Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury

Abstract

There is increasing evidence that some people can experience persistent symptoms for up to a year following mild TBI. However, few longitudinal studies of mild TBI exist and the longer-term impact remains unclear. The purpose of this study is to determine if there are long-term effects of mild traumatic brain injury (TBI) four-years later. Adults (aged ≥16 years) identified as part of a TBI incidence study who experienced a mild-TBI four-years ago (N = 232) were compared to age-sex matched controls (N = 232). Sociodemographic variables, prior TBI and symptoms were assessed at the time of injury. Four years post-injury participants completed the Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and the Participation Assessment with Recombined Tools. Analysis of covariance was used to compare differences between TBI cases four years post-injury and controls, controlling for prior TBI and depression. A multiple regression model was used to identify the predictors of increased symptoms and reduced participation. The mild-TBI sample experienced significantly increased self-reported cognitive symptoms (F = 19.90, p = <0.01) four years post-injury than controls. There were no differences between the groups for somatic (F = 0.02, p = 0.89) or emotional symptoms (F = 0.31, p = 0.58). Additionally, the mild-TBI group reported significantly poorer community participation across all three domains: productivity (F = 199.07, p = <0.00), social relations (F = 13.93, p = <0.00) and getting out and about (F = 364.69, p = <0.00) compared to controls. A regression model accounting for 41% of the variance in cognitive symptoms in TBI cases revealed a history of TBI, receiving acute medical attention and baseline cognitive symptoms, sleep quality, anxiety and depression were predictive of outcome. The results indicate that whilst somatic and emotional symptoms resolve over time, cognitive symptoms can become persistent and that mild TBI can impact longer-term community participation. Early intervention is needed to reduce the longer-term impact of cognitive symptoms and facilitate participation.

Fatigue, Participation and Quality of Life in Adolescents and Young Adults with Acquired Brain Injury in an Outpatient Rehabilitation Cohort

“…Therefore, the question remains whether it is necessary to measure both patient-and parent-reported fatigue as was suggested in other studies. 15,51,52 Participation Patients and their parents in this study reported participation restrictions in all domains of participation (median total score 82.5 (IQR 68.8, 92.3), 91.1 (80.0, 96.9), respectively), supporting earlier studies in this patient population (pediatric ABI 27,53 ; adult mTBI 54 ; stroke. 55 ) In the current study, AYAs reported significantly more participation restrictions than their parents, in home, community and school activities.…”

Physical activity after mild traumatic brain injury: What are the relationships with fatigue and sleep quality?

“…Seven items (subjective sleep quality, sleep latency (the time from lying down for sleep to the start of actual sleep), sleep duration, habitual sleep efficiency (the proportion of actual sleep time spent in bed), sleep disturbances, use of sleep medication and day time dysfunction) are scored on 4 point Likert scales (0e3, low to high), with a total score ranging from 0 to 21 with higher scores representing poorer sleep quality. The PSQI has been used in pediatric 42 and adult TBI studies. 43 2.8.…”

Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

“…Although the emergency department is the typical point of entry into the health care system, increasingly, patients with mTBI are first seeking medical attention from a community-based primary care provider. [11][12][13][14] Primary care providers and specialists (eg, neurologists, physiatrists, etc) unattached to a TBI-specific clinic are often relied on to provide and/or arrange early follow-up care. 15 Traditionally, mTBI has been thought to require minimal clinical management beyond watchful waiting.…”