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

Linda Fordal; Jonas Stenberg; Grant L Iverson; Simen B Saksvik; Migle Karaliute; Anne Vik; Alexander Olsen; Toril Skandsen

doi:10.1016/j.apmr.2021.09.016

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

Arch Phys Med Rehabil. 2022 Feb;103(2):313-322. doi: 10.1016/j.apmr.2021.09.016. Epub 2021 Oct 23.

Authors

Linda Fordal¹, Jonas Stenberg², Grant L Iverson³, Simen B Saksvik⁴, Migle Karaliute⁵, Anne Vik², Alexander Olsen⁴, Toril Skandsen⁶

Affiliations

¹ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
² Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
³ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, United States; Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts, United States; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, United States.
⁴ Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁵ Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. Electronic address: toril.skandsen@ntnu.no.

PMID: 34695386
DOI: 10.1016/j.apmr.2021.09.016

Abstract

Objective: To examine the trajectories of persistent postconcussion symptoms (PPCS) after mild traumatic brain injury (MTBI) and to investigate which injury-related and personal factors are associated with symptom reporting.

Design: Prospective longitudinal cohort study. Follow-up at 3 and 12 months postinjury.

Setting: A level 1 trauma center and an emergency outpatient clinic.

Participants: Patients with MTBI (n=358), trauma controls (n=75), and community controls (n=78).

Main outcome measures: Symptoms were assessed with the British Columbia Postconcussion Symptom Inventory (BC-PSI). Participants were categorized as having moderate to severe PPCS (msPPCS) when reporting ≥3 moderate/severe symptoms or a BC-PSI total score of ≥13. BC-PSI total scores were compared between the groups and were further used to create cutoffs for reliable change by identifying uncommon and very uncommon change in symptoms in the community control group. Associations between symptom reporting and 25 injury-related and personal factors were examined.

Results: The MTBI group had a similar prevalence of msPPCS at 3 and 12 months (21%) and reported more symptoms than the control groups. Analyses of individual trajectories, however, revealed considerable change in both msPPCS and BC-PSI total scores in the MTBI group, where both worsening and improvement was common. Intracranial lesions on computed tomography were associated with a greater likelihood of improving from 3 to 12 months. Those with msPPCS at both assessments were more likely to be women and to have these personal preinjury factors: reduced employment, pain, poor sleep, low resilience, high neuroticism and pessimism, and a psychiatric history.

Conclusions: Group analyses suggest a stable prevalence of msPPCS the first year postinjury. However, there was considerable intraindividual change. Several personal factors were associated with maintaining symptoms throughout the first year.

Keywords: Brain concussion; Longitudinal studies; Neurological rehabilitation; Post-concussion syndrome; Prognosis; Rehabilitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Concussion* / complications
Brain Concussion* / psychology
Cohort Studies
Female
Humans
Longitudinal Studies
Male
Post-Concussion Syndrome* / psychology
Prospective Studies