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Eagle SR, Jain S, Sun X, Preszler J, McCrea MA, Giacino JT, Manley GT, Okonkwo DO, Nelson LD. Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study. Front Neurol 2023; 14:1308540. [PMID: 38148980 PMCID: PMC10750770 DOI: 10.3389/fneur.2023.1308540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Mild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI symptoms relate to each other. The centrality hypothesis of network theory posits that certain symptoms in a network are more relevant (central) or have above average influence over the rest of the network. However, no studies have used NA to characterize the interrelationships between symptoms in a cohort of patients who presented with mTBI to a U.S. Level 1 trauma center emergency department and how subacute central symptoms relate to long-term outcomes. Methods Patients with mTBI (Glasgow Coma Scale = 13-15) evaluated across 18 U.S. Level 1 trauma centers from 2013 to 2019 completed the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 2 weeks (W2) post-injury (n = 1,593) and at 3 months (M3), 6 months (M6), and 12 months (M12) post-injury. Network maps were developed from RPQ subscale scores at each timepoint. RPQ scores at W2 were associated with M6 and M12 functional and quality of life outcomes. Results Network structure did not differ across timepoints, indicating no difference in symptoms/factors influence on the overall symptom network across time. The cognitive factor had the highest expected influence at W2 (1.761), M3 (1.245), and M6 (1.349). Fatigue had the highest expected influence at M12 (1.275). The emotional factor was the only other node with expected influence >1 at any timepoint, indicating disproportionate influence of emotional symptoms on overall symptom burden (M3 = 1.011; M6 = 1.076). Discussion Several symptom factors at 2-weeks post-injury were more strongly associated with incomplete recovery and/or poorer injury-related quality of life at 6 and 12 months post-injury than previously validated demographic and clinical covariates. The network analysis suggests that emotional, cognitive, and fatigue symptoms may be useful treatment targets in this population due to high centrality and activating potential of the overall symptom network.
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Affiliation(s)
- Shawn R. Eagle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | | | | | - Joseph T. Giacino
- Physical Medicine and Rehabilitation, Harvard University, Cambridge, MA, United States
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
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Silverberg ND, Mikolić A. Management of Psychological Complications Following Mild Traumatic Brain Injury. Curr Neurol Neurosci Rep 2023; 23:49-58. [PMID: 36763333 DOI: 10.1007/s11910-023-01251-9] [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] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW It has been clear for decades that psychological factors often contribute to mild traumatic brain injury (mTBI) outcome, but an emerging literature has begun to clarify which specific factors are important, when, for whom, and how they impact recovery. This review aims to summarize the contemporary evidence on psychological determinants of recovery from mTBI and its implications for clinical management. RECENT FINDINGS Comorbid mental health disorders and specific illness beliefs and coping behaviors (e.g., fear avoidance) are associated with worse recovery from mTBI. Proactive assessment and intervention for psychological complications can improve clinical outcomes. Evidence-based treatments for primary mental health disorders are likely also effective for treating mental health disorders after mTBI, and can reduce overall post-concussion symptoms. Broad-spectrum cognitive-behavioral therapy may modestly improve post-concussion symptoms, but tailoring delivery to individual psychological risk factors and/or symptoms may improve its efficacy. Addressing psychological factors in treatments delivered primarily by non-psychologists is a promising and cost-effective approach for enhancing clinical management of mTBI. Recent literature emphasizes a bio-psycho-socio-ecological framework for understanding mTBI recovery and a precision rehabilitation approach to maximize recovery. Integrating psychological principles into rehabilitation and tailoring interventions to specific risk factors may improve clinical management of mTBI.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada.
| | - Ana Mikolić
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 1M9, Canada
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Sullivan K, Keyter A, Jones K, Ameratunga S, Starkey N, Barker-Collo S, Webb J, Theadom A. Atypical symptom reporting after mild traumatic brain injury. BRAIN IMPAIR 2023; 24:114-123. [PMID: 38167586 DOI: 10.1017/brimp.2021.30] [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: 11/07/2022]
Abstract
OBJECTIVE Early reporting of atypical symptoms following a mild traumatic brain injury (mTBI) may be an early indicator of poor prognosis. This study aimed to determine the percentage of people reporting atypical symptoms 1-month post-mTBI and explore links to recovery 12 months later in a community-dwelling mTBI sample. METHODS Adult participants (>16 years) who had experienced a mTBI were identified from a longitudinal incidence study (BIONIC). At 1-month post-injury, 260 participants completed the Rivermead Post-Concussion Symptoms Questionnaire (typical symptoms) plus four atypical symptom items (hemiplegia, difficulty swallowing, digestion problems and difficulties with fine motor tasks). At 12 months post-injury, 73.9% (n = 193) rated their overall recovery on a 100-point scale. An ordinal regression explored the association between atypical symptoms at 1 month and recovery at 12 months post-injury (low = 0-80, moderate = 81-99 and complete recovery = 100), whilst controlling for age, sex, rehabilitation received, ethnicity, mental and physical comorbidities and additional injuries sustained at the time of injury. RESULTS At 1-month post-injury <1% of participants reported hemiplegia, 5.4% difficulty swallowing, 10% digestion problems and 15.4% difficulties with fine motor tasks. The ordinal regression model revealed atypical symptoms were not significant predictors of self-rated recovery at 12 months. Older age at injury and higher typical symptoms at 1 month were independently associated with poorer recovery at 12 months, p < 0.01. CONCLUSION Atypical symptoms on initial presentation were not linked to global self-reported recovery at 12 months. Age at injury and typical symptoms are stronger early indicators of longer-term prognosis. Further research is needed to determine if atypical symptoms predict other outcomes following mTBI.
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Affiliation(s)
- Karen Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Anna Keyter
- Auckland University of Technology, Auckland, New Zealand
| | - Kelly Jones
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Nicola Starkey
- Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand
| | | | | | - Alice Theadom
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
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Brooks KJL, Sullivan KA. Factor structure of the modified Rivermead Post-concussion Symptoms Questionnaire (mRPQ): an exploratory analysis with healthy adult simulators. Brain Inj 2023; 37:87-94. [PMID: 36653341 DOI: 10.1080/02699052.2023.2165150] [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: 01/20/2023]
Abstract
OBJECTIVE Persistent postconcussion symptoms (PPCS) are challenging to diagnose. An improved diagnostic process could consider typical and atypical postconcussion symptoms. This study examined the structure of a modified Rivermead Post-concussion Symptoms Questionnaire (mRPQ) with both symptom types. METHOD 298 adult volunteers were randomized into groups: honest responders, mild traumatic brain injury (mTBI) simulators (MS), and biased mTBI simulators (BMS). Both mTBI simulating groups were coached about mTBI and primed about the simulation context (compensation evaluation). The BMS group was also encouraged to bias (exaggerate) symptoms. The participants completed an online battery of tests, including the mRPQ. RESULTS An exploratory factor analysis of the mRPQ (full sample) revealed a three-factor solution, including a separate dimension for atypical symptoms (all item loadings >0.45, ~4% of explained variance). The overall and group analyses of the standard RPQ items (typical symptoms) found a one- or two-factor solution, as did the analyses of atypical symptoms. CONCLUSIONS Consistent with prior RPQ research, a unidimensional or bifactor structure was measurable from standard RPQ symptoms. Whilst this study did not find support for domain-level symptom scores for either typical or atypical symptoms, the findings support the use of an overall atypical symptoms score.
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Affiliation(s)
- Kelly Jack Lee Brooks
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Karen A Sullivan
- School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Jobin K, Wang M, du Plessis S, Silverberg ND, Debert CT. The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms. NeuroRehabilitation 2023; 53:199-208. [PMID: 37638460 DOI: 10.3233/nre-237002] [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 Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. OBJECTIVE To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. METHODS Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. RESULTS We found that total RPQ score (βˆ= 0.27; 95% CI = [0.16, 0.38]), GAD-7 score (βˆ= 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score (βˆ= 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). CONCLUSION The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.
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Affiliation(s)
- Kaiden Jobin
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sané du Plessis
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Mucha A, Pardini JE, Herring SA, Murphy J, Elbin RJ, Bauer RM, Schmidt JD, Resch JE, Broshek DK. Persisting symptoms after concussion: Considerations for active treatment. PM R 2022; 15:663-673. [PMID: 36507616 DOI: 10.1002/pmrj.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Anne Mucha
- UPMC Centers for Rehab Services, UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Jamie E Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Justin Murphy
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - R J Elbin
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Russell M Bauer
- Department of Clinical & Health Psychology, University of Florida Department of Clinical & Health Psychology, Gainesville, Florida, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K Broshek
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Green K, Cairncross M, Panenka WJ, Stubbs JL, Silverberg ND. History of Functional Somatic Syndromes and Persistent Symptoms After Mild Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2022; 33:109-115. [PMID: 33203306 DOI: 10.1176/appi.neuropsych.20060159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Somatization is thought to underlie functional somatic syndromes (FSSs) and may also contribute to prolonged symptoms after mild traumatic brain injury (mTBI). The investigators evaluated the prevalence of FSSs in patients seeking specialty care after mTBI and whether a history of FSSs was associated with symptom persistence. METHODS A total of 142 patients with mTBI completed questionnaires regarding demographic information, injury characteristics, and medical history, including history of diagnosed FSSs at clinic intake (mean=41 days postinjury [SD=22.41]). Postconcussion symptoms were assessed at clinic intake and again 1 and 3 months later. A linear mixed-effects model was used to determine whether history of FSSs was related to persistent mTBI symptoms over time. RESULTS A history of at least one FSS was reported by 20.4% of patients. In the linear mixed model, postconcussion symptom scores were not significantly different over time among patients with a history of one or more FSSs or two or more FSSs from those with no FSSs. A history of one or more FSSs or two or more FSSs (versus no FSS) was not associated with increased odds of severe postconcussion symptoms at clinic intake (one or more FSSs: odds ratio=0.88, 95% CI=0.38-2.03; two or more FSSs: odds ratio=1.78, 95% CI=0.45-7.03), at the 1-month follow-up visit (one or more FSSs: odds ratio=0.57, 95% CI=0.22-1.45; two or more FSSs: odds ratio=0.57, 95% CI=0.14-2.37), or at the 3-month follow-up visit (one or more FSSs: odds ratio=0.97, 95% CI=0.36-2.63; two or more FSSs: odds ratio=1.27, 95% CI=0.29-5.65). CONCLUSIONS In this sample, the prevalence rates of FSSs were higher than rates previously reported for the general population. However, FSS history did not predict higher postconcussion symptom burden at clinic intake or persistence over the following 3 months. Further research is needed to clarify the potential role of somatization in poor mTBI outcome.
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Affiliation(s)
- Katherine Green
- Department of Psychiatry (Green, Panenka, Stubbs), and Department of Psychology (Silverberg), University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada (Panenka, Stubbs); British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada (Panenka); Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada (Cairncross, Silverberg); and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada (Cairncross, Silverberg)
| | - Molly Cairncross
- Department of Psychiatry (Green, Panenka, Stubbs), and Department of Psychology (Silverberg), University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada (Panenka, Stubbs); British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada (Panenka); Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada (Cairncross, Silverberg); and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada (Cairncross, Silverberg)
| | - William J Panenka
- Department of Psychiatry (Green, Panenka, Stubbs), and Department of Psychology (Silverberg), University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada (Panenka, Stubbs); British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada (Panenka); Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada (Cairncross, Silverberg); and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada (Cairncross, Silverberg)
| | - Jacob L Stubbs
- Department of Psychiatry (Green, Panenka, Stubbs), and Department of Psychology (Silverberg), University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada (Panenka, Stubbs); British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada (Panenka); Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada (Cairncross, Silverberg); and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada (Cairncross, Silverberg)
| | - Noah D Silverberg
- Department of Psychiatry (Green, Panenka, Stubbs), and Department of Psychology (Silverberg), University of British Columbia, Vancouver, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada (Panenka, Stubbs); British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, Canada (Panenka); Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada (Cairncross, Silverberg); and Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada (Cairncross, Silverberg)
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Picon EL, Perez DL, Burke MJ, Debert CT, Iverson GL, Panenka WJ, Silverberg ND. Unexpected symptoms after concussion: Potential links to functional neurological and somatic symptom disorders. J Psychosom Res 2021; 151:110661. [PMID: 34739941 DOI: 10.1016/j.jpsychores.2021.110661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Reporting of unexpected symptoms after concussion might, in some people, reflect a Functional Neurological Disorder (FND), Somatic Symptom Disorder (SSD), or exaggeration (feigning). This study aimed to determine whether reporting unexpected symptoms after concussion was associated with risk factors for FND/SSD, exaggeration, or both. METHOD Adults with persistent symptoms following concussion (N = 77; 61% women) rated the presence and severity of unexpected neurological symptoms (from the Screening for Somatoform Symptoms scale, e.g., paralysis) and somatic symptoms (from the Patient Health Questionnaire-15, e.g., stomach pain) that did not overlap with post-concussion symptom scale items. The independent variables were risk factors for exaggeration (neuropsychological performance validity test failure and personal injury litigation) and predisposing and perpetuating factors for developing FND and/or SSD (e.g., fear avoidance behavior). RESULTS When adjusting for all covariates, fear avoidance behavior was most strongly related to unexpected neurological symptoms (B = 0.11, 95% confidence interval = 0.05-0.18, p < .001), while current anxiety scores were most strongly related to unexpected somatic symptoms (B = 0.34, 95% confidence interval = 0.15-0.52, p < .001). Performance validity test failure and litigation were not significant predictors in either model. CONCLUSION Unexpected neurological and other somatic symptoms after concussion should not be dismissed as exaggeration. Psychological factors thought to perpetuate FND and SSD (e.g., fear avoidance behavior) may contribute to unexpected symptoms following concussion. More research is needed at the intersection of FND, SSD, and persistent post-concussive symptoms.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Canada.
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School; USA.
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA.
| | - Chantel T Debert
- Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Canada.
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital and Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, USA.
| | - William J Panenka
- Department of Psychiatry, University of British Columbia; BC Mental Health and Substance Use Research Institute; BC Neuropsychiatry Program, Canada.
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada.
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The Relationship Between Cognitive Functioning and Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder in Adults with a Traumatic Brain Injury: a Meta-Analysis. Neuropsychol Rev 2021; 32:758-806. [PMID: 34694543 DOI: 10.1007/s11065-021-09524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S, Skirrow P. Psychological flexibility in mild traumatic brain injury: an evaluation of measures. Brain Inj 2021; 35:1103-1111. [PMID: 34334064 DOI: 10.1080/02699052.2021.1959062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PRIMARY OBJECTIVE In this study, we examined the psychometric properties of measures of psychological flexibility in a mild traumatic brain injury (mTBI) sample. METHOD AND PROCEDURES Adults who sustained a mTBI (n = 112) completed the Acceptance and Action Questionnaire - Acquired Brain Injury reactive avoidance subscale (AAQ-ABI (RA). Exploratory factor analysis and Rasch analysis were conducted to evaluate the facture structure, dimensionality, and differential item functioning. Construct validity was determined by correlating the AAQ-ABI (RA) with the Acceptance and Action Questionnaire-Revised (AAQ-II) and Fear Avoidance after Traumatic Brain Injury (FAB-TBI). MAIN OUTCOME AND RESULTS The AAQ-ABI (RA) was found to have strong internal consistency (Cronbach's α = 0.87). Consistent with previous findings, the AAQ-ABI (RA) had one distinct factor. Fit to the unidimensional Rasch model was adequate (χ2 (18) = 22.5, p = .21) with no evidence of differential item functioning across person factors examined. The AAQ-ABI (RA) also had expected relationships with theoretically relevant constructs. CONCLUSIONS The AAQ-ABI (RA) appears to be a psychometrically sound measure of psychological flexibility in mTBI.
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Affiliation(s)
- Josh W Faulkner
- School of Psychology, Massey University, Wellington, New Zealand
| | - Deborah L Snell
- University of Otago Christchurch, University of Otago, Christchurch
| | - Alice Theadom
- TBI Network, Auckland University of Technology, TBI Network, Auckland University of Technology, University of Technology, Northcote, Auckland
| | - Susan Mahon
- TBI Network, Auckland University of Technology, TBI Network, Auckland University of Technology, University of Technology, Northcote, Auckland
| | | | - Paul Skirrow
- University of Otago Wellington, University of Otago, Newtown, Wellington
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11
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Fure SCR, Howe EI, Spjelkavik Ø, Røe C, Rike PO, Olsen A, Ponsford J, Andelic N, Løvstad M. Post-concussion symptoms three months after mild-to-moderate TBI: characteristics of sick-listed patients referred to specialized treatment and consequences of intracranial injury. Brain Inj 2021; 35:1054-1064. [PMID: 34314269 DOI: 10.1080/02699052.2021.1953593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To present pre-injury, injury-related, work-related and post-injury characteristics, and to compare patients with and without traumatic intracranial abnormalities, in a treatment-seeking sample with persistent post-concussion symptoms (PPCS) after mild-to-moderate TBI.Methods: Cross-sectional design in the context of a specialized TBI outpatient clinic. Eligible patients were aged 18-60 years, employed ≥ 50% at time of injury, and sick listed ≥ 50% at inclusion due to PPCS. Data were collected 8-12 weeks after injury through review of medical records, semi-structured interviews, questionnaires, and neuropsychological screening.Results: The study included 116 patients, of whom 60% were women, and predominantly white-collar workers in full-time positions. Ninety-four percent had a mild TBI, and 23% had intracranial abnormalities. The full sample reported high somatic, emotional, and cognitive symptom burden, and decreased health-related quality of life. Patients with normal CT/MRI results reported higher overall symptom burden, while patients with intracranial abnormalities had worse memory function.Conclusion: Injury severity and traumatic intracranial radiological findings should not be the sole ground for planning of rehabilitation service provision in patients with PPCS, as subjective complaints do not necessarily co-vary with these variables.
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Affiliation(s)
- Silje Christine Reistad Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
| | - Per-Ola Rike
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Technology and Science, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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Sullivan KA, Bennett D. An Experimental Study of the Effects of Biased Responding on the Modified Rivermead Post-concussion Symptoms Questionnaire and Validity Indicators. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Young G. Thirty Complexities and Controversies in Mild Traumatic Brain Injury and Persistent Post-concussion Syndrome: a Roadmap for Research and Practice. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09395-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Skandsen T, Stenberg J, Follestad T, Karaliute M, Saksvik SB, Einarsen CE, Lillehaug H, Håberg AK, Vik A, Olsen A, Iverson GL. Personal Factors Associated With Postconcussion Symptoms 3 Months After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 102:1102-1112. [PMID: 33127352 DOI: 10.1016/j.apmr.2020.10.106] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe personal factors in patients with mild traumatic brain injury (MTBI) and 2 control groups and to explore how such factors were associated with postconcussion symptoms (PCSs). DESIGN Prospective cohort study. SETTING Level 1 trauma center and outpatient clinic. PARTICIPANTS Participants (N=541) included patients with MTBI (n=378), trauma controls (n=82), and community controls (n=81). MAIN OUTCOME MEASURES Data on preinjury health and work status, personality, resilience, attention deficit/hyperactivity, and substance use. Computed tomography (CT) findings and posttraumatic amnesia were recorded. Symptoms were assessed at 3 months with the British Columbia Postconcussion Symptom Inventory and labeled as PCS+ if ≥3 symptoms were reported or the total score was ≥13. Predictive models were fitted with penalized logistic regression using the least absolute shrinkage and selection operator (lasso) in the MTBI group, and model fit was assessed with optimism-corrected area under the curve (AUC) of the receiver operating characteristic curve. RESULTS There were few differences in personal factors between the MTBI group and the 2 control groups without MTBI. Rates of PCS+ were 20.8% for the MTBI group, 8.0% for trauma controls, and 1.3% for community controls. In the MTBI group, there were differences between the PCS+ and PCS- group on most personal factors and injury-related variables in univariable comparisons. In the lasso models, the optimism-corrected AUC for the full model was 0.79, 0.73 for the model only including personal factors, and 0.63 for the model only including injury variables. Working less than full time before injury, having preinjury pain and poor sleep quality, and being female were among the selected predictors, but also resilience and some personality traits contributed in the model. Intracranial abnormalities on CT were also a risk factor for PCS. CONCLUSIONS Personal factors convey important prognostic information in patients with MTBI. A vulnerable work status and preinjury health problems might indicate a need for follow-up and targeted interventions.
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Affiliation(s)
- Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Jonas Stenberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Migle Karaliute
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Simen B Saksvik
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Cathrine E Einarsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanna Lillehaug
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Asta K Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alexander Olsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts
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15
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Faulkner JW, Theadom A, Mahon S, Snell DL, Barker-Collo S, Cunningham K. Psychological flexibility: A psychological mechanism that contributes to persistent symptoms following mild traumatic brain injury? Med Hypotheses 2020; 143:110141. [DOI: 10.1016/j.mehy.2020.110141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
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