additionally, those reporting sensory difficulties also reported lower SF-36 domain and composite scores compared to those reporting no such symptoms. After controlling for known co-factors, hierarchical multiple regression analyses indicated that the combination of light and noise sensitivity explained between 8 and 35% of the variance in SF-36 scores. CONCLUSIONS Light and noise sensitivity appear to degrade the quality of life of those with a mild TBI. Our findings challenge contemporary rehabilitation practices that tend to sideline sensory complaints and instead focus on the remediation of acute TBI symptoms.
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22
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Shepherd D, Landon J, Kalloor M, Theadom A. Clinical correlates of noise sensitivity in patients with acute TBI. Brain Inj 2019; 33:1050-1058. [PMID: 31007081 DOI: 10.1080/02699052.2019.1606443] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Primary objective: The impact of noise sensitivity (NS) on the daily functioning of people who have experienced a traumatic brain injury (mTBI) is an understudied area, particularly following mTBI. The primary objective of this cross-sectional study was to investigate clinical markers of NS in a sample of New Zealand adults following mTBI. Research design: Cross-sectional study. Methods and procedures: A community-based sample of 151 adults who had experienced a brain injury in the last two weeks completed assessments estimating cognitive functioning, postconcussion symptoms (including NS), and affective state. Results: Over half the sample (59%) reported some degree of NS. Exploratory statistical analyses indicated that NS was associated with being female, living in a rural area, number of previous brain injuries, cognitive flexibility scores, reaction time, perceptions of recovery, anxiety, and depression. Regression analyses revealed that anxiety was the dominant correlate of NS (B = .120, p < .001, 95% CI [0.069, 1.71]). Conclusions: As the first study to explore the correlates of NS following mild TBI, the findings have important clinical and research implications. The present findings suggest that treatment approaches targeting anxiety may be effective in reducing NS in people who have experienced a brain injury. Moreover, evidence is presented suggesting that NS is unlikely to reflect malingering, and should be treated as a genuine somatic symptom of brain injury.
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Affiliation(s)
- Daniel Shepherd
- a Department of Psychology , Auckland University of Technology , Auckland , New Zealand
| | - Jason Landon
- a Department of Psychology , Auckland University of Technology , Auckland , New Zealand
| | - Mathew Kalloor
- a Department of Psychology , Auckland University of Technology , Auckland , New Zealand
| | - Alice Theadom
- a Department of Psychology , Auckland University of Technology , Auckland , New Zealand
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23
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An Evidence-Based Objective Study Protocol for Evaluating Cardiovascular and Cerebrovascular Indices Following Concussion: The Neary Protocol. Methods Protoc 2019; 2:mps2010023. [PMID: 31164604 PMCID: PMC6481075 DOI: 10.3390/mps2010023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: The prevalence and incidence of sport-related concussion have continued to increase over the past decade, and researchers from various backgrounds strive for evidenced-based clinical assessment and management. When diagnosing and managing a concussion, a battery of tests from several domains (e.g., symptom reporting, neurocognitive, physiology) must be used. In this study, we propose and develop an objective, evidence-based protocol to assess the pathophysiology of the brain by using non-invasive methods. Methods: Contact sport athletes (n = 300) will be assessed at the beginning of the season in a healthy state to establish baseline values, and then prospectively followed if a mild traumatic brain injury (mTBI) occurs on approximately days 1–2, 3–5, 7–10, 21, 30, and subsequently thereafter, depending on the severity of injury. The protocol includes spontaneous measurements at rest, during head postural change, controlled breathing maneuvers for cerebrovascular reactivity, a neurovascular coupling stimuli, and a baroreflex/autoregulation maneuver. Physiological data collection will include cerebral blood flow velocity, cerebral oxygenation, respiratory gases for end-tidal oxygen and carbon dioxide, finger photoplethysmography for blood pressure, seismocardiography for cardiac mechanics, and electrocardiography. Conclusion, Limitations, and Ethics: The protocol will provide an objective, physiological evidence-based approach in an attempt to better diagnose concussion to aid in return-to-play or -learn. Ethics approval has been granted by the University Research Ethics Board.
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Dovey S. From the Editor: The transformative power of tin. J Prim Health Care 2018; 10:97-99. [DOI: 10.1071/hcv10n2_ed1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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