Feasibility of Concussion Rehabilitation Approaches Tailored to Psychological Coping Styles: A Randomized Controlled Trial

Silverberg, Noah D.; Cairncross, Molly; Brasher, Penelope M. A.; Vranceanu, Ana‐Maria; Snell, Deborah L.; Yeates, Keith Owen; Panenka, William J.; Iverson, Grant L.; Debert, Chantel T.; Bayley, Mark; Hunt, Cindy; Baker, Andrew J.; Burke, Matthew J.

doi:10.1016/j.apmr.2021.12.005

Cited by 20 publications

(22 citation statements)

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“…The present study used baseline data from a randomized feasibility trial of behavioral interventions for persistent symptoms following mTBI (Silverberg et al, 2022). Adults with mTBI ( N = 91) were recruited from two outpatient mTBI clinics in British Columbia, Canada, between April 2019 and February 2020.…”

Section: Methodsmentioning

confidence: 99%

“…We measured catastrophic thinking about symptoms using an adapted version of the Pain Catastrophizing Scale (Sullivan et al, 1995). The parent study adapted the Pain Catastrophizing Scale by replacing “pain” with “symptoms” throughout (Silverberg et al, 2022). The scale begins with the stem “When I’m having symptoms” and includes 13 stem completion items (e.g., “it’s terrible and I think it’s never going to get any better”) that are rated on a 5-point scale ranging from 0 ( not at all ) to 4 ( all the time ).…”

Section: Methodsmentioning

confidence: 99%

“…Details of the parent study design and recruitment procedures are reported in Silverberg et al (2022). We report in the present study how we selected participants from the parent study (Appelbaum et al, 2018).…”

Section: Methodsmentioning

confidence: 99%

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Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury.

Shi,

Picon,

Rioux

et al. 2024

Neuropsychology

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Objective: Persistent cognitive symptoms after mild traumatic brain injury (mTBI) often do not correlate with objective neuropsychological performance. Catastrophizing (i.e., excessively negative interpretations of symptoms) may help explain this discrepancy. We hypothesize that symptom catastrophizing will be associated with greater cognitive symptom reporting relative to neuropsychological test performance in people seeking treatment for mTBI. Method: Secondary analysis of baseline data from a randomized controlled trial. Adults with mTBI (N = 77) were recruited from two outpatient mTBI clinics in British Columbia, Canada. Questionnaires and assessments were administered at baseline (M = 17.7 weeks postinjury). The sample was 64% women with a mean age of 42 years (SD = 11.5). Validated questionnaires were used to assess catastrophizing, cognitive symptoms, and affective distress. Neuropsychological performance was assessed using the National Institutes of Health Toolbox Cognition Battery. Discrepancies between cognitive symptoms and cognitive functioning were operationalized using standard residuals from neuropsychological test performance scores regressed on cognitive symptom scores. Generalized linear models were run to measure the association between symptom catastrophizing, cognitive variables, and their discrepancy, with affective distress as a covariate. Results: Symptom catastrophizing was associated with more severe cognitive symptoms when controlling for neuropsychological performance (β = 0.44, 95% CI [0.23, 0.65]). Symptom catastrophizing was also associated with higher subjective-objective cognition residuals (β = 0.43, 95% CI [0.22, 0.64]). Catastrophizing remained a significant predictor after affective distress was introduced as a covariate. Conclusions: Catastrophizing is associated with misperceptions of cognitive functioning following mTBI, specifically overreporting cognitive symptoms relative to neuropsychological performance. Symptom catastrophizing may be an important determinant of cognitive symptom reporting months after mTBI. Key PointsQuestion: Can symptom catastrophizing help explain excess cognitive symptoms after mTBI? Findings: Symptom catastrophizing was associated with greater cognitive symptom reporting relative to neuropsychological test performance in patients seeking treatment for mTBI. Importance: Symptom catastrophizing may be a modifiable risk factor for persistent cognitive symptoms after mTBI. Next Steps: Future studies should evaluate psychological interventions targeting catastrophizing, such as cognitive behavioral therapy, for patients with excess cognitive symptoms after mTBI.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury.

Shi,

Picon,

Rioux

et al. 2024

Neuropsychology

Self Cite

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“…This study is a secondary analysis of a clinical trial investigating the feasibility of rehabilitation approaches tailored to psychological coping styles after mTBI (Silverberg et al 7 ; ClinicalTrials.gov: NCT03972579). The University of British Columbia Behavioural Research Ethics Board approved all study procedures.…”

Section: Study Populationmentioning

confidence: 99%

Litigation, Performance Validity Testing, and Treatment Outcomes in Adults With Mild Traumatic Brain Injury

Mikolic,

Panenka,

Iverson

et al. 2023

Journal of Head Trauma Rehabilitation

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Objective: To investigate whether involvement in litigation and performance validity test (PVT) failure predict adherence to treatment and treatment outcomes in adults with persistent symptoms after mild traumatic brain injury (mTBI). Setting: Outpatient concussion clinics in British Columbia, Canada. Participants were assessed at intake (average 12.9 weeks postinjury) and again following 3 to 4 months of rehabilitation. Participants: Adults who met the World Health Organization Neurotrauma Task Force definition of mTBI. Litigation status was known for 69 participants (n = 21 reported litigation), and 62 participants completed a PVT (n = 13 failed the Test of Memory Malingering) at clinic intake. Design: Secondary analysis of a clinical trial (ClinicalTrials.gov #NCT03972579). Main Measures: Outcomes included number of completed sessions, homework adherence, symptoms (Rivermead Post Concussion Symptoms Questionnaire), disability ratings (World Health Organization Disability Assessment Schedule 2.0), and patient-rated global impression of change. Results: We did not observe substantial differences in session and homework adherence associated with litigation or PVT failure. Disability and postconcussion symptoms generally improved with treatment. Involvement in litigation was associated with a smaller improvement in outcomes, particularly disability (B = 2.57, 95% confidence interval [CI] [0.25-4.89], P = .03) and patient-reported global impression of change (odds ratio [OR] = 4.19, 95% CI [1.40-12.57], P = .01). PVT failure was not associated with considerable differences in treatment outcomes. However, participants who failed the PVT had a higher rate of missing outcomes (31% vs 8%) and perceived somewhat less global improvement (OR = 3.47, 95% CI [0.86-14.04]; P = .08). Conclusion: Adults with mTBI who are in litigation or who failed PVTs tend to adhere to and improve following treatment. However, involvement in litigation may be associated with attenuated improvements, and pretreatment PVT failure may predict lower engagement in the treatment process.

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“…If this is accurate for a concussed population, intervention addressing these coping methods can be implemented. Encouragingly, fear avoidance behaviour responds well to graded exposure therapy in adults with prolonged concussion symptoms (Silverberg et al, 2022). Both fear avoidance and pain catastrophizing will be assessed in this thesis.…”

Section: Fear Avoidancementioning

confidence: 99%

Ready to Play: A Biopsychosocial Approach to Return-to-Sport in Adults with Prolonged Concussion Symptoms

Wong¹

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Introduction: Sport-related concussions are recognized in all types of sports in athletes of all ages. While concussion presentation involves transient symptoms, some may have prolonged symptoms that linger past the typical 2-week recovery time for adults. These prolonged symptoms can affect physical, emotional, cognitive, and sleep domains.Research Significance: This thesis examined adult athletes who experience prolonged symptoms of sport-related concussion to further our understanding of the type of symptoms that are common in an understudied population. Many of the psychological and sociological deficits are not evaluated in preparation for return to sport, but the aim of the thesis is to show their need to be included. Links between psychosocial and physical impairments can drive decisions regarding return to sport. Methods:Based on the biopsychosocial model, 3 cross-sectional studies assessed which symptom domains were clinically relevant, associated with disability, and related to each other. The studies included several clinical outcome measures delivered in online format such as the concussion symptoms, fear avoidance, sleep changes, cogniphobia, pain catastrophizing, and disability post-concussion. The last study included a small sample of participants doing a qualitative interview to confirm objective findings. They were asked to reflect on mental health, sociological impacts, and physical symptoms. Results:The concussion groups showed clinically relevant levels of concussion symptoms, mental health distress, and fear avoidance behaviour. The athletes also presented with significant changes in their abilities of daily activities. Episodic memory was also found to be a deficit for this study. Athlete interviews had statements about fear, loss of self, acceptance, and emotional regulation. Limitations included changing to online formats due to Covid-19, small sample sizes, and utilization of new outcome measures. Future work would expand on the emotional and sociological findings and address cognitive tasks for adults with prolonged symptoms. Evaluation in conjunction with physical activity or training helps an athlete return to sport.Conclusions: Adult athletes with prolonged symptoms of sport-related concussion live with many physical, emotional, and sociological impairments. It is a population that needs further research to focus on their impact and future intervention plans.

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Feasibility of Concussion Rehabilitation Approaches Tailored to Psychological Coping Styles: A Randomized Controlled Trial

Cited by 20 publications

References 65 publications

Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury.

Catastrophizing is associated with excess cognitive symptom reporting after mild traumatic brain injury.

Litigation, Performance Validity Testing, and Treatment Outcomes in Adults With Mild Traumatic Brain Injury

Ready to Play: A Biopsychosocial Approach to Return-to-Sport in Adults with Prolonged Concussion Symptoms

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