Caroline van Heugten’s research while affiliated with Maastricht University and other places

A significant number of COVID-19 survivors continue to experience persistent physical, cognitive, and psychological symptoms up to one year after discharge. This study aimed to examine the frequency, severity, and progression of and risk factors for these symptoms. This single-centre retrospective cohort study included 126 COVID-19 patients admitted to the VieCuri Medical Centre between 2020 and 2022. Follow-up assessments were conducted at 3 and 12 months postdischarge, including pulmonary function tests, CT scans, bioimpedance analysis, and questionnaires on physical, cognitive, and psychological symptoms. At both follow-up assessments, 31–32% of patients reported moderate to severe physical symptoms, 26–27% reported multiple cognitive symptoms, and 14–18% experienced depressive or posttraumatic stress symptoms (PTSSs). Only anxiety symptoms significantly decreased between the 3-month follow-up and the 12-month follow-up (from 22 to 12%; p = .014). The persistence of symptoms at 12 months was significantly associated with premorbid conditions (chronic respiratory disease, multiple comorbidities), illness severity (infection during the third wave), physical factors (COVID-19-related pulmonary abnormalities, lower total lung capacity, and dyspnoea), and cognitive and psychological factors (cognitive symptoms, anxiety, depression, and PTSS) (p < .05). These findings suggest that a significant proportion of COVID-19 survivors continue to experience persistent symptoms due to biopsychosocial factors, thus emphasizing the need for a biopsychosocial approach in early screening and treatment.

Background: Sensory changes are commonly observed in individuals with moderate-severe traumatic brain injury (msTBI) but remain under-researched. Objectives: This study examined the prevalence of sensory changes after msTBI and relationships with emotional distress, functional disability, and life satisfaction. Methods: A cross-sectional survey was conducted including 387 participants with msTBI (M=12.8 years post-injury; range=0.4–35.0) and 60 controls, not matched on age and sex but recruited in the same time period. Self-reported sensory symptoms were assessed using a custom checklist and the Somatic Symptom Scale–8. Emotional distress, functional disability, and life satisfaction were measured through the Hospital Anxiety and Depression Scale, 12-Item World Health Organization Disability Assessment Schedule 2.0, and Satisfaction With Life Scale. We compared the frequency of sensory symptoms between groups, and associations with demographics, injury factors, and clinical outcomes were examined within the msTBI sample. Results: 70% with msTBI reported experiencing ≥1 sensory changes due to their brain injury, and 35% reported experiencing dizziness in the previous week, averaging 2.2 symptoms in total—significantly higher than controls after adjusting for age and sex. Sensory changes were more common in younger participants (light hypersensitivity), females (light and noise hypersensitivity), those with more severe TBI (overall sensory changes, affected vision, reduced smell), and those fewer years post-injury (overall sensory changes, noise hypersensitivity, reduced smell, altered taste, dizziness), though many of these associations did not survive multiple comparison correction. Sensory changes were clearly and consistently associated with worse clinical outcomes, with medium-large effect sizes for emotional distress and functional disability and smaller effects for life satisfaction. Conclusions: Although causality cannot be established, these findings suggest that sensory changes are a clinically significant issue after msTBI, even among individuals more than a decade post-injury on average. This underscores the need for routine assessment and further research on underlying mechanisms and interventions.

Background Emotional and cognitive problems are prevalent after stroke. We developed an intervention including screening for emotional and cognitive problems, screening for participation restrictions, self-management support including education and, if needed, referral to rehabilitation services. This intervention was delivered through a nurse-led outpatient consultation at six weeks after stroke. Its effectiveness was examined in a patient-blinded, cluster-randomized controlled trial and its feasibility in a process evaluation. This process evaluation aims to (1) assess the reach, dose and fidelity of the intervention, (2) evaluate barriers and facilitators to implementation and (3) explore experiences from the perspective of healthcare providers. Methods A mixed-methods study was conducted. Specialized nurses offering the intervention completed registration forms to evaluate the reach, dose and fidelity of the intervention. The Barriers and Facilitators Instrument (BFAI) was used to evaluate barriers and facilitators. Furthermore, the specialized nurses participated in a group interview to explore experiences in delivering the intervention. Group interviews were analysed using inductive thematic analysis. Results In total, 262 of 264 patients (99.2%) attended the intervention. In 233 patients (88.9%), all screening instruments were completed. The BFAI demonstrated that the intervention was feasible and was not considered time-consuming or hindered by contextual factors. Barriers to deliver the intervention were limited to patient characteristics. During group interviews, specialized nurses reported that the intervention significantly overlapped with care as usual prior to start of the trial, yet indicated that the intervention provided a more profound understanding of post-stroke sequelae. Conclusions The implementation of a nurse-led intervention, comprising screening and care for emotional and cognitive problems after stroke, was generally well executed and deemed feasible. If this intervention proves to be clinically and/or cost-effective in our upcoming primary analyses, we will advocate to incorporate it in daily clinical practice and to adhere to the implementation strategy as presented in this process evaluation. Trial registration This study was registered at 25 September 2018 in the Netherlands Trial Register (NL7295).

Introduction Following acquired brain injury (ABI), individuals often experience anxiety and/or depressive symptoms. BrainACT is an adapted form of Acceptance and Commitment Therapy (ACT) tailored to this target group. The current study is a trial-based health-economic evaluation comparing BrainACT to a psychoeducation and relaxation control treatment. Methods An economic evaluation from a societal perspective was conducted in the Netherlands alongside a multicenter randomized controlled two-armed parallel trial including 72 participants. A cost-utility and cost-effectiveness analysis was conducted where incremental costs, quality-adjusted life-years (QALYs), and anxiety/depression (Hospital Anxiety and Depression Scale (HADS) score) were collected and presented over a 1-year follow-up period. Bootstrapping, scenario, and subgroup analyses were performed to test the robustness of the results. Results The BrainACT arm reported non-significant lower total costs (incremental difference of €−4,881; bootstrap interval €−12,139 to €2,330) combined with significantly decreased anxiety/depression (HADS) (3.2; bootstrap intervals 0.7–5.7). However, the total QALYs were non-significantly lower (−0.008; bootstrap interval −0.060 to 0.042) for BrainACT. The probability of the intervention being cost-effective was 86 percent at a willingness-to-accept threshold of €50,000/QALY. The scenario and subgroup analyses confirmed the robustness of the results. Conclusion BrainACT may be a more cost-effective alternative to a psychoeducation and relaxation intervention for anxiety and/or depressive symptoms following ABI. Despite limitations, BrainACT appears to be a promising addition to treatment options in the Netherlands. Further research is needed to validate these findings, and consideration should be given to implementing BrainACT in Dutch clinical settings with ongoing monitoring.

A small percentage of patients with mild traumatic brain injury (mTBI) does not follow the expected recovery trajectory but develop persistent post-concussion symptoms (PCS). The fear-avoidance model (FAM) is a general biopsychosocial model that may potentially explain the development and continuation of persistent PCS for a subgroup of patients. The aim of the present study was to investigate if the FAM can (at least partially) explain PCS at 3 and 6 months post-mTBI by investigating associations between the elements of the FAM. A prospective, longitudinal, multicenter cohort study with outcome assessments at 2 weeks, 3 months, and 6 months post-mTBI was conducted in 163 patients with mTBI recruited from the emergency department and neurology department within 2 weeks post-mTBI. The FAM components PCS, catastrophizing, fear-avoidance behavior and depressive symptoms correlated significantly with each other at 3 months post-mTBI (p < 0.01) and correlations ranged from 0.40 to 0.72. No significant correlations were found between disuse and the other components. Depressive symptoms at 3 months post-mTBI significantly correlated with PCS at 6 months post-mTBI. Our results suggest that the FAM could be an explanatory model for the development of persistent PCS. This implies that treatment development for patients with persistent PCS could be aimed at the components of the FAM, such as exposure therapy to reduce catastrophizing and avoidance behavior.