Trajectories of Persistent Postconcussion Symptoms and Factors Associated With Symptom Reporting After Mild Traumatic Brain Injury

Fordal, Linda; Stenberg, Jonas; Saksvik, Simen Berg; Karaliute, Migle; Vik, Anne; Olsen, Alexander; Skandsen, Toril

doi:10.1016/j.apmr.2021.09.016

Cited by 19 publications

(11 citation statements)

References 53 publications

(79 reference statements)

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“…4,18,41 While concussionrelated symptoms gradually improve within a week in most cases, 27 persistent postconcussive symptoms can be observed in 21% to 46% of adults 3 to 6 months after the injury. 6,10,40 Symptoms and disability should be objectively documented to monitor a patient's status and progress over time in order to guide clinical decision-making. 36 The Post-Concussion Symptom Scale (PCSS), also known as the 22-Item Post-Concussion Scale, 19 is a self-reported questionnaire that was recommended at the 5th International Conference on Concussion in Sport 27 to monitor clinical recovery.…”

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confidence: 99%

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confidence: 99%

“…4,18,41 While concussion-related symptoms gradually improve within a week in most cases, 27 persistent postconcussive symptoms can be observed in 21% to 46% of adults 3 to 6 months after the injury. 6,10,40…”

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confidence: 99%

“…Secondary objectives were to evaluate the longitudinal validity of the PCSS compared with other questionnaires and to explore the internal responsiveness of the NPRS, NDI, DHI, and HDI for a population with persistent symptoms after a concussion. Since time and rehabilitation interventions have been shown to lead to large improvements in this population, 10,21,37,40 the a priori hypotheses were that (1) the PCSS would be highly responsive (ES and SRM, >0.8); (2) the area under the ROC curve (AUC) of the PCSS MCID would be ≥0.7 35 ; (3) change scores on the PCSS and change scores on the NDI, DHI, and HDI would be positively and moderately correlated (>0.5), while they would not be correlated with change scores on NPRS because NPRS evaluates a single construct and symptom; and (4) HDI, NDI, DHI, and NPRS would be highly responsive (>0.8).…”

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confidence: 99%

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Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury

Langevin

Frémont

Fait

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity of symptoms after a concussion/mild traumatic brain injury. However, its responsiveness to monitor clinical recovery has yet to be determined. Purpose: To evaluate the responsiveness of the PCSS to change and longitudinal validity in patients with persistent postconcussive symptoms as well as to explore the responsiveness of other clinical outcome measures to monitor recovery of physical symptoms in patients with persistent postconcussive symptoms. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with persistent symptoms after a concussion (N = 109) were evaluated using self-reported questionnaires at baseline and after a 6-week rehabilitation program. The program consisted of an individualized symptom-limited aerobic exercise program combined with education. Questionnaires included the PCSS, Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), and Numeric Pain Rating Scale (NPRS) related to 1) neck pain and 2) headache. Internal responsiveness was evaluated using the effect size (ES) and standardized response mean (SRM), and external responsiveness was determined with the minimal clinically important difference (MCID) calculated using a receiver operating characteristic curve. The global rating of change was used as the external criterion. Pearson correlations were used to determine the longitudinal validity. Results: The PCSS was highly responsive (ES and SRM, >1.3) and had an MCID of 26.5 points (of 132) for the total score and 5.5 (of 22) for the number of symptoms. For longitudinal validity, low to moderate correlations were found between changes in PCSS and changes in NDI, HDI, and DHI. The NDI, HDI, DHI, and NPRS were also highly responsive (ES and SRM, >0.8). Conclusion: All questionnaires including the PCSS were highly responsive and can be used with confidence by clinicians and researchers to evaluate change over time in a concussion population with persistent symptoms.

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Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury

Langevin

Frémont

Fait

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Both the parasympathetic and sympathetic divisions of the autonomic nervous system are affected (Blennow et al, 2012;Leddy et al, 2010), leading to common symptoms including dizziness, difficulty concentrating, and headache (Permenter et al, 2017). Persistence of symptoms is likely dependent on the interaction of numerous biopsychosocial factors (Wäljas et al, 2015), including pre-injury physical and mental health conditions (Fordal et al, 2022;Gornall et al, 2019), poor coping skills (Cassetta et al, 2021), low resilience (Fordal et al, 2022;Skandsen et al, 2021), and personality characteristics (Garden et al, 2010;Skandsen et al, 2021).…”

Section: Impact Of Concussion: Persistent Post-concussive Symptomsmentioning

confidence: 99%

Regional Blood Flow Alterations Following Pediatric Concussion: A PedCARE+MRI Substudy

Kardish¹

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Background: This study examined whether cerebral blood flow (CBF) differed between children with concussion and orthopedic injury (OI) controls at 72 hours and 4 weeks post-injury. It also examined whether psychological resilience and acute CBF improved prediction of 2-and 4-week concussion symptoms beyond the existing 5P score prediction tool.Methods: Concussed and OI participants, aged 10-18 years, were enrolled from CHEO's Emergency Department. Arterial spin labelling was used to measure CBF at 72 hours and 4 weeks post-injury. Symptoms were assessed using the Health and Behaviour Inventory at 2 and 4 weeks. Self-reported psychological resilience was measured with the Connor-Davidson Resilience Scale. Crude and adjusted mixed model analyses were conducted to assess absolute CBF (aCBF) and normalized aCBF in both groups over time. Multiple regression analyses assessed whether the 5P score, regional CBF, and resilience combined predicted 2-and 4-week symptoms for the concussion group.Results: A total of 70 participants with concussion (Mage=13.05±2.02, 47% female) and 29 with OI (Mage=12.59±1.97, 41% female) were included. For aCBF, a significant group*time interaction was found in the left anterior cingulate/medial frontal cortex (L_ACC_MFC) and right middle frontal gyrus (R_MFG). In the L_ACC_MFC, the concussion group showed increased CBF compared to OIs both time points (p<.001). In the R_MFG, CBF was increased compared to OIs at 4 weeks (p<.001), but not 72 hours. In both regions, CBF increased over time in the concussion group (p≤.001), but did not differ between time points for OIs. Concussed participants also had increased CBF in the left angular gyrus (L_angular) that did not differ between time points. For normalized aCBF, the concussion group displayed significantly iii increased CBF in the L_ACC_MFC, R_MFG, and L_angular, and significantly decreased CBF in the right superior temporal gyrus (R_STG), right fusiform gyrus (R_fusiform), and bilateral lingual gyri. The multiple regression model revealed that the 5P score, L_ACC_MFC or R_MFG CBF, and resilience combined did not significantly predict 2-or 4-week symptoms for the concussion group.Conclusion: Though clinical significance remains unclear, these results are an important contribution to the pediatric concussion literature, as they indicate clear CBF alterations in pediatric concussion with some regional CBF varying in time. These results are important for understanding persistent neurobiological deficits after concussion.

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Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

et al. 2022

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ImportanceApproximately 15% to 30% of individuals with a history of concussion present with persistent postconcussion symptoms (PPCS). Individuals with PPCS are at greater risk of experiencing depressive symptoms.ObjectiveTo synthesize the association between depressive symptoms and PPCS in children, adolescents, and adults via meta-analysis and to investigate potential moderators of that association.Data SourcesSystematic search of Ovid Medline, CINAHL, PsycInfo, and Embase from 1995 to January 2022 was performed. Additionally, references from included studies were hand-searched to ensure relevant articles were captured in the search.Study SelectionStudies that involved participants who experienced PPCS and quantified depressive symptoms were included. The definition of PPCS was limited to physician-diagnosed or self-reported concussion, with symptoms lasting for a minimum of 4 weeks postinjury. Two authors independently screened all articles to determine study eligibility.Data Extraction and SynthesisStudy characteristics were extracted independently by 2 trained investigators. Study data were meta-analyzed using a random-effects meta-analysis.ExposurePPCS.Main Outcomes and MeasuresThe the primary outcome was depressive symptoms.ResultsData were extracted from 18 studies with a total of 9101 participants. Of the 18 studies, all were cohort studies, and 13 (72%) comprised adult populations. The mean (SD) time since concussion was 21.3 (18.7) weeks. After accounting for potential publication bias, the random-effects meta-analysis found a significant positive association between PPCS and depressive symptoms, (odds ratio, 4.56; 95% CI, 2.82-7.37; P &lt; .001). There were no significant moderators, likely due to the small number of studies included.Conclusions and RelevanceIn this meta-analysis, experiencing PPCS was associated with a higher risk of experiencing depressive symptoms. There are several important clinical and health policy implications of the findings. Most notably, the development of strategies for effective prevention and earlier intervention to optimize mental health recovery following a concussion should be supported.

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Trajectories of Persistent Postconcussion Symptoms and Factors Associated With Symptom Reporting After Mild Traumatic Brain Injury

Cited by 19 publications

References 53 publications

Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury

Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury

Regional Blood Flow Alterations Following Pediatric Concussion: A PedCARE+MRI Substudy

Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

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