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Roberts SD, Champigny C, Feldman SJ, Flora DB, Wojtowicz M. Screening for Anxiety and Depression Symptoms Using Concussion Symptom Scales Among Varsity Athletes. Clin J Sport Med 2024; 34:105-111. [PMID: 37584442 DOI: 10.1097/jsm.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/09/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE This study examined associations between Sport Concussion Assessment Tool-5 (SCAT-5) symptom reporting and gold-standard measures of anxiety and depression, and explored the utility SCAT-5 symptom subscales to identify anxiety and depression symptomology. DESIGN Prospective cross-sectional study. SETTING York University in Toronto, Canada. PARTICIPANTS Preseason data were collected for varsity athletes (N = 296) aged between 17 and 25 years ( M = 20.01 years, SD = 1.69 years; 52% male). MAIN OUTCOME MEASURES The SCAT-5 symptom evaluation scale was used to assess baseline symptoms. The Generalized Anxiety Disorder Index-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess symptoms of anxiety and depression, respectively. RESULTS Endorsement of SCAT-5 symptoms of feeling anxious, sadness, irritability, and feeling more emotional had the strongest correlations with the GAD-7 ( r' s > 0.400; P' s < 0.001). Sadness, trouble falling asleep, concentration problems, feeling slowed down, anxious, irritability, mental fog, fatigue, and memory problems had the highest correlations with the PHQ-9 ( r' s >0 .400; P' s < 0.001). The Emotional subscale from the SCAT-5 predicted mild to severe anxiety on the GAD-7 ( P < 0.001). The Sleep, Cognitive, and Emotional subscales predicted mild to severe depression on the PHQ-9 ( P' s < 0.05). CONCLUSIONS These findings provide better delineation of symptoms endorsed on the SCAT-5 symptoms that aid in identification of athletes with symptoms of anxiety or depression who may be at risk for developing a clinical disorder or experiencing persistent symptoms after a concussion.
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Bowman TG, Lininger MR, Oldham JR, Smetana RM, Kelshaw PM, Beidler E, Campbell TR, Walton SR, Munce TA, Larson MJ, Didehbani N, Cullum CM, Rosenblum DJ, Cifu DX, Resch JE. Physical activity and recovery following concussion in collegiate athletes: a LIMBIC MATARS Consortium Investigation. Brain Inj 2024:1-8. [PMID: 38324635 DOI: 10.1080/02699052.2024.2310791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To investigate whether routine daily activities (RDA), non-prescribed exercise (Non-ERx), or prescribed exercise (ERx) were associated with recovery from sport-related concussion (SRC) in collegiate athletes. MATERIALS AND METHODS Data for this cross-sectional, retrospective chart review of collegiate athletes diagnosed with SRC (n = 285[39.6% female], age = 19.5 ± 1.4 years) were collected during the 2015-16 to 2019-20 athletic seasons. The independent variable was group (RDA, Non-ERx, ERx). Dependent variables included days from date of diagnosis to symptom resolution (Dx-SR) and SR to return to sport (SR-RTS). RESULTS Those in the Non-ERx group took nearly 1.3 times longer to achieve SR (IRR = 1.28, 95% CI: 1.11, 1.46) and, 1.8 times longer for RTS (IRR = 1.82, 95% CI: 1.11, 2.71) when compared to those in the RDA group. No other comparisons were significant. CONCLUSION Collegiate athletes in the Non-ERx group took approximately 1 week longer to achieve SR as compared to the RDA and ERx groups. Our findings suggest that if exercise is recommended following SRC, it must be clearly and specifically prescribed. If exercise parameters cannot be prescribed, or monitored, RDA appear to be similarly beneficial during recovery for collegiate athletes with concussion.
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Affiliation(s)
- Thomas G Bowman
- Department of Athletic Training, College of Health Sciences, University of Lynchburg, Lynchburg, Virginia, USA
| | - Monica R Lininger
- Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Racheal M Smetana
- Neuropsychology Assessment Clinic, University of Virginia Health, Charlottesville, Virginia, USA
| | - Patricia M Kelshaw
- Department of Kinesiology, Brain Research and Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, NH, USA
| | - Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas R Campbell
- School of Rehabilitation Sciences, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Thayne A Munce
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, South Dakota, USA
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Nyaz Didehbani
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- Departments of Psychiatry, Neurology, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Rosenblum
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Bretzin AC, Schmitt AJ, Teel E, Holmes JH, Wiebe DJ, Beidler E. Parent and Youth Athlete Perceptions of Concussion Injury: Establishing a Factor Structure. Arch Clin Neuropsychol 2024:acad109. [PMID: 38244578 DOI: 10.1093/arclin/acad109] [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: 08/16/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE The first objective was to establish the respective factor structures of a concussion perceptions inventory that was adapted for youth athletes (ages 8-14 years) and their parents from the Perceptions of Concussion Inventory for Athletes. The second objective was to understand the associations between the concussion perceptions of youth athlete-parent dyads. METHOD In this cross-sectional study, 329 parent-youth athlete dyads completed a respective concussion perception inventory. Mean age of youth respondents was 10.9 ± 1.8 years (70.1% male) and mean age of parent respondents was 40.5 ± 13.6 years (60.9% female). RESULTS Exploratory factor analyses revealed unique 7-factor structures for both the youth athlete and parent inventories (youth athlete: anxiety, clarity, treatment, permanent injury, symptom variability, long-term outcomes, and personal control; parent: anxiety, clarity, treatment, permanent injury, symptom variability, and long-term outcomes, and affect others). Weak associations were found between dyads on the 5 factors that were composed of identical items (anxiety, clarity, treatment, permanent injury, and symptom variability). CONCLUSIONS Findings suggest that this adapted inventory has adequate psychometric properties to be used in the study of the concussion perceptions of youth athletes and their parents. Weak correlations across the concussion perceptions in the dyads suggest that parents and children hold different concussion perceptions and this should be considered in instrument selection of future studies.
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Affiliation(s)
- Abigail C Bretzin
- Emergency Medicine, Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Ara J Schmitt
- Department of Counselor Education and School Psychology, Duquesne University, Pittsburgh, PA, USA
| | - Elizabeth Teel
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - John H Holmes
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas J Wiebe
- Emergency Medicine, Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Erica Beidler
- Athletic Training, Duquesne University, Pittsburgh, PA, USA
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Caccese JB, Master CL, Buckley TA, Chrisman SPD, Clugston JR, Eckner JT, Ermer E, Harcum S, Hunt TN, Jain D, Kelly LA, Langford TD, Lempke LB, McDevitt J, Memmini AK, Mozel AE, Perkins SM, Putukian M, Roby PR, Susmarski A, Broglio SP, McAllister TW, McCrea M, Pasquina PF, Esopenko C. Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study. Sports Med 2023:10.1007/s40279-023-01982-2. [PMID: 38133787 DOI: 10.1007/s40279-023-01982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. METHODS National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24-48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale. RESULTS Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24-48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5-70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6-49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1-2.9; male athletes, mean = 4.1, 95% CI 1.5-10.9). CONCLUSIONS Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.
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Affiliation(s)
- Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA.
| | | | | | | | | | | | - Elsa Ermer
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stacey Harcum
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Divya Jain
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Anne E Mozel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan M Perkins
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | | | | | - Paul F Pasquina
- Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA
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Valovich McLeod TC, Snedden T, Halstead M, Wilson J, Master C, Grady M, Fazekas M, Santana J, Zaslow T, Miller S, Coel R, Howell DR. Influence of Personal and Injury-Related Factors Predicting Deficits in Quality of Life Domains Among Pediatric Athletes: Findings From the Sport Concussion Outcomes in Pediatrics Study. Clin J Sport Med 2023; 33:489-496. [PMID: 36858431 DOI: 10.1097/jsm.0000000000001140] [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: 09/29/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To examine patient and injury factors that may predict quality of life (QoL) and symptom duration after concussion. DESIGN Prospective, longitudinal. SETTINGS Six children's hospital-based medical centers and 9 secondary school athletic training facilities. PATIENTS Pediatric patients (8-18 years) were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit for a diagnosis of sport-related concussion. INTERVENTIONS Patients completed a medical history, the Postconcussion Symptom Inventory (PCSI), and Patient-Reported Outcomes Measurement Information System Pediatric Profile-25 (PROMIS-PP). MAIN OUTCOME MEASURES Eight predictor variables [age, sex, assessment time, loss of consciousness, amnesia and history of concussion, migraines, or attention-deficit hyperactivity disorder or (ADHD)] were assessed using regression models constructed for each dependent variable. RESULTS A total of 244 patients (15.1 ± 2.1 years, 41% female) were enrolled (mean = 5 ± 3 days after concussion; range = 1-14 days). Female sex, later initial assessment, and presence of amnesia were associated with lower QoL scores on several domains, whereas loss of consciousness was associated with higher QoL for fatigue. A history of migraines was associated with lower peer relationship QoL. Patients who subsequently developed persisting symptoms had lower mobility scores and higher anxiety, depressive symptom, fatigue, and pain interference scores. CONCLUSIONS Female sex, later clinic presentation, and amnesia were associated with a lower QoL related to mobility, anxiety, depressive symptoms, fatigue, and pain interference. Interestingly, previous concussion and preinjury ADHD diagnosis did not negatively impact postinjury QoL at the initial visit. Future studies should assess the influence of these factors on QoL at later postinjury time points using a concussion-specific outcomes instrument.
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Affiliation(s)
| | | | | | - Julie Wilson
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Matthew Grady
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Tracy Zaslow
- Cedars-Sinai Kerlan Jobe Institute, Los Angeles, CA, USA
| | - Shane Miller
- Scottish Rite for Children, Dallas, TX, USA; and
| | - Rachel Coel
- Kapi'olani Medical Center for Women and Children, Honolulu, HI
| | - David R Howell
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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D'Alonzo BA, Wiebe DJ, Master CL, Castellana MC, Willer BS, Leddy JJ. Relationship between anxiety and concussion symptoms among adolescents enrolled in a randomized controlled trial of aerobic exercise. NeuroRehabilitation 2023; 53:187-198. [PMID: 37638452 DOI: 10.3233/nre-220221] [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] [Indexed: 08/29/2023]
Abstract
BACKGROUND Affective symptoms, specifically, anxiety, are often overlooked after sport-related concussion (SRC), and may contribute to prolonged recovery. OBJECTIVE To examine the impact of anxiety during clinical recovery among adolescents (13-18y) enrolled in a randomized trial of aerobic exercise for SRC. METHODS Patients at three sites were randomized into aerobic exercise or stretching arms, and enrolled in the 4-week intervention. The relationship between PROMIS Anxiety score at initial visit and time to symptom resolution was evaluated with survival analysis. The relationship between weekly PROMIS Anxiety score and Post-concussion Symptom Inventory (PCSI) score was evaluated with Linear Mixed Models. Analyses adjusted for study arm and baseline covariates. RESULTS Among 54 adolescents (median age = 15.8y, initial visit PCSI score = 32, pre-injury PROMIS Anxiety score = 2), median time to symptom resolution was 10 days (25th-75th percentiles: 6-24) in the Low-PROMIS Anxiety group and 12 days (25th-75th percentiles: 5-21) in the High-PROMIS Anxiety group (p = 0.62). Each additional unit of PROMIS Anxiety score corresponded to a 1.52-unit higher PCSI total score (p < 0.01). Neither effect varied by aerobic exercise/stretching group. CONCLUSION Higher initial PROMIS Anxiety score was not significantly associated with delayed symptom resolution. However, over time, PROMIS Anxiety score was significantly associated with elevated PCSI score, regardless of exercise/stretching group.
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Affiliation(s)
- Bernadette A D'Alonzo
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas J Wiebe
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina L Master
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew C Castellana
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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