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Purpose:
To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI).
Methods:
This was a prospective longitudinal study of 100 participants with mTBI from neurosurgical outpatient departments in Chiayi...
Context in source publication
Citations
... They significantly impact the health-related quality of life (HRQOL) of concerned individuals and their families (2). Consequently, after TBI, individuals often feel isolated, leading to deterioration of their physical and mental health (3)(4)(5)(6). ...
This study analyzed the linguistic and psychometric validation of the Japanese version of the Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) consisting of six items which cover several TBI-relevant domains. We hypothesized that the Japanese version has good reliability, convergent validity, and divergent validity, compared with its long version, the 37-item QOLIBRI. The QOLIBRI-OS Japanese version was forward and back-translated from the English version. In total, 129 individuals participated in this study after experiencing a traumatic brain injury and attending clinics, rehabilitation centers, and support centers in Japan. The structure of the QOLIBRI-OS was investigated by confirmatory factor analyses and compared with the QOLIBRI. Only one factor was extracted, and a model with one underlying factor had a good fit. The QOLIBRI-OS showed good-to-excellent internal consistency and test-retest reliability. The QOLIBRI-OS was positively correlated with the QOLIBRI, Short Form Health Survey-36 version 2, and Glasgow Outcome Scale Extended, and negatively correlated with the Hospital Anxiety and Depression Scale. The results suggest that the QOLIBRI-OS Japanese version is a reliable and valid tool for assessing disease-specific health-related QOL in individuals after traumatic brain injury in Japan.
... Inaccurate or incomplete reporting of factors such as symptom severity, loss of consciousness, and post-traumatic amnesia may confound meaningful clinical assessment (Menon et al., 2010). To add to the complications, patients over 40 years old have slower recovery from mTBI compared to patients under 40 (Chiang et al., 2016). ...
... In this study, patients with lower FA in the total/anterior/midbody CC had more persistent cognitive symptoms. The expected parallels between the two studies is based on previous studies, which report lower FA (Ilvesmäki et al., 2014) and slower recovery from mTBI (Chiang et al., 2016) in older participants. The parallel between the two study results is not perfect; there are also some symptoms for which age-related patterns and FA-related patterns were not similar. ...
... This is a tentative conclusion based on indirect evidence, as it was not possible to directly address the hypothesis in the statistical analysis of symptom persistence, given the sample sizes that resulted from splitting the data set into age groups and the relatively large number of unimproved or unresolved cases. Within extant literature, age has been associated with prolonged recovery time post-mTBI (Katz et al., 2004;Chiang et al., 2016;Erlebach et al., 2017). Further study is required to separate age-related differences in symptom Frontiers in Neuroimaging frontiersin.org . ...
Background
Mild traumatic brain injuries (mTBIs) comprise 80% of all TBI, but conventional MRI techniques are often insensitive to the subtle changes and injuries produced in a concussion. Diffusion tensor imaging (DTI) is one of the most sensitive MRI techniques for mTBI studies with outcome and symptom associations described. The corpus callosum (CC) is one of the most studied fiber tracts in TBI and mTBI, but the comprehensive post-mTBI symptom relationship has not fully been explored.
Methods
This is a retrospective observational study of how quantitative DTI data of the CC and its sub-regions may relate to clinical presentation of symptoms and timing of resolution of symptoms in patients diagnosed with uncomplicated mTBI. DTI and clinical data were obtained retrospectively from 446 (mean age 42 years, range 13–82) civilian patients. From patient medical charts, presentation of the following common post-concussive symptoms was noted: headache, balance issues, cognitive deficits, fatigue, anxiety, depression, and emotional lability. Also recorded was the time between injury and a visit to the physician when improvement or resolution of a particular symptom was reported. FA values from the total CC and 3 subregions of the CC (genu or anterior, mid body, and splenium or posterior) were obtained from hand tracing on the Olea Sphere v3.0 SP12 free-standing workstation. DTI data was obtained from 8 different 3T MRI scanners and harmonized via ComBat harmonization. The statistical models used to explore the association between regional Fractional Anisotropy (FA) values and symptom presentation and time to symptom resolution were logistic regression and interval-censored semi-parametric Cox proportional hazard models, respectively. Subgroups related to age and timing of first scan were also analyzed.
Results
Patients with the highest FA in the total CC ( p = 0.01), anterior CC ( p < 0.01), and mid-body CC ( p = 0.03), but not the posterior CC ( p = 0.91) recovered faster from post-concussive cognitive deficits. Patients with the highest FA in the posterior CC recovered faster from depression ( p = 0.04) and emotional lability ( p = 0.01). There was no evidence that FA in the CC or any of its sub-regions was associated with symptom presentation or with time to resolution of headache, balance issues, fatigue, or anxiety. Patients with mTBI under 40 had higher FA in the CC and the anterior and mid-body subregions (but not the posterior subregion: p = 1.00) compared to patients 40 or over ( p ≤ 0.01). There was no evidence for differences in symptom presentation based on loss of consciousness (LOC) or sex ( p ≥ 0.18).
Conclusion
This study suggests that FA of the CC has diagnostic and prognostic value for clinical assessment of mTBI in a large diverse civilian population, particularly in patients with cognitive symptoms.
... A substantial proportion of people can experience post-concussion symptoms that can persist for several months and sometimes even years (4)(5)(6)(7). The implications of persistent post-concussion symptoms can be profound resulting in high disability, lower quality of life and increased use of healthcare resources (8)(9)(10). Thus, a better understanding of the aetiology of these symptoms is needed to inform intervention and prevention. ...
Objective
A latent disease explanation cannot exclusively explain post-concussion symptoms after mild traumatic brain injury (mTBI). Network analysis offers an alternative form of explanation for relationships between symptoms. The study aimed to apply network analysis to post-concussion symptoms in two different mTBI cohorts; an acute treatment-seeking sample and a sample 10 years post-mTBI.
Method
The treatment-seeking sample (n = 258) were on average 6 weeks post-injury; the 10 year post mTBI sample (n = 193) was derived from a population-based incidence and outcomes study (BIONIC). Network analysis was completed on post-concussion symptoms measured using the Rivermead Post-Concussion Questionnaire.
Results
In the treatment-seeking sample, frustration, blurred vision, and concentration difficulties were central to the network. These symptoms remained central in the 10 year post mTBI sample. A Network Comparison Test revealed evidence of a difference in network structure across the two samples (p = 0.045). However, the only symptoms that showed significant differences in strength centrality across samples were irritability and restlessness.
Conclusion
The current findings suggest that frustration, blurred vision and concentration difficulties may have an influential role in the experience and maintenance of post-concussion symptoms. The impact of these symptoms may remain stable over time. Targeting and prioritising the management of these symptoms may be beneficial for mTBI rehabilitation.
... Similar class solutions have been reported elsewhere in the literature concerning outcome trajectories for depression and PTSD symptoms after TBI (i.e., low symptoms/resilience, delayed symptoms, recovery, and persistent symptoms) [68,73]. In another study [111] focusing on generic and disease-specific HRQoL, GOSE, as well as post-concussion symptoms, only two to three different trajectories were identified. This might be due to differences regarding the study population with a much smaller sample size (N = 100) and the exclusion of participants after moderate/severe TBI. ...
Traumatic brain injury (TBI) remains one of the leading causes of death and disability worldwide. To better understand its impact on various outcome domains, this study pursues the following: (1) longitudinal outcome assessments at three, six, and twelve months post-injury; (2) an evaluation of sociodemographic, premorbid, and injury-related factors, and functional recovery contributing to worsening or improving outcomes after TBI. Using patient-reported outcome measures, recuperation trends after TBI were identified by applying Multivariate Latent Class Mixed Models (MLCMM). Instruments were grouped into TBI-specific and generic health-related quality of life (HRQoL; QOLIBRI-OS, SF-12v2), and psychological and post-concussion symptoms (GAD-7, PHQ-9, PCL-5, RPQ). Multinomial logistic regressions were carried out to identify contributing factors. For both outcome sets, the four-class solution provided the best match between goodness of fit indices and meaningful clinical interpretability. Both models revealed similar trajectory classes: stable good health status (HRQoL: n = 1944; symptoms: n = 1963), persistent health impairments (HRQoL: n = 442; symptoms: n = 179), improving health status (HRQoL: n = 83; symptoms: n = 243), and deteriorating health status (HRQoL: n = 86; symptoms: n = 170). Compared to individuals with stable good health status, the other groups were more likely to have a lower functional recovery status at three months after TBI (i.e., the GOSE), psychological problems, and a lower educational attainment. Outcome trajectories after TBI show clearly distinguishable patterns which are reproducible across different measures. Individuals characterized by persistent health impairments and deterioration require special attention and long-term clinical monitoring and therapy.
... 8 The implications of PCS can be significant for both the individual and their family/ whānau, as well as burdening health services. 13 The concept of PCS has been debated in abundance in the literature and amongst clinicians in the field. 14 This is predominately driven by the non-specificity of PCS, as well as concussion symptoms that don't persist. ...
The non-specificity of persisting concussion symptoms (PCS) following concussion can make treatment and rehabilitation a complex and challenging endeavour for clinicians. International studies have demonstrated that in neurologic-ally healthy individuals similar symptoms also exist. This study aimed to examine the presence and frequency of symptoms similar to PCS in neurologically healthy adults in Aotearoa New Zealand and compare these to PCS following concussion. 252 neurologically healthy adults (34.22 years); completed the Rivermead Post-Concussion Questionnaire (RPQ). Scores on this measure were evaluated and compared with 146 individuals who were at least three months post-injury (34.62 years). 25.79% (n = 65) of the neurologically healthy individuals had scores on the RPQ of ≥16. Fatigue was the most commonly endorsed symptom (67.9%), followed by sleep disturbances (59.9%). Certain demographic factors (age, education history and gender) were associated with higher endorsement but only on specific symptoms. The concussion group had significantly higher scores on the RPQ and significantly more individuals with PCS. However, at the individual item level, just over half of PCS symptoms were significantly higher in the concussion group. These symptoms were predominately neurological, with only forgetfulness and irritability significantly different between the concussion and neurologically healthy groups. Symptoms similar to PCS are prevalent in neurologically healthy individuals in Aotearoa New Zealand. The implications of these findings on the rehabilitation and management of PCS are discussed.
... Los avances en medicina están permitiendo que cada vez se salven más vidas de personas que han sufrido un DCA. Sin embargo, el porcentaje de personas que continúan con secuelas y discapacidades permanentes es muy alto [4], incluso en los casos más leves [5,6]. Las secuelas del DCA son muy variadas, pero, en términos generales, se pueden agrupar en déficits motores y sensoriales (por ejemplo, espasticidad, problemas de movilidad y dolor crónico), déficits cognitivos (por ejemplo, trastornos en las funciones ejecutivas, la atención, la memoria y el aprendizaje, la comunicación y, comúnmente, presencia de anosognosia), alteraciones emocionales y conductuales (por ejemplo, ansiedad y depresión, anhedonia, irritabilidad) y sociales (por ejemplo, aislamiento social e incapacidad de regresar a la vida laboral activa) [4,5,[7][8][9][10]. ...
... Sin embargo, el porcentaje de personas que continúan con secuelas y discapacidades permanentes es muy alto [4], incluso en los casos más leves [5,6]. Las secuelas del DCA son muy variadas, pero, en términos generales, se pueden agrupar en déficits motores y sensoriales (por ejemplo, espasticidad, problemas de movilidad y dolor crónico), déficits cognitivos (por ejemplo, trastornos en las funciones ejecutivas, la atención, la memoria y el aprendizaje, la comunicación y, comúnmente, presencia de anosognosia), alteraciones emocionales y conductuales (por ejemplo, ansiedad y depresión, anhedonia, irritabilidad) y sociales (por ejemplo, aislamiento social e incapacidad de regresar a la vida laboral activa) [4,5,[7][8][9][10]. Estos aspectos, junto con su elevada prevalencia, hacen que el DCA imponga considerables costos a la sociedad debido a los años de vida perdidos por discapacidad o muerte [11]. ...
Introduction:
Rehabilitation after Acquired Brain Injury (ABI) is a dynamic, progressive process aimed at functional improvement of the affected person and their family. There is an international consensus on how the model that guides this process should be; however, in our country there are numerous territorial discrepancies regarding its application. Therefore, the objective of this work is to analyze and update the knowledge about the practices developed in the field of rehabilitation and the regulations available in each autonomous community.
Subjects and methods:
62 participants (71.7% women), including both direct care professionals and public administration positions from the 17 Spanish Autonomous Communities and the autonomous cities of Ceuta and Melilla. A questionnaire composed of 31 questions on the functioning of rehabilitation throughout the three phases of care that often follow ABI was developed. This questionnaire was applied to these professionals in each of the Autonomous Communities, through semi-structured interviews.
Results:
The results show the great territorial inequality existing in the functioning of rehabilitation during the recovery process of a person with ABI and the significant deficiencies of specific resources, specialized professionals such as neuropsychologists and necessary aspects such as socio-sanitary coordination.
Conclusions:
It is necessary to develop state regulations that guarantee the minimum basic aspects of the rehabilitation process in the DCA, in its different phases and in all the Autonomous Communities.
... PCCS can manifest as combinations of somatic, vestibular, cognitive and affective symptoms and their implications can be profound [9]. It can impact functional status, quality of life, vocation, and health care utilisation [10,11,12]. ...
Purpose: This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes.
Method: Adults with mTBI (N =147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N=102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors.
Results: The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury.
Conclusion: The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.
... However, other studies reported no sex differences in QoL after TBl (Jorge & Arciniegas, 2014;Styrke et al., 2013). Higher levels of education and employment were associated with better QoL after mild TBI (Aza et al., 2021;Carod-Artal, 2012;Chiang et al., 2016). Finally, higher participation as worker or being employed in general contributed to a more stable QoL after TBI (Juengst et al., 2015). ...
Het huidige onderzoek was drieledig: 1) Literatuuroverzicht van de effectiviteit van interventies gericht op het verminderen van gevolgen van NAH in forensische populaties en van risicofactoren
voor NAH en behandelmogelijkheden, 2) Inzicht verkrijgen in de huidige kennis, en beperkingen daarin, over NAH bij behandelaars en hoe de behandeling wordt aangepast bij (een vermoeden
van) NAH en 3) Uitvoeren van validatieonderzoek naar de sensitiviteit van een NAH-screener. Voor doel 1 zijn twee reviews uitgevoerd, waaruit een hogere prevalentie van NAH in de forensische dan in de algemene populatie bleek, 50% versus 12%. Om inzicht in NAH-gerelateerde beperkingen te vergroten bleek psycho-educatie zinvol. Daarbij was er matig bewijs voor verbeteringen in cognitie en gedrag middels interventies die sociale vaardigheden verbeterden en
cognitieve vervormingen verminderden. De uitkomsten suggereren dat NAH een risicofactor is voor recidive, maar ook de behandeleffectiviteit kan belemmeren in termen van responsiviteit. Er blijkt veel winst te behalen binnen wetenschappelijk onderzoek en de verbetering van diagnostiek en behandeling van NAH in de forensische populatie. Voor doel 2 waren de bevindingen van het veldonderzoek onder behandelaars en patiënten grotendeels in lijn met doel 1. Het screenen op (gevolgen van) NAH is geen standaard onderdeel
van het zorgtraject: slechts de helft van de behandelaars gaf aan wel eens een neuropsychologische test te hebben gebruikt en rekening te hebben gehouden met de klinische implicaties. Voor een deel lijkt de kennis en kunde op het gebied van NAH dan ook nog onvoldoende om NAH tijdig en adequaat te herkennen, evenals om er de behandeling op te kunnen aanpassen. Cliënten rapporteerden dat er in eerdere behandelingen onvoldoende aandacht was voor NAH, maar dat dit in de huidige behandeling beter was. De in huidig onderzoek ontwikkelde
handreiking had een duidelijke meerwaarde voor de behandelaars. Zij werden bewust gemaakt op, en kregen (blijvend) aandacht voor, NAH. De handvatten omtrent hoe in de behandeling om te
gaan met de gevolgen van NAH werden als zeer waardevol ervaren.
Voor doel 3 bleek uit het validatieonderzoek naar de positieve uitslagen dat de screener in de huidige vorm geen valide methode is om adequaat (een vermoeden van) NAH in kaart te brengen. Een positieve uitslag, dus (vermoeden van) NAH, werd niet bevestigd middels objectivering op neuropsychologisch onderzoek of MRI. Mogelijke verklaringen, waaronder een beperkte steekproef, worden in het betreffende hoofdstuk besproken. Wel kan de screener
aanleiding geven tot verder onderzoek bij de cliënt en zorgt het voor bewustwording omtrent NAH.
... The number of participants included in each study that participated in each follow-up session ranged from 8 to 1,727 (median = 94). Only three studies (37,38,45) had <50% male participant groups. ...
Background: Treatment approaches often differ dependent upon whether a person experiences a sports-related or a non-sports-related mild traumatic brain injury. It remains unclear if recovery from these injuries is comparable or unique to context of the injury.
Objective: To identify knowledge gaps on self-reported outcomes and trajectories between sports- and non-sports-related mild traumatic brain injuries and how they are assessed in adults.
Methods: This scoping review used a systematic search of key electronic databases, including PubMed, SPORTDiscus, Embase, MEDLINE, and CINAHL for articles published in 1937 until March 10, 2021. Articles were included if they were available in English; full text published in a peer-reviewed journal; had a prospective or retrospective study design; reported data on mild TBI cases >16 years of age, and included data from at least two time points on self-reported outcomes within 12 months post-injury. A standardized data extraction spreadsheet was used to determine the participant characteristics, definitions, assessment methods, outcomes, and recovery time frames.
Results: Following removal of duplicates, the search strategy elicited 6,974 abstracts. Following abstract review, 174 were retained for full text review. Of the 42 articles that met inclusion criteria, 18 were sports related (15 in the USA and three in Canada) and 24 were general population studies (six in USA, three in Canada, three in Australasia, nine in Europe, two in Taiwan, and one in Morocco). Direct comparison in recovery trajectories between the sport and general population studies was difficult, given notable differences in methodology, definitions, types of outcome measures, and timing of follow-up assessments. Only one article reported on both sports-related and non-sports-related traumatic brain injuries separately at comparable timepoints. This study revealed no differences in recovery time frames or overall symptom burden.
Discussion: Whilst there is a clear benefit in researching specific subpopulations in detail, standardized outcome measures and follow-up time frames are needed across contexts to facilitate understanding of similarities and differences between sports- and non-sports-related mild traumatic brain injuries to inform clinical treatment.
... V súvislosti s mladými aj dospelými ľuďmi má značný socioekonomický vplyv spojený s vysokými nákladmi na zdravotnú starostlivosť a obrovskou stratou produktivity práce (Wang, Jiang & Sun et al., 2017, Wang, W. Zhang, X. Yang et al., 2019. Vďaka pokroku v medicíne a technike je možné zachrániť čoraz viac ľudí, dôsledkom čoho je narastajúci počet tých, ktorí zostávajú žiť s trvalými následkami alebo si vyžadujú dlhodobú starostlivosť (Chiang et al., 2015). Títo pacienti často trpia fyzickými a emocionálnymi problémami (Haagsma et al., 2015;Lin et al., 2010), kognitívnymi deficitmi (Grauwmeijer et al., 2018;Yeoh et al., 2019) a behaviorálnymi a sociálnym zmenami a dôsledkami (Azouvi et al., 2016;Lin et al., 2010) ktoré negatívne ovplyvňujú kvalitu života (QoL) (Andelic et al., 2009;Forslund et al., 2013;Pagnini et al., 2019;Yeoh et al., 2019). ...
