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: Purpose ‐ Ex-service personnel face numerous and significant problems upon discharge from the forces. The purpose of this paper is to explore experiences of the transition from military to civilian life and to identify some of the barriers and facilitators to re-employment. Design/methodology/approach ‐ In-depth interviews were carried out with 11 ex-servicemen who had previously served in the UK armed forces and analysed using interpretative phenomenological analysis (IPA). Findings ‐ Participants described their experiences in terms of three broad themes: characteristics of a military life; loss as experienced upon return to civilian life; and the attempt to bridge the gap between these two lives. Transcending these themes was the notion of identity, illustrating that the transition from military to civilian life can be viewed as a shift in sense of self from soldier to civilian. Research limitations/implications ‐ The current study only recruited male ex-service personnel and therefore the findings may not accurately represent the experiences of female service leavers. Practical implications ‐ The military needs to ensure that not only is support provided for all service personnel, but that it goes beyond basic vocational advice. Although the needs of ex-service personnel are defined by factors other than unemployment, such as trauma or the sudden loss of security, they do relate back to unemployment in some capacity. Methodological changes to the discharge process could help this population to achieve a more continuous trajectory rather than a fragmented one. Originality/value ‐ The present study has provided further insight into the identity experiences of ex-service personnel along their journey from soldier to civilian. Breakwell's Identity Process Theory provided a valuable framework for understanding the experiences of ex-service personnel.Journal of Aggression. 01/2013; 5(2).
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ABSTRACT: We undertook a best-evidence synthesis to study fatigue in traumatic brain injury.•We examined natural history, predictors and consequences of post-traumatic fatigue.•Different factors influence the course of new onset or chronic fatigue.•Certain variables are predictors of fatigue severity at follow-up.•Early fatigue predicted post-concussive symptoms and outcome score at follow-up.Neuroscience & Biobehavioral Reviews 11/2014; · 10.28 Impact Factor
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ABSTRACT: Objective: To examine the epidemiology of referrals to a specialist neurotrauma clinic and explore and highlight implications for clinical practice and service development for persons with head injury/traumatic brain injury (HI/TBI). Design and methods: A retrospective population-based cohort study of all referrals to a specialist neurotrauma clinic over a 9-year period. Data from a specialist head injury database (which included all persons presenting to hospital with traumatic brain injury) were analysed. Results: In total, 1235 new patients of all ages, severities of injury, both admitted and non-admitted were referred. Referrals have increased due to successful integration with new service developments and resulting optimization of resources. Conclusions: Data gathered from the cohort gives increased understanding of the characteristics and numbers of patients requiring rehabilitation and adds to the evidence-base. Integration with new and complementary service developments has optimized the function/aims of the clinic and enhanced its role in terms of patient service and outcome and as a research resource. The model provides principles which may be applied to planning, organizing and providing follow-up/rehabilitation services for HI/TBI.Brain Injury 08/2014; · 1.51 Impact Factor