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Haider MN, Cole WR, Willer BS, McCulloch K, Horn EC, Bertz PE, Ramsey C, Leddy JJ. Early targeted heart rate exercise is safe and May hasten return-to-duty in service members with acute concussion, a preliminary study. Brain Inj 2024; 38:119-125. [PMID: 38329063 DOI: 10.1080/02699052.2024.2306334] [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: 04/18/2022] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To evaluate the feasibility of an exercise tolerance assessment and intervention added to the Progressive Return to Activity Clinical Recommendations (PRA-CR) in acutely concussed service members (SMs). METHODS This non-randomized, pilot trial was performed at one center. SMs in the experimental group (ERG) performed the Buffalo Concussion March-in-place Test (BCMT) at every clinic visit and were prescribed at least 20 minutes/day of targeted exercise in addition to PRA-CR. Data for the control group (SCG) were extracted from the same clinic immediately prior to ERG. SMs in both groups were assessed by the same clinician to determine return-to-duty. RESULTS BCMT identified concussion-related exercise intolerance in 100% (n = 14) at screening visit (mean 3.4 days after injury) and in 0% (n = 7) who had recovered. No adverse effects were associated with BCMT. The estimated recovery time for ERG who performed the exercise intervention (n = 12) was 17.0 (12.8, 21.2) days and for SCG (n = 15) was 23.7 (19.9, 27.5) days (p = 0.039). CONCLUSION Assessment of exercise tolerance was feasible and could be incorporated into the PRA-CR. Future definitive, randomized controlled trials should be performed to assess the effectiveness of exercise reset program for SMs after concussion.
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Affiliation(s)
- Mohammad Nadir Haider
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Wesley R Cole
- Department of Exercise and Sport Science, Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Karen McCulloch
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily C Horn
- UBMD Pediatric, Division of Neonatology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Patrick E Bertz
- Department of Exercise and Sport Science, Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Crystal Ramsey
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John J Leddy
- Department of Orthopedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
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Hoover P, Adirim-Lanza A, Adams RS, Dismuke-Greer CE, French LM, Caban J. Changes in Outpatient Healthcare Utilization and Costs Following Mild Traumatic Brain Injury Among Service Members in the Military Health System by Preexisting Behavioral Health Condition Status. J Head Trauma Rehabil 2023; 38:368-379. [PMID: 36854098 DOI: 10.1097/htr.0000000000000857] [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: 03/02/2023]
Abstract
OBJECTIVE To evaluate changes in healthcare utilization and cost following an index mild traumatic brain injury (mTBI) diagnosis among service members (SMs). We hypothesized that differences in utilization and cost will be observed by preexisting behavioral health (BH) diagnosis status. SETTING Direct care outpatient healthcare facilities within the Military Health System. PARTICIPANTS A total of 21 984 active-duty SMs diagnosed with an index mTBI diagnosis between 2017 and 2018. DESIGN This retrospective study analyzed changes in healthcare utilization and cost in military treatment facilities among SMs with an index mTBI diagnosis. Encounter records 1 year before and after mTBI were assessed; preexisting BH conditions were identified in the year before mTBI. MAIN MEASURES Ordinary least squares regressions evaluated difference in the average change of total outpatient encounters and costs among SMs with and with no preexisting BH conditions (eg, posttraumatic stress disorder, adjustment disorder). Additional regressions explored changes in utilization and cost within clinic types (eg, mental health, physical rehabilitation). RESULTS There was a 39.5% increase in overall healthcare utilization during the following year, representing a 34.8% increase in total expenditures. Those with preexisting BH conditions exhibited smaller changes in overall utilization (β, -4.9; [95% confidence interval (CI), -6.1 to -3.8]) and cost (β, $-1873; [95% CI, $-2722 to $-1024]), compared with those with no BH condition. The greatest differences were observed in primary care clinics, in which those with prior BH conditions exhibited an average decreased change of 3.2 encounters (95% CI, -3.5 to -3) and reduced cost of $544 (95% CI, $-599 to $-490) compared with those with no prior BH conditions. CONCLUSION Despite being higher utilizers of healthcare services both pre- and post-mTBI diagnosis, those with preexisting BH conditions exhibited smaller changes in overall cost and utilization. This highlights the importance of considering prior utilization and cost when evaluating the impact of mTBI and other injury events on the Military Health System.
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Affiliation(s)
- Peter Hoover
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, Maryland (Messrs Hoover and Adirim-Lanza and Drs French and Caban); Division of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts (Dr Adams); VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, Colorado (Dr Adams); Health Economics Resource Center (HERC), VA Palo Alto Healthcare System, Palo Alto, California (Dr Dismuke-Greer); and Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr French)
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Buckley TA, Munkasy BA, Evans KM, Clouse B. Acute Physical and Mental Activity Influence on Concussion Recovery. Med Sci Sports Exerc 2022; 54:307-312. [PMID: 34559729 PMCID: PMC8760145 DOI: 10.1249/mss.0000000000002787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Physical activity (PA) and mental activity (MA) postconcussion has received renewed attention to improve concussion management; however, most protocols start after several days and do not assess the acute window. Therefore, the purpose of this study was to assess PA and MA in the first 48 h postconcussion on the time to symptom-free status and return to play. METHODS We recruited 78 NCAA Division I athletes (male, 51.3%; age, 19.6 ± 1.4 yr; height, 173.7 ± 11.5 cm; weight, 80.1 ± 23.2 kg) who were diagnosed with a sports-related concussion. Participants completed a 0-5 PA and MA scale daily until fully cleared for return to participation (mean, 15.1 ± 6.9 d). A quadratic model regression assessed PA and MA over the first 2 d (acute) postconcussion on to time to symptom-free status and return to play. RESULTS The overall model was significant for both time to symptom free (r2 = 0.27, P = 0.004) and return to play (r2 = 0.23, P = 0.019). Reported PA was the only significant predictor for time to symptom-free (P = 0.002) and return-to-participation (P = 0.006) day. Reported MA was not associated either outcome. CONCLUSIONS The primary finding of this study was that mild to moderate PA acutely postconcussion was associated with reduced time to symptom free and return to participation as opposed to either lower or higher levels of PA. Conversely, acute MA was not associated with recovery outcomes. These results further elucidate the role of postconcussion PA.
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Affiliation(s)
- Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, Interdisciplinary program in Biomechanics and Movement Science University of Delaware, Newark, DE
| | - Barry A. Munkasy
- School of Health and Kinesiology, Georgia Southern University, Statesboro, GA
| | | | - Brandy Clouse
- Department of Intercollegiate Athletics, Georgia Southern University, Statesboro, GA
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4
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Remigio-Baker RA, Babakhanyan I, Gregory E, Cole WR, Ettenhofer ML, West T, Qashu F, Mullins L, Bailie JM. Impact of Prior Brain Injury on Concussion Recovery in Military Personnel: Evaluation of Timing Between Concussions. J Head Trauma Rehabil 2021; 36:456-465. [PMID: 34145155 DOI: 10.1097/htr.0000000000000694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the potential impact of timing between the current and the most recent previous concussions on symptom severity among acutely concussed active duty military Service members (SMs). SETTING Three military installations. PARTICIPANTS Eighty-four SMs aged 18 to 44 years who sustained a concussion within 72 hours of enrollment. No previous concussion within 1 year preenrollment. DESIGN Longitudinal study with enrollment within 72 hours of injury, and follow-up at 1 week and 1 month postinjury. MAIN MEASURES Lifetime concussion history (yes/no) and recency of the latest concussion (no history, relatively more recent [1 to <6 years ago], and more remote [6+ years ago]) from the current concussion using the Ohio State University Traumatic Brain Injury Identification Method-Interview Form. Symptom severity (total and by categories: cognitive, affective, somatosensory, vestibular) at all time points using the Neurobehavioral Symptoms Inventory. RESULTS Concussion history assessed as having any previous concussion was not found significantly related to symptom severity (total or by categories) following a current concussion. However, when timing between concussion was taken into account, time since previous concussion was significantly related to symptomatology, whereby those with relatively more recent previous concussion had greater total symptoms within 72 hours of injury and at 1 week postinjury (though not at 1 month) than those with more remote previous concussion (≤72 hours: difference = 15.4, 95% CI = 1.8 to 29.1; 1 week: difference = 15.2, 95% CI = 1.2 to 29.2) or no history (≤72 hours: difference = 11.6, 95% CI = 0.4 to 22.8; 1 week: difference = 13.9, 95% CI = 2.4 to 25.4). When evaluated by symptom category, this relationship was particularly important on affective and somatosensory symptoms. CONCLUSION In recently concussed active duty SMs, the timing between the current and previous concussions may be an important factor in determining prognosis. Clinical assessment of concussion history that accounts for the timing of the most recent event may be necessary to identify patients who may require a more conservative plan of care and more gradual return to activity in the acute recovery stage.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Drs Remigio-Baker, Babakhanyan, Gregory, Ettenhofer, Mullins, and Bailie); Naval Hospital Camp Pendleton, Camp Pendleton, California (Drs Remigio-Baker, Babakhanyan, and Bailie); Henry M. Jackson Foundation, Bethesda, Maryland (Dr Remigio-Baker); General Dynamics Information Technology, Fairfax, Virginia (Drs Babakhanyan and Bailie); Intrepid Spirit Center, Womack Army Medical Center, Fort Bragg, North Carolina (Dr Cole); Naval Medical Center San Diego, San Diego, California (Drs Ettenhofer and Mullins); University of California, San Diego (Dr Ettenhofer); US Army Medical Research and Materiel Command, Fort Detrick, Maryland (Dr West); and National Institutes of Health, Bethesda, Maryland (Dr Qashu)
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5
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Lumba-Brown A, Prager EM, Harmon N, McCrea MA, Bell MJ, Ghajar J, Pyne S, Cifu DX. A Review of Implementation Concepts and Strategies Surrounding Traumatic Brain Injury Clinical Care Guidelines. J Neurotrauma 2021; 38:3195-3203. [PMID: 34714147 DOI: 10.1089/neu.2021.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite considerable efforts to advance the science surrounding traumatic brain injury (TBI), formal efforts supporting the current and future implementation of scientific findings within clinical practice and healthcare policy are limited. While many and varied guidelines inform the clinical management of TBI across the spectrum, clinicians and healthcare systems are not broadly adopting, implementing, and/or adhering to them. As part of the Brain Trauma Blueprint TBI State of the Science, an expert workgroup was assembled to guide this review article, which describes: (1) possible etiologies of inadequate adoption and implementation; (2) enablers to successful implementation strategies; and (3) strategies to mitigate the barriers to adoption and implementation of future research.
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Affiliation(s)
- Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | | | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neurosurgery Research Laboratory, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Michael J Bell
- Pediatrics, Critical Care Medicine, Children's National Hospital, Washington DC, USA
| | - Jamshid Ghajar
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Scott Pyne
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - David X Cifu
- Virginia Commonwealth University School of Medicine, and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
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Schmidt JD, Anderson M, Weber Rawlins M, Foster CA, Johnson BR, D'Lauro C. Number of prior concussions predict poorer concussion care seeking in military cadets. Brain Inj 2021; 35:1598-1606. [PMID: 34546810 DOI: 10.1080/02699052.2021.1976418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE To determine whether concussion history predicts concussion care seeking, self-management practices, or confidence to recognize/report. RESEARCH DESIGN Cross-sectional. METHODS & PROCEDURES 706 United States Air Force Academy (USAFA) cadets completed survey items regarding concussion history (0,1,2,3+), likelihood of reporting a concussion, self-management, and confidence to recognize/report. We used multivariate ordinal and binary logistic regression models to predict responses using concussion history, sex, and race.Main outcomes & results: cadets with 1 (OR = 0.59, 95%CI:0.43-0.82), 2 (OR = 0.55, 95%CI:0.31-0.98), or 3+ (OR = 0.36, 95%CI:0.17-0.78) concussions while at USAFA had respective 41%, 45%, and 64% lower likelihood to report the concussion scenario (ref = no history, p < .001). USAFA cadets with more extensive concussion histories had higher prevalence of not seeking care for a concussion (p < .001); more strongly endorsed self-management (p = .001-0.010); and had greater confidence in their ability to recognize a concussion (p = .005), but not to report (p = .198-0.413). CONCLUSIONS Prior concussion experiences may deter cadets from seeking medical care for future concussions. Interventions should address concussion history and clinicians should consider how the post-concussion management process might deter care seeking.
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Affiliation(s)
- Julianne D Schmidt
- UGAConcussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, USA
| | - Melissa Anderson
- UGAConcussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, USA
| | - Michelle Weber Rawlins
- Department of Interdisciplinary Health Sciences, At Still University, Mesa, Arizona, USA
| | - Craig A Foster
- Department of Behavioral Sciences and Leadership, USAF Academy, Colorado, USA
| | - Brian R Johnson
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, USAF Academy, Colorado, USA
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7
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Remigio-Baker RA, Kiser S, Ferdosi H, Gregory E, Engel S, Sebesta S, Beauchamp D, Malik S, Scher A, Hinds SR. Provider Training in the Management of Headache Following Concussion Clinical Recommendation: Promoting a Standardized Means for Efficient Patient Recovery and Timely Return to Duty. Front Neurol 2020; 11:559311. [PMID: 33178105 PMCID: PMC7593659 DOI: 10.3389/fneur.2020.559311] [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: 05/05/2020] [Accepted: 08/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Headache is a common symptom reported following concussion/mild traumatic brain injury. The Department of Defense's clinical recommendation (CR) describes guidance for primary care providers for the management of post-traumatic headache (PTH) in Service members. Objective: The objective of this study is to examine the association between training on the CR with provider clinical practice, patient behaviors, and symptom recovery. Methods: Participants were healthcare providers and two patient groups (one receiving care as usual [CAU] and another receiving care after provider training on PTH CR [CR+]). Providers were interviewed at three time points: (1) prior to CAU enrollment; (2) after CAU enrollment, but prior to training; and (3) after CR+ follow-up. Data from the second and third provider interview were used to evaluate a potential difference between provider practices pre- and post-training (n = 13). Patients were enrolled within 6 months of concussion. Patient outcomes (including neurobehavioral and headache symptoms) were assessed at three time-points: within 72 h (n = 35), at 1-week (n = 34) and at 1-month post-enrollment (n = 27). Results: Most follow-up care reported by providers were recommended within 72 h of initial visit post-training vs. >1 week pre-training. Additionally, providers reported a greater number of visits based on patient symptoms after training than before. Post-training, most providers reported referring patients to higher level of care “as needed,” if not “very rarely,” compared to 25% reported referrals prior to training. At 1-week post-enrollment the CR+ patient group reported more frequent medical provider visits compared to the CAU group. This trend was reversed at the 1-month follow-up whereby more CAU reported seeing a medical provider compared to CR+. By 1-week post-enrollment, fewer patients in the CR+ group reported being referred to any other providers or specialists compared to the CAU group. No differences in patient outcomes by provider training was found. Conclusion: The study results demonstrate the feasibility of training on the Management of Headache Following Concussion CR in order to change provider practices by promoting timely care, and promoting patient compliance as shown through improvement in follow-up visits and more monitoring within the primary care clinic.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States.,Naval Hospital Camp Pendleton, Camp Pendleton, CA, United States
| | - Seth Kiser
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,General Dynamics Information Technology, Falls Church, VA, United States
| | - Hamid Ferdosi
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,General Dynamics Information Technology, Falls Church, VA, United States
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
| | - Scot Engel
- Fort Hood Intrepid Spirit Center, Fort Hood, TX, United States
| | - Sean Sebesta
- Fort Bliss Intrepid Spirit Center, Fort Bliss, TX, United States
| | - Daniel Beauchamp
- Fort Bliss Intrepid Spirit Center, Fort Bliss, TX, United States
| | - Saafan Malik
- Defense and Veterans Brain Injury Center, Silver Spring, MD, United States
| | - Ann Scher
- Uniformed Services University, Bethesda, MD, United States
| | - Sidney R Hinds
- Uniformed Services University, Bethesda, MD, United States
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Ettenhofer ML, Remigio-Baker RA, Bailie JM, Cole WR, Gregory E. Best Practices for Progressive Return to Activity after Concussion: Lessons Learned from a Prospective Study of U.S. Military Service Members. Neurotrauma Rep 2020; 1:137-145. [PMID: 33274343 PMCID: PMC7703689 DOI: 10.1089/neur.2020.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary care providers can play a crucial role in the clinical management of concussion. However, many providers lack up-to-date information about best practices for rest and return to activity after these injuries. Most research on this topic has been conducted in athletes, and so less is known about how to assist patients with returning to activity in other settings and populations. This article provides a review of best practices for management of progressive return to activity after concussion, with an emphasis on "lessons learned" from the Defense and Veterans Brain Injury Center (DVBIC) Progressive Return to Activity (PRA) study, a multi-site longitudinal research project conducted to evaluate concussion management practices and the effectiveness of provider training on DVBIC clinical recommendations (CRs). Provider clinical practices and patient outcomes were examined at three U.S. military treatment facilities before and after providers completed a standardized training on DVBIC PRA CRs. In summary, research findings provide additional support that concussion recovery can be influenced by patients' activity levels after injury. Patients with concussion may experience poorer outcomes if they return to pre-injury levels of activity too rapidly, but they may also be at risk for prolonged symptoms if they fail to increase activity levels over time after an initial period of rest. Additionally, training primary care providers in return to activity guidelines can result in more effective patient education and better clinical outcomes. This knowledge can be used to inform best practices for progressive return to activity in both civilian and military settings.
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Affiliation(s)
- Mark L. Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- University of California, San Diego, La Jolla, California, USA
| | - Rosemay A. Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
- Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
| | - Wesley R. Cole
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
- Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA
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9
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Remigio-Baker RA, Gregory E, Cole WR, Bailie JM, McCulloch KL, Cecchini A, Stuessi K, Andrews TR, Mullins L, Ettenhofer ML. Beliefs About the Influence of Rest During Concussion Recovery May Predict Activity and Symptom Progression Within an Active Duty Military Population. Arch Phys Med Rehabil 2020; 101:1204-1211. [PMID: 32234413 DOI: 10.1016/j.apmr.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate relationships between beliefs about the impact of rest and the level of activities and symptoms over time among active duty Service members sustaining concussion, and whether these relationships vary by provision of concussion education. DESIGN Longitudinal study using multilevel modeling to assess the relationship between beliefs about rest within 72 hours of concussion and change in activity and symptom level over time, as well as interaction by concussion education at the initial clinic visit. SETTING Three military treatment facilities. PARTICIPANTS Study participants included active duty Service members diagnosed with a concussion (N=111; median age, 24 y). Individuals with previous history of concussion within 12 months of study enrollment were excluded. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Activity questionnaire and the Neurobehavioral Symptom Inventory assessed within 72 hours of concussion; at 1 week; and at 1, 3, and 6 month(s) postinjury. RESULTS Receipt of concussion education from providers was significantly associated with greater belief that rest influences concussion recovery. Greater belief that rest influences symptom recovery at the acute stage of concussion was associated with a greater increase in activities over time, but only among those who received education from their provider. Additionally, greater belief about the influence of rest was related to a more rapid decrease in symptoms over time. CONCLUSIONS Concussed Service members who underestimate the influence of rest during acute recovery may be at risk for poorer recovery. Treatment of Service members with postconcussive symptoms should consider patient knowledge and/or beliefs about rest and recovery, which may influence prognosis. Our results support the provider's use of concussion education to correct potential misconceptions that may negatively impact symptom recovery.
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Affiliation(s)
- Rosemay A Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; Henry M. Jackson Foundation, Bethesda, MD.
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD
| | - Wesley R Cole
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Womack Army Medical Center, Fort Bragg, NC
| | - Jason M Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; General Dynamics Health Solutions, Silver Spring, MD
| | - Karen L McCulloch
- Henry M. Jackson Foundation, Bethesda, MD; Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy Cecchini
- Womack Army Medical Center, Fort Bragg, NC; Geneva Foundation, Tacoma, WA
| | - Keith Stuessi
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Hospital Camp Pendleton, Camp Pendleton, CA; General Dynamics Health Solutions, Silver Spring, MD
| | - Taylor R Andrews
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA
| | - Lynita Mullins
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA
| | - Mark L Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, MD; Naval Medical Center San Diego, San Diego, CA; American Hospital Services Group LLC, Exton, PA
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10
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Cole WR, Cecchini AS, Remigio-Baker RA, Gregory E, Bailie JM, Ettenhofer ML, McCulloch KL. “Return to duty” as an outcome metric in military concussion research: Problems, pitfalls, and potential solutions. Clin Neuropsychol 2020; 34:1156-1174. [DOI: 10.1080/13854046.2020.1715484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Wesley R. Cole
- Intrepid Spirit, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Amy S. Cecchini
- Intrepid Spirit, Womack Army Medical Center, Fort Bragg, NC, USA
- Geneva Foundation, Tacoma, WA, USA
| | - Rosemay A. Remigio-Baker
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Emma Gregory
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Jason M. Bailie
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
- General Dynamics Health Solutions, Falls Church, VA, USA
| | - Mark L. Ettenhofer
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Naval Medical Center San Diego, San Diego, CA, USA
- American Hospital Services Group, Exton, PA, USA
- University of California San Diego, San Diego, CA, USA
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