Post-Concussion Psychological Distress at Return to Play Does Not Predict Subsequent Musculoskeletal Injury

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S7.2-S7
Author(s):  
Alexander Enrique ◽  
Katie Hunzinger ◽  
Autumn Gourley ◽  
Kelsey Bryk ◽  
Thomas A. Buckley
Keyword(s):  
Psychological Distress ◽  
Psychological Health ◽  
Injury Risk ◽  
Collegiate Athletes ◽  
Musculoskeletal Injury ◽  
Brief Symptom Inventory ◽  
Return To Play ◽  
Limited Attention ◽  
Global Severity Index ◽  
Post Injury

ObjectiveTo assess the association between the Brief Symptom Inventory 18 (BSI-18) response at post-concussion return to play (RTP) and subsequent lower extremity musculoskeletal injury (LE-MSI).BackgroundConcussion evaluation includes a multifaceted neurologic assessment at baseline and post-injury. Despite emotional sequelae after concussion, psychological assessments have received limited attention thus athletes may RTP despite persistent psychological distress post-concussion. Recent evidence has suggested an ∼2x elevated rate of post-concussion LE-MSI in collegiate athletes; however there is limited understanding of potential mechanisms. As psychological distress has been associated with MSI, the purpose of this study was to assess BSI-18 as a potential predictor of subsequent MSI.Design/MethodsThis analysis utilized a cross-sectional design of 67 NCAA intercollegiate students-athletes with a diagnosed concussion (59.7% female, age: 19.7 ± 1.4 years). Participants completed the BSI-18, an 18-item questionnaire based on a 5-point Likert scale (0–4) used to measure psychological distress at the RTP clinical time-point. Outcome measures were the Global Severity Index (GSI) which is the total score of symptoms (0–72) with higher scores representing greater psychological distress and subsequent MSI (yes or no) collected retrospectively through an electronic medical record in the year following diagnosed concussion. Binary logistic regression was used to assess the predictive capabilities of BSI-18 GSI and subsequent LE-MSI.ResultsThe BSI-18 GSI did not significantly predict subsequent LE-MSI (p = 0.095, Exp(B) = 2.436, Nagelkerke R2 = 0.181).ConclusionsThe BSI-18 GSI at RTP did not predict post-concussion subsequent LE-MSI. While the underlying mechanism for post-concussion MSI remains to be fully elucidated, results suggest that psychological health, as measured by the BSI-18 GSI, at RTP is not associated with subsequent LE-MSI. If MSI risk can be predicted then targeted, established, and clinically feasible injury prevention programs can be implemented to reduce injury risk.

scholarly journals Lower Extremity Musculoskeletal Screening Tool Practices Among Athletic Trainers in Secondary School and Collegiate Settings

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Megan Fowler ◽  
Elizabeth Neil ◽  
Cameron Powden
Keyword(s):  
Secondary School ◽  
Lower Extremity ◽  
Injury Risk ◽  
Online Survey ◽  
Screening Tool ◽  
Athletic Trainers ◽  
Screening Tools ◽  
Return To Play ◽  
Post Injury ◽  
Cross Sectional

Purpose: Musculoskeletal (MSK) screening tools can allow athletic trainers (AT) to focus prevention efforts by providing patient risk information. The purpose of this study is to examine lower extremity MSK screening tool practices and perceptions of ATs in traditional settings. Methods: A cross-sectional online survey was distributed to 4,937 full- and part-time collegiate and secondary school ATs randomly selected by the NATA. MSK screening tools were grouped into 7 categories: Range of Motion (ROM), Strength, Balance, Drop and Jump Landing (D/J Land), Double- and Single-Leg Hopping (D/S Hop), Movement Quality (MQual), and Injury History (History). For each screening tool category, questions assessed MSK screening tool usage, the perceived effectiveness of MSK screening tools to provide relevant injury risk and return to play (RTP) information, and MSK screening tools effect on decisions to implement prevention programs. Results: A total of 372 participants (female=215(48.4%), male=152(34.2%), age=35±10 years, experience=12±10 years, secondary school=194(52.2%), collegiate=178(47.8%)) completed the survey. Participants within our study indicated the used of the following screening tools categories in clinical practice: ROM=339(91.1%), Strength=342(91.9%), Balance=238(64.0%), D/J-Landing=134(36.0%), D/S-Hopping=233(62.6%), MQual=212(57.0%), History=316(85.0%), and None=18(4.8%). Conclusions: ATs in traditional settings indicate that they primarily use ROM, Strength, and History screening tools to gather information concerning LE injury risk and RTP. Implementation of screening tools most frequently occurred post-injury. Lastly, it seemed that intervention prescriptions were consistent regardless of screening tool used, suggesting blanket interventions prescription. This may have been do feelings of moderate effectiveness of these tools to determine injury risk.

Age of First Concussion and Cognitive, Psychological, and Physical Outcomes

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S17-S17
Author(s):  
Jena Nicole Moody ◽  
Jasmeet Hayes ◽  
Thomas A. Buckley ◽  
Julianne Schmidt ◽  
Steven Broglio ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Clinical Outcomes ◽  
Postural Stability ◽  
Collegiate Athletes ◽  
Multiple Comparisons ◽  
Brief Symptom Inventory ◽  
Neurocognitive Performance ◽  
Symptom Inventory ◽  
Clinical Consequences

ObjectiveThis study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and concussion symptoms in healthy collegiate student athletes.BackgroundConcussions are common among youth athletes, yet the long-term clinical consequences are largely unknown. We hypothesized that earlier AFC (younger age at first injury) would be associated with worse clinical outcomes.Design/MethodsParticipants included 4,267 collegiate athletes with a positive concussion history from various contact, limited-contact, and non-contact sports (1,818 women and 2,449 men) who completed baseline assessments as part of the Concussion Assessment, Research and Education (CARE) Consortium. Self-reported AFC included both sport- and non-sport-related concussions. Participants completed the Brief Symptom Inventory-18 (assessing psychological distress), the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT, assessing neurocognitive performance and symptoms), the Sport Concussion Assessment Tool symptom evaluation, and the Balance Error Scoring System (assessing postural stability). Generalized linear models were implemented for men and women separately to examine the effects of AFC on clinical outcomes.ResultsMedian time from AFC to assessment was four years. After correcting for multiple comparisons, earlier AFC was associated with greater somatic (Exp(B) = 0.96, p = 0.001) and global (Exp(B) = 0.96, p < 0.001) psychological distress on the Brief Symptom Inventory-18, and slower ImPACT reaction time (B = −0.003, p = 0.001) in women. After correcting for multiple comparisons, AFC was not associated with any clinical outcomes in men.ConclusionsEarlier AFC appears to have some long-term clinical consequences in women but not men, which is consistent with work suggesting that women report greater overall symptoms than men following concussion. These results underscore the importance of minimizing the risk of and properly managing concussions in youth sports, as they may have lasting effects. Future work should examine mechanisms of the AFC sex effects as well as longer-term clinical outcomes in middle and older adulthood.

Fear Avoidance Following Musculoskeletal Injury in Male Adolescent Gaelic Footballers

2020 ◽  
Vol 29 (4) ◽  
pp. 413-419
Author(s):  
Sinéad O’Keeffe ◽  
Niamh Ní Chéilleachair ◽  
Siobhán O’Connor
Keyword(s):  
Psychological Distress ◽  
Injury Severity ◽  
Emergency Services ◽  
Musculoskeletal Injury ◽  
Return To Play ◽  
Male Adolescent ◽  
Fear Avoidance ◽  
Loss Of Function ◽  
Time Loss ◽  
Previous Injury

Context: Participating in Gaelic football provides a wealth of benefits, but a risk of musculoskeletal injury also exists. Injury is associated with physical consequences, including pain, discomfort, loss of function, time absent from school/sport, and considerable medical expenses, along with placing undue pressure on emergency services and hospital staff. Concurrent psychological consequences, such as fear avoidance, can also occur, causing psychological distress. There is a current dearth of available research examining the psychology of injury in male adolescent Gaelic footballers. Objective: To examine fear avoidance postinjury in male adolescent Gaelic footballers, the effect of pain, time loss, injury severity, and previous injury on the extent of fear avoidance, and the usefulness of a modified Athlete Fear Avoidance Questionnaire (AFAQ) as a screening tool for predicting injury. Design: Prospective cohort study. Setting: Recreational clubs. Participants: A total of 97 male adolescent club Gaelic footballers (13.4 [1.1] y). Interventions: Musculoskeletal injuries sustained during participation in Gaelic football, defined as any injury sustained during training or competition causing restricted performance or time lost from play, were assessed and recorded weekly by a certified athletic and rehabilitation therapist. Injuries requiring time loss from participation were classed as time-loss injuries. Injury characteristics that included type, nature, location, severity, and pain were recorded. Main Outcome Measures: Injured players completed the AFAQ, a measure of injury-related fear avoidance following injury assessment (AFAQ1). With time-loss injuries, the AFAQ was completed again (AFAQ2) prior to return to play. Modified AFAQ was completed at baseline. Results: Twenty-two injuries were recorded during the season with fear avoidance evident postinjury that significantly decreased before returning to play. Fear avoidance postinjury was higher in those with greater pain but time loss, injury severity, and previous injury did not significantly affect the extent of fear avoidance. Baseline fear avoidance did not predict injury. Conclusions: Psychological rehabilitation is recommended for managing postinjury psychological distress in male adolescent Gaelic footballers.

scholarly journals Transitioning Out of Professional Sport: The Psychosocial Impact of Career-Ending Non-Musculoskeletal Injuries Among Male Cricketers From England and Wales

2019 ◽  
Vol 13 (4) ◽  
pp. 629-644 ◽  
Author(s):  
Monna Arvinen-Barrow ◽  
Kelsey DeGrave ◽  
Stephen Pack ◽  
Brian Hemmings
Keyword(s):  
Interpretative Phenomenological Analysis ◽  
Injury Risk ◽  
Sport Injury ◽  
Career Transition ◽  
Musculoskeletal Injury ◽  
Musculoskeletal Injuries ◽  
Structured Interviews ◽  
Post Injury ◽  
England And Wales ◽  
Negative Effect

The purpose of this study was to document the lived experiences of professional cricketers who had encountered a career-ending non-musculoskeletal injury. Three male cricketers each with over nine years of playing experience in professional cricket representing England and Wales participated in retrospective in-depth semi-structured interviews. The Interpretative Phenomenological Analysis revealed that at the time of the injury, the participants were at the “final stretch” of their professional sporting careers and that despite a range of unpleasant reactions to injury, all participants experienced a healthy career transition out of sport. To best prepare athletes for a life outside of sport, ensuring athletes have sufficient plans in motion early on in their careers can reduce external and internal stressors, which if not addressed, can increase sport injury risk and have a negative effect on athletes’ reactions post-injury.

Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes

2016 ◽  
Vol 44 (3) ◽  
pp. 742-747 ◽  
Author(s):  
M. Alison Brooks ◽  
Kaitlin Peterson ◽  
Kevin Biese ◽  
Jennifer Sanfilippo ◽  
Bryan C. Heiderscheit ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Collegiate Athletes ◽  
Musculoskeletal Injury ◽  
Return To Play

scholarly journals King-Devick Sensitivity and Specificity to Concussion in Collegiate Athletes

2021 ◽  
Author(s):  
Rachel K. Le ◽  
Justus D. Ortega ◽  
Sara P. D. Chrisman ◽  
Anthony P. Kontos ◽  
Thomas A. Buckley ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Cutoff Score ◽  
Confounding Factors ◽  
Post Injury ◽  
Cross Sectional ◽  
Cutoff Scores

Context: The King-Devick (K-D) is used to identify oculomotor impairment following concussion. However, the diagnostic accuracy of the K-D over time has not been evaluated. Objective: (a) Examine the sensitivity and specificity of the K-D test at 0–6 hours of injury, 24–48 hours, asymptomatic, return-to-play, and 6-months following concussion and (b) compare outcomes for differentiating athletes with a concussion from non-concussed across confounding factors (sex, age, contact level, school year, learning disorder, ADHD, concussion history, migraine history, administration mode). Design: Retrospective, cross-sectional design. Setting: Multisite institutions within the Concussion Assessment, Research, and Education (CARE) Consortium. Patients or Other Participants: 1239 total collegiate athletes without a concussion (age=20.31±1.18, male=52.2%) were compared to 320 athletes with a concussion (age=19.80±1.41, male=51.3%). Main Outcome Measure(s): We calculated K-D time difference (sec) by subtracting baseline from the most recent time. Receiver operator characteristics (ROC) and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across timepoints. We identified cutoff scores and corresponding specificity at 80% and 70% sensitivity levels. We repeated ROC with AUC outcomes by confounding factors. Results: King-Devick predicted positive results at 0-6 hours (AUC=0.724, p&lt;0.001), 24-48 hours (AUC=0.701, p&lt;0.001), return-to-play (AUC=0.640, P&lt;0.001), and 6-months (AUC=0.615, P&lt;0.001), but not at asymptomatic (AUC=0.513, P=0.497). The 0–6 and 24–48-hour timepoints yielded an 80% sensitivity cutoff score of −2.6 and −3.2 seconds (faster) respectively, but 46% and 41% specificity. The K-D test had significantly better AUC when administered on an iPad (AUC=0.800, 95%CI:0.747,0.854) compared to the spiral card system (AUC=0.646, 95%CI:0.600,0.692; p&lt;0.001). Conclusions: The K-D test has the greatest diagnostic accuracy at 0–6 and 24–48 hours of concussion, but declines across subsequent post-injury timepoints. AUCs did not significantly differentiate between groups for confounding factors. Our negative cutoff scores indicate that practice effects contribute to improved performance, requiring athletes to outperform their baseline.

Effects of seeking compensation on the psychological health and recovery of injured patients: the role of stress vulnerability and injury-related disability

2020 ◽  
pp. 1-12 ◽  
Author(s):  
I. Pozzato ◽  
A. Kifley ◽  
A. Craig ◽  
B. Gopinath ◽  
Y. Tran ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Psychological Health ◽  
Systems Approach ◽  
Convincing Evidence ◽  
Post Injury ◽  
Severe Injuries ◽  
Related Factors ◽  
Stress Vulnerability ◽  
Injured Patients

Abstract Background Seeking compensation has been shown to have an adverse effect on the psychological health and recovery of injured patients, however, this effect requires clarification. Methods A total of 2019 adults sustaining a traffic injury were recruited. Of these, 709 (35.1%) lodged a compensation claim. Interviews occurred at 1-, 6- and 12-month post-injury. Outcomes were psychological distress (posttraumatic stress (PTS) and depressive symptoms) and health-related functioning (HrF) (quality of life measured by EQ-5D-3L and disability by WHODAS) over 12-months post-injury. Covariates included individual stress vulnerability (preinjury, injury-related factors). Results Compared with non-compensation participants, compensation groups had higher stress vulnerability (more severe injuries and negative reactions) and poorer baseline outcomes (psychological health and HrF). After adjustment, we found an effect of compensation on HrF [β-0.09 (−0.11 to −0.07), p < 0.001] and PTS [β = 0.36 (0.16 to 0.56), p = 0.0003], but not on depression [β = −0.07 (−0.42 to 0.28), p = 0.7]. Both groups improved over time. Vulnerable individuals (β = 1.23, p < 0.001) and those with poorer baseline outcomes (PTS: β = 0.06, p = 0.002; HrF: β = −1.07, p < 0.001) were more likely to lodge a claim. In turn, higher stress vulnerability, poor baseline outcomes and claiming compensation were associated with long-term psychological distress and HrF. Nevertheless, concurrent HrF in the model fully accounted for the compensation effect on psychological distress (β = −0.14, p = 0.27), but not vice versa. Conclusions This study provides convincing evidence that seeking compensation is not necessarily harmful to psychological health. The person's stress vulnerability and injury-related disability emerge as major risk factors of long-term psychological distress, requiring a whole-systems approach to address the problem.

scholarly journals Greater Accuracy in Concussion Diagnosis in Collegiate Athletes through the use of Blood Brain Biomarkers

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S5.1-S5
Author(s):  
Anand Tripathi ◽  
Sundeep Dhanju ◽  
Steve Rowson ◽  
Eric Smith ◽  
Mike Goforth ◽  
...  
Keyword(s):  
Collegiate Athletes ◽  
Pilot Project ◽  
Football Player ◽  
Athletic Participation ◽  
Return To Play ◽  
Health Concern ◽  
Head Acceleration ◽  
Post Injury ◽  
Blood Brain ◽  
Acceleration Data

ObjectiveThe primary aim is to document the cumulative neuropathologic burden of sport-related concussion via brain biomarkers (e.g., S100B and GFAP) in collegiate athletes at baseline, during the acute phase of a concussive injury, at return to play, and upon completion of collegiate athletic participation.BackgroundSport-related concussion is a major public health concern currently. Yet, the diagnosis is all done clinically, without a standardized objective measurement that could definitively implicate the presence of a concussion. Previous studies have shown blood brain biomarkers to be useful in determining the diagnosis of traumatic brain injury. Indeed, few studies have shown biomarkers that are highly sensitive and specific for detecting concussion in the general population and the FDA has approved such a biokit for public use. This biokit is used to determine if a brain CT scan is needed for an alert patient that presents to the emergency department following head trauma. However, much more work is needed to for concussion diagnosis in collegiate athletes.Design/MethodsA retrospective study is being conducted to analyze the blood biomarkers and head acceleration data collected from a pilot project. Four different groups are being used in this study: (1) nonimpact, (2) vigorous athletic controls (swimming, running, and baseball), (3) non- concussed football player (active controls), and (4) concussed football players.ResultsPreliminary results indicate significant differences in the means for the aforementioned groups (F = 3.85, df = 5.69 p = 0.0070, n = 74). Serum S100B levels are also significantly different for pre- and post-concussion groups (F = 4.51, p = 0.0405, df = 37).ConclusionsThere is a statistical difference in the blood biomarker levels in concussed versus non-concussed players. Current work is being undertaken to correlate head acceleration data to serum biomarker findings of concussion at baseline, post injury and completion of collegiate athletic participation to further study biomarker as a diagnostic tool in athletes.

scholarly journals The Influence of Psycho-Stimulant Medication on Concussion Recovery in Athletes with ADHD: Findings from the NCAA-DOD Concussion Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S22.2-S23
Author(s):  
Brett Gunn ◽  
Michael McCrea ◽  
Steven Broglio ◽  
R. Davis Moore
Keyword(s):  
Repeated Measures ◽  
Stimulant Medication ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Adhd Group ◽  
Post Injury ◽  
Stimulant Medications ◽  
Multiple Variables ◽  
Concussion Recovery ◽  
The Impact

ObjectiveWe sought to longitudinally evaluate concussion recovery in collegiate athletes with ADHD who were and were not taking psycho-stimulant medication.BackgroundPsycho-stimulant medication is commonly prescribed to individuals with ADHD. Some have posited that psycho-stimulant medications may mitigate impairments following sport-related concussion. However, no studies longitudinally evaluated the influence of psycho-stimulant medications on concussion recovery in collegiate athletes.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to evaluate athletes with ADHD who were not taking psycho-stimulant medications (Rx-ADHD; n = 20), athletes with ADHD who were taking psycho-stimulant medications (Rx+ADHD; n = 20), and controls (n = 80). Athletes with ADHD were double-matched to controls on biological sex, age, and body mass index. All athletes were assessed prior to their sporting season, 24-48 hours post-injury, and again upon unrestricted return-to-play (RTP). Cognition and clinical symptoms were evaluated using the ImPACT test.ResultsAthletes in the Rx-ADHD (10.4 ± 1.5 days) and Rx + ADHD (11.9 ± 1.7) groups exhibited prolonged symptom durations compared to controls (4.2 ± .8; p’s ≤ 0.05). Repeated-measures analyses of covariance (baseline scores = covariate) group × time interactions for multiple variables (p’s ≤ 0.05). Univariate analyses revealed that both groups with ADHD demonstrated poorer verbal memory, and greater total symptoms at 24–48 hours post-injury than controls (p’s ≤ 0.01). Additionally, athletes in the Rx-ADHD group demonstrated poorer cognitive efficiency at 24–48 hours post-injury, and at RTP than controls (p’s ≤ 0.05). Lastly, athletes in the Rx+ADHD group demonstrated slower visual motor speed at 24–48 hours post-injury, and at RTP than controls (p’s ≤ 0.05).ConclusionsT Our findings suggest that following concussion athletes with ADHD may experience longer recovery than controls, regardless of medicated status. Interestingly, athletes with ADHD who were taking medication did not appear to have different recovery time relative to un-medicated athletes with ADHD.

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