Physical activity behavior in the first month after mild traumatic brain injury is associated with physiological and psychological risk factors for chronic pain

Abstract Background: Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized. Methods: This is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records. Results: At one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW. Conclusions: Risk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.

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SWOT analysis of an outpatient rehabilitation physical activity intervention for individuals with mild traumatic brain injury

10.21203/rs.3.rs-1152870/v1 ◽

2021 ◽

Author(s):

Christophe Alarie ◽

Isabelle Gagnon ◽

Lily Trang Than Huynh ◽

Karine Doucet ◽

Adèle Pichette-Auray ◽

...

Keyword(s):

Physical Activity ◽

Traumatic Brain Injury ◽

Quality Improvement ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Swot Analysis ◽

Physical Activity Intervention ◽

Service Providers ◽

Outpatient Rehabilitation ◽

Physical Activity Interventions

Abstract Background Physical activity interventions have been shown to be an effective therapeutic approach to improve symptoms and reduce recovery time after a mild traumatic brain injury. Service providers from a specialized traumatic brain injury outpatient rehabilitation program recognized the need to ensure their physical activity intervention integrated evidence-based treatment components, while considering user needs and preferences. To inform quality improvement efforts, service providers felt it necessary to learn about the perceptions of key stakeholders, regarding the quality of the intervention. The study objective was to explore the perceptions of administrators, clinicians and users of the specialized program regarding the physical activity intervention’s strengths, weaknesses, opportunities and threats (SWOT). Methods Using a SWOT analysis framework, this qualitative study explored the perspectives of the purposive sample (n=14) composed of the managerial staff, six clinicians and five program users. Semi-structured interviews were performed, recorded, transcribed verbatim and analyzed using a qualitative content analysis approach. Results Fifty categories were generated resulting in 15 strengths, 17 weaknesses, 12 opportunities and 6 threats grouped into 8 overarching categories: physical activity intervention, health-related outcomes, clinical expertise, knowledge translation, communication, user engagement, resources, accessibility. Category descriptions, convergent and divergent perspectives, and salient quotes of participants are provided. Conclusions This study successfully identified perceived strengths, many weaknesses, several opportunities and a few threats. Participants were generally positive about the intervention but identified weaknesses including the need for service providers to better describe the physical activity intervention using theoretically driven approaches before engaging in quality improvement activities. Convergent and divergent perspectives of service providers and program users helped identify areas to maintain and others to improve upon when the program develops their new intervention. Study results may also inform the development of other physical activity interventions designed for adults with persisting symptoms of a mild traumatic brain injury.

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Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study

Brain Sciences ◽

10.3390/brainsci10050269 ◽

2020 ◽

Vol 10 (5) ◽

pp. 269

Author(s):

Debbie Madhok ◽

John Yue ◽

Xiaoying Sun ◽

Catherine Suen ◽

Nathan Coss ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Pilot Study ◽

Mild Traumatic Brain Injury ◽

Psychiatric History ◽

Clinical Predictors ◽

Head Ct ◽

Risk Patients

A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13–15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with p < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at p < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74–0.98)), prior psychiatric history (AOR = 3.75 (1.73–8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93–196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29–9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17–10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability.

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