When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury.
ABSTRACT A significant proportion (15-30%) of patients with mild traumatic brain injury (MTBI) are at risk of developing postconcussional syndrome (PCS). The aim of this study was to investigate the contributions of cognitive, emotional, behavioural and social factors to the development of PCS and identify early predictors.
A prospective cohort design was employed. 126 MTBI patients completed baseline questionnaire assessments within 2 weeks of the injury and 107 completed follow-up questionnaire assessments at 3 and 6 months. A series of self-report measures were used to assess cognitive, behavioural and emotional responses to MTBI. The primary outcome was the ICD-10 diagnosis for PCS. Demographic and clinical characteristic variables were compared between PCS cases and non-cases using independent sample t tests and χ(2) tests. Individual and multivariate logistic regression analyses were used to detect predictors of PCS.
Of 107 MTBI patients, 24 (22%) met the criteria for PCS at 3 months and 22 (21%) at 6 months. Individual logistic regression analysis indicated that negative MTBI perceptions, stress, anxiety, depression and all-or-nothing behaviour were associated with the risk of PCS. Multivariate analysis revealed that all-or-nothing behaviour was the key predictor for the onset of PCS at 3 months while negative MTBI perceptions predicted PCS at 6 months.
The study provides good support for the proposed cognitive behavioural model. Patients' perceptions of their head injury and their behavioural responses play important roles in the development of PCS, indicating that cognitive and behavioural factors may be potential targets for early preventive interventions.
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ABSTRACT: Abstract Objective: Best practice guidelines outline ways in which mild traumatic brain injury (mTBI) and persistent post-concussive symptoms (PPCS) should be managed. In line with the existing evidence base, DMRC Headley Court established a treatment programme for UK servicemen and women with mTBI. This study explored the experiences of a sample of UK military personnel living with PPCS, who also received psycho-educational intervention (Phase 2) at this unit. Setting: DMRC Headley Court, Southeast England. Participants: Sixteen service personnel who had completed the intervention within 24 months prior to interview. Design: Semi-structured qualitative interview study, with purposive sampling and thematic analysis. Results: Participants described their mTBI in terms of: (1) onset; (2) subsequent symptom experience; (3) recovery; and (4) acceptance. All participants reported a significant degree of confusion and chaos in the aftermath of their traumatic event. These themes highlighted how, following enrolment onto the Phase 2 intervention at DMRC Headley Court, participants reported being (largely) able to manage PPCS. Further, many reported acceptance of their condition and described how they had managed to re-establish a sense of order. Conclusions: Following a flexible and tailored intervention for PPCS, patients report feeling empowered and describe having a renewed sense of stability.Brain Injury 01/2014; 28(1):71-80. · 1.51 Impact Factor
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ABSTRACT: Objective To determine the incidence, course, and prognosis of adult mild traumatic brain injury (MTBI) caused by motor vehicle collisions. Design Prospective, population-based, inception cohort study. Setting The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants. Participants All adults (N=1716) incurring an MTBI in a motor vehicle collision between November 1997 and December 1999 in Saskatchewan. Interventions Not applicable. Main Outcome Measures Age- and sex-stratified incidence rates, time to self-reported recovery, and prognostic factors over a 1-year follow-up. Results Of 7170 adults injured in a motor vehicle collision over the 2-year inception period, 1716 (24%) met our cohort definition of MTBI. There were more women affected (53%), and MTBI was most common in the 18- to 23-year-old group. Most were not hospitalized (73%), but 28% reported loss of consciousness and 23% reported posttraumatic amnesia. The annual incidence of MTBI per 100,000 adults was 106.1 (95% confidence interval [CI], 98.9–113.6) in the first year and 118.3 (95% CI, 110.8–126.3) in the second year of the study. The 1-year follow-up rate was 84%. The median time to recovery was 100 days (95% CI, 97–103), and about 23% reported not having recovered by 1 year. Factors associated with delayed recovery included being older than 50 years, having less than a high school education, having poor expectations for recovery, having depressive symptoms, having arm numbness, having hearing problems, having headaches, having low back pain, and having thoracic back pain. Loss of consciousness and posttraumatic amnesia were not associated with recovery. Conclusions MTBI affects almost a quarter of persons reporting an injury after a traffic collision. The median time to recovery is 100 days, but 23% have still not recovered by 1 year. A mix of biopsychosocial factors is associated with recovery, including a strong effect of poor expectations for recovery.Archives of physical medicine and rehabilitation 01/2014; 95(3):S278–S285. · 2.18 Impact Factor
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ABSTRACT: Objective To update the mild traumatic brain injury (MTBI) prognosis review published by the World Health Organization Task Force in 2004. Data Sources MEDLINE, PsycINFO, Embase, CINAHL, and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies with more than 30 adult cases. Study Selection Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess subjective, self-reported outcomes. After 77,914 titles and abstracts were screened, 299 articles were eligible and reviewed for scientific quality. This includes 3 original International Collaboration on MTBI Prognosis (ICoMP) research studies. Data Extraction Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed each study and tabled data from accepted articles. A third reviewer was consulted for disagreements. Data Synthesis Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress. Conclusions Common subjective symptoms after MTBI are not necessarily caused by brain injury per se, but they can be persistent in some patients. Those with more initial complaints and psychological distress recover slower. We need more high-quality research on these issues.Archives of physical medicine and rehabilitation 01/2014; 95(3):S132–S151. · 2.18 Impact Factor