Objective
Variability in recovery time following sport-related concussion (SRC) is poorly understood. We explored the utility of brief mood, anxiety, and sleep questionnaires as postinjury predictors of SRC symptom clearance in adolescents.
Method
At initial visit 0–2 weeks postinjury, concussed athletes aged 12–18 years self-reported injury/medical factors (prior concussion, loss of consciousness, amnesia, and concussion symptom severity) and were administered psychological symptom measures. At 3 months, medical record review determined return-to-play (RTP) date. Subjects were divided into two datasets, with the first utilized for developing cutoff scores and then validated with the second dataset.
Results
A total of 64% of the 141 participants had early RTP (within 21 days postinjury), and 23% had late RTP (postinjury day 30 or later). The Generalized Anxiety Disorder Screener (GAD-7, M = 2.1, SD = 3.1) was the only significant predictor (p = .001), with a 1.4-fold [95% CI 1.2–1.8] increased risk for every point. No other factors in the full model discriminated recovery groups (ps > .05). Receiver operating characteristic curve analysis derived a GAD-7 cut score ≥3 (sensitivity= 56.7%, specificity = 74.2%, AUCs = 0.63–0.79, ps < .001).
Conclusions
Postconcussion anxiety symptoms may help identify individuals at increased risk for prolonged recovery.
The National Spinal Cord Injury Statistical Center estimates 294,000 people in the US live with a spinal cord injury (SCI), with approximately 17,810 new cases each year. Although the physical outcomes associated with SCI have been widely studied, the psychological consequences of sustaining a SCI remain largely unexplored. Scant research has focused on posttraumatic stress disorder (PTSD) in this population, despite prevalence estimates suggesting that up to 60% of individuals with SCI experience PTSD post-injury, compared to only 7% of the general US population. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. However, no trauma focused exposure-based therapy for PTSD (e.g. PE) has not yet been tested in a SCI population. Thus, we aim to conduct the first test of an evidence-based intervention for PTSD among patients with SCI. Adults with SCI and PTSD (
N
= 60) will be randomly assigned to either: (1) 12-sessions of PE (2–3 sessions per week) or (2) a treatment as usual (TAU) control group who will receive the standard inpatient rehabilitation care for SCI patients. Primary outcomes will be assessed at 0, 6, 10, and 32 weeks.
Background:
Clinical diagnosis of cognitive disorders depends on accurate reporting of
medical history, yet little is known about the reliability and the validity
of such reports, particularly in older patients with and without cognitive
impairment.
Methods:
In 2 studies, we examined the reliability and the validity of reported
histories of select medical events in adults with and without cognitive
impairment from a large national cohort.
Results:
Information from subjects (N
1
= 3664), obtained from 2 time
points, 6 to 12 months apart, was consistent across most medical events,
regardless of the diagnostic group (range = 97.6%-100% agreement; Cohen κ
range = 0.712-0.945), with few exceptions. Validity analyses
(N
2
= 382) revealed that 3 of 5 medical events assessed showed
substantial agreement between self-report information and clinician
diagnosis.
Conclusions:
These data represent some of the first to demonstrate the reliability and the
validity of reported select medical events in older adults with and without
cognitive impairment.
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