A Scale Measuring Academic-Related Anxiety Following Concussion

Does academic-related anxiety contribute to an adolescent’s recovery process and return to activity after experiencing a concussion? The authors created a novel measure of academic-related anxiety (Mularoni Measure of Academic Anxiety following Concussion [MMAAC]) and administered it to adolescents following concussion in outpatient pediatric sports medicine clinics. Two previously validated measures of anxiety were also administered, and results were compared with the MMAAC scores as well as the lengths of time for return to school and sports. Results show that higher MMAAC scores positively correlate with the length of time an adolescent needs to return to school. Study results indicate that the MMAAC reliably measures academic-related anxiety in adolescents suffering from concussions and can be helpful in predicting a basic timetable for return to school. The authors believe that this brief survey can be used by physicians in clinic to evaluate anxiety and assist with return to school expectations to provide comprehensive recovery support.

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Variations in Time to Recovery from Pediatric Concussion Based on Differing Outcomes of Interest

Neurology ◽

10.1212/01.wnl.0000801828.94648.3d ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S10.2-S11

Author(s):

Christina Master ◽

Kristi Metzger ◽

Mr. Daniel Corwin ◽

Catherine McDonald ◽

Melissa Pfeiffer ◽

...

Keyword(s):

Sports Medicine ◽

Clinical Care ◽

Median Number ◽

Self Report ◽

Return To School ◽

Self Assessment ◽

Concussion Management ◽

Pediatric Concussion ◽

Concussion Recovery ◽

Definition Of

ObjectiveTo quantify variability in pediatric concussion recovery across multiple outcomes of interest.BackgroundPediatric concussion studies are hindered by a common significant limitation: lack of agreement on a standard definition of “recovery.” A variety of clinical outcomes of interest utilized across studies, including symptom self-report, neurocognitive testing results, self-reported return to activity, and physician clearance for activity, leads to challenges for both research, as well as clinical concussion management.Design/MethodsWe enrolled concussed youth, ages 11–18 years, from a specialty sports medicine clinic = 28 days of injury. Patients were followed as part of clinical care for concussion for up to 13 weeks. At each visit, participants completed questionnaires and a battery of clinical measures. From these data, we constructed 10 potential definitions of recovery: 3 based on self-reported symptoms (change from pre-injury, no symptoms, below pre-determined thresholds), 2 based on visio-vestibular examination (VVE) deficits (none, = 1), 2 based on physician clearance (for return to school/sport), and 3 based on self-assessment (“back to normal”, return to school/exercise).ResultsOne hundred seventy-four concussed youth were enrolled (median age: 15 years, 54.6% female) with a median time from injury to initial visit of 12 days (IQR: 7, 20). Median number of visits was 2 (range: 1, 5). We observed a wide variation in the proportion of participants recovered across the 10 definitions. Depending on definition, between 4% and 45% were considered recovered within 4 weeks, and between 10% and 80% were considered recovered at the end of follow-up. The VVE-based definition (=1 deficit) consistently had the highest proportion recovered at all time points, while self-reported return to exercise had the lowest proportion.ConclusionsRecovery from concussion is not a single unitary point in time. These results will provide valuable guidance to clinicians in managing concussion and researchers in designing future observational and interventional trials of pediatric concussion.

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Pediatric Sports Medicine Injuries

Clinics in Sports Medicine ◽

10.1016/j.csm.2017.12.012 ◽

2018 ◽

Vol 37 (2) ◽

pp. 351-362 ◽

Cited By ~ 4

Author(s):

Joel B. Huleatt ◽

Carl W. Nissen ◽

Matthew D. Milewski

Keyword(s):

Sports Medicine ◽

Pediatric Sports Medicine

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Multidisciplinary Perspective on Controversial Issues in Pediatric Sports Medicine

10.1542/peds.147.3_meetingabstract.164-a ◽

2021 ◽

Author(s):

Zachary S. Stinson ◽

Cassidy M. Foley Davelaar ◽

Gary M. Kiebzak ◽

Eric W. Edmonds

Keyword(s):

Sports Medicine ◽

Controversial Issues ◽

Pediatric Sports Medicine ◽

Multidisciplinary Perspective

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VALIDATION OF A COMPUTER-BASED SYSTEM FOR THE COLLECTION OF PATIENT REPORTED OUTCOME MEASURES IN PEDIATRIC SPORTS MEDICINE

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00037 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0003

Author(s):

Meagan J. Sabatino ◽

Catherine V. Gans ◽

Aaron J. Zynda ◽

Chan-Hee Jo ◽

Jane Chung ◽

...

Keyword(s):

Outcome Measures ◽

Sports Medicine ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Electronic Format ◽

Pediatric Sports Medicine ◽

Patient Reported ◽

Computer Based ◽

Activity Scale ◽

Tegner Activity Scale

Background: In orthopedics, patient reported outcome measures (PROMs) have become popularized due to an increase in patient-centered research and pay for performance reimbursement models. Most pediatric PROMs have been utilized and validated in paper format. However, the use of a computer-based system may improve patient and physician efficiency, decrease cost, ensure completion, provide instantaneous information, and minimize inconvenience. The purpose of the study is to validate the use, evaluate patient satisfaction, and review differences of electronic compared to paper PROMs in a pediatric sports medicine practice. Methods: New patients between 12 – 19 years of age with a knee-related primary complaint were identified prior to their appointment. Patients were then randomized into two groups to complete standard clinical PROMs; including the Pedi-IKDC, HSS Pedi-FABS, Tegner Activity Scale, Visual Analogue Scale (VAS) and PedsQL-Teen. Group 1 completed paper forms followed by electronic, while Group 2 received the electronic format followed by paper, with a 10-minute break between formats in each group. Following the completion of PROMs, subjects completed a satisfaction survey. A Pearson’s correlation was used to calculate the association between the measures and a paired t-test to compare means between electronic and paper forms. Reliability analysis was conducted using an ICC calculation. Results: 87 subjects were enrolled with one excluded due to incomplete PROMs, for a total of 86. 54 subjects were female and 32 were male with an average age of 14.3 years (range 12-18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC, HSS Pedi-FABS, PedsQL 13-18 and the Tegner activity scale (Figure 1). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 vs 4.6, p<0.001). Excluding the 10-minute break, it took subjects an average of 21.3 minutes to complete the PROMs. Although not significant, electronic PROMs took less time than paper on average (10.0 min vs 11.2 min, p=0.096). All subjects endorsed that PROMs captured on paper were the same as electronic with 69.8% of subjects preferring the electronic PROMs. 67.4% of subjects reported they felt the electronic format was faster, with only 5.8% of patients reporting the electronic forms were hard or confusing. 93.0% stated they would complete forms at home prior to appointments if it were an option and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion/Significance: PROMs captured electronically were reliable and valid when compared to paper, with differences noted only on the VAS. Electronic PROMs may be quicker, will not require manual scoring, and are preferred by patients. Electronic PROMs will improve the clinician’s ability to collect complete and validated data while reducing the burden on the clinical staff and patients. [Figure: see text]

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Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2019-000667 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000667 ◽

Cited By ~ 2

Author(s):

Carol DeMatteo ◽

E Dimitra Bednar ◽

Sarah Randall ◽

Katie Falla

Keyword(s):

Systematic Review ◽

Paediatric Population ◽

Acute Stage ◽

Current Data ◽

Return To School ◽

Original Research ◽

Reference List ◽

Eligibility Criteria ◽

Outcomes For Children ◽

Return To Activity

ObjectiveTo determine the effects of following return to activity (RTA) and return to school (RTS) protocols on clinical outcomes for children with concussion. The 12 subquestions of this review focus on the effectiveness of protocols, guidelines and recommendations, and the evidence supporting content of the protocols including rest, exercise and school accommodations.DesignSystematic review.Data sourcesPubMed, MEDLINE, EMBASE, CINAHL, ERIC and manual reference list check.Eligibility criteria for selecting studiesStudies were included if they evaluated RTA or RTS protocols in children aged 5–18 years with a concussion or if they reported a rigorous study design that provided evidence for the recommendations. Included studies were original research or systematic reviews. Articles were excluded if they did not report on their methodology or included participants with significant neurological comorbidities.ResultsThe literature search retrieved 198 non-duplicate articles and a total of 13 articles were included in this review. Despite the adoption of several RTS and RTA protocols in clinical practice there is little evidence to determine their efficacy in the paediatric population.SummaryThe current data support the recommendation that children in the acute stage postconcussion should undergo 1–2 days physical and cognitive rest as they initiate graduated RTA/RTS protocols. Prolonged rest may increase reported symptoms and time to recovery. Further interventional studies are needed to evaluate the effectiveness of RTA/RTS protocols in youth with concussion.

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Pediatric Sports Medicine

Textbook of Clinical Pediatrics ◽

10.1007/978-3-642-02202-9_411 ◽

2012 ◽

pp. 3945-3952

Author(s):

Mary K. Mulcahey ◽

Keith O. Monchik ◽

Michael J. Hulstyn ◽

Paul D. Fadale

Keyword(s):

Sports Medicine ◽

Pediatric Sports Medicine

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Identifying Persistent Postconcussion Symptom Risk in a Pediatric Sports Medicine Clinic

The American Journal of Sports Medicine ◽

10.1177/0363546518796830 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3254-3261 ◽

Cited By ~ 19

Author(s):

David R. Howell ◽

Roger Zemek ◽

Anna N. Brilliant ◽

Rebekah C. Mannix ◽

Christina L. Master ◽

...

Keyword(s):

Risk Score ◽

Sports Medicine ◽

Risk Scores ◽

Secondary Outcome ◽

Symptom Duration ◽

Clinical Risk Score ◽

Symptom Resolution ◽

Sports Concussion ◽

Clinical Risk ◽

Pediatric Sports Medicine

Background: Although most children report symptom resolution within a month of a concussion, some patients experience persistent postconcussion symptoms (PPCS) that continues for more than 1 month. Identifying patients at risk for PPCS soon after an injury can provide useful clinical information. Purpose: To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)–derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a study of patients seen at a pediatric sports medicine concussion clinic between May 1, 2013, and October 1, 2017, who were <19 years of age and evaluated within 10 days of a concussion. The main outcome was PPCS, defined as symptoms lasting >28 days. Nine variables were used to calculate the 5P clinical risk score, and we assessed the association between the 5P clinical risk score and PPCS occurrence. The secondary outcome was total symptom duration. Results: We examined data from 230 children (mean age, 14.8 ± 2.5 years; 50% female; mean time from injury to clinical assessment, 5.6 ± 2.7 days). In univariable analyses, a greater proportion of those who developed PPCS reported feeling slowed down (72% vs 44%, respectively; P < .001), headache (94% vs 72%, respectively; P < .001), sensitivity to noise (71% vs 43%, respectively; P < .001), and fatigue (82% vs 51%, respectively; P < .001) and committed ≥4 errors in tandem stance (33% vs 7%, respectively; P < .001) than those who did not. Higher 5P clinical risk scores were associated with increased odds of developing PPCS (adjusted odds ratio [OR], 1.62 [95% CI, 1.30-2.02]) and longer symptom resolution times (β = 8.40 [95% CI, 3.25-13.50]). Among the individual participants who received a high 5P clinical risk score (9-12), the majority (82%) went on to experience PPCS. The area under the curve for the 5P clinical risk score was 0.75 (95% CI, 0.66-0.84). After adjusting for the effect of covariates, fatigue (adjusted OR, 2.93) and ≥4 errors in tandem stance (adjusted OR, 7.40) were independently associated with PPCS. Conclusion: Our findings extend the potential use for an ED-derived clinical risk score for predicting the PPCS risk into the sports concussion clinic setting. While not all 9 predictor variables of the 5P clinical risk score were independently associated with the PPCS risk in univariable or multivariable analyses, the combination of factors used to calculate the 5P clinical risk score was significantly associated with the odds of developing PPCS. Thus, obtaining clinically pragmatic risk scores soon after a concussion may be useful for early treatments or interventions to mitigate the PPCS risk.

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Concussion Management for Children Has Changed: New Pediatric Protocols Using the Latest Evidence

Clinical Pediatrics ◽

10.1177/0009922819879457 ◽

2019 ◽

Vol 59 (1) ◽

pp. 5-20 ◽

Cited By ~ 3

Author(s):

Carol DeMatteo ◽

Sarah Randall ◽

Katie Falla ◽

Chia-Yu Lin ◽

Lucy Giglia ◽

...

Keyword(s):

Systematic Review ◽

Cohort Study ◽

Empirical Data ◽

Prospective Cohort ◽

Specific Activity ◽

Rest Period ◽

Return To School ◽

Concussion Management ◽

Pediatric Concussion ◽

Return To Activity

Return to activity (RTA) and return to school (RTS) are important issues in pediatric concussion management. This study aims to update CanChild’s 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts. The new protocols highlight differences from the earlier versions, mainly, (1) symptom strata to allow quicker progression for those who recover most quickly; (2) a shortened rest period (24-48 hours) accompanied by symptom-guided activity; (3) the recommendation that children progress through the stages before they are symptom free, if symptoms have decreased and do not worsen with activity; (4) specific activity suggestions at each stage of the RTA protocol; (5) recommendations for the amount of time to spend per stage; and (6) integration of RTS and RTA.

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