Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury

Alice Theadom, Nicola Starkey, Suzanne Barker-Collo, Kelly Jones, Shanthi Ameratunga, Valery Feigin, BIONIC4you Research Group, Alice Theadom, Nicola Starkey, Suzanne Barker-Collo, Kelly Jones, Shanthi Ameratunga, Valery Feigin, BIONIC4you Research Group

Abstract

There is increasing evidence that some people can experience persistent symptoms for up to a year following mild TBI. However, few longitudinal studies of mild TBI exist and the longer-term impact remains unclear. The purpose of this study is to determine if there are long-term effects of mild traumatic brain injury (TBI) four-years later. Adults (aged ≥16 years) identified as part of a TBI incidence study who experienced a mild-TBI four-years ago (N = 232) were compared to age-sex matched controls (N = 232). Sociodemographic variables, prior TBI and symptoms were assessed at the time of injury. Four years post-injury participants completed the Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and the Participation Assessment with Recombined Tools. Analysis of covariance was used to compare differences between TBI cases four years post-injury and controls, controlling for prior TBI and depression. A multiple regression model was used to identify the predictors of increased symptoms and reduced participation. The mild-TBI sample experienced significantly increased self-reported cognitive symptoms (F = 19.90, p = <0.01) four years post-injury than controls. There were no differences between the groups for somatic (F = 0.02, p = 0.89) or emotional symptoms (F = 0.31, p = 0.58). Additionally, the mild-TBI group reported significantly poorer community participation across all three domains: productivity (F = 199.07, p = <0.00), social relations (F = 13.93, p = <0.00) and getting out and about (F = 364.69, p = <0.00) compared to controls. A regression model accounting for 41% of the variance in cognitive symptoms in TBI cases revealed a history of TBI, receiving acute medical attention and baseline cognitive symptoms, sleep quality, anxiety and depression were predictive of outcome. The results indicate that whilst somatic and emotional symptoms resolve over time, cognitive symptoms can become persistent and that mild TBI can impact longer-term community participation. Early intervention is needed to reduce the longer-term impact of cognitive symptoms and facilitate participation.

Conflict of interest statement

Competing Interests: The authors declare that no competing interests exist.

Figures

Fig 1. Participant flow diagram.
Fig 1. Participant flow diagram.

References

    1. Feigin VF, Theadom A, Barker-Collo SL, Starkey N, McPherson K, Kahan M, et al. Incidence of traumatic brain injury in New Zealand: a population-based study. Lancet Neurol. 2013;12(1):53–64. doi:
    1. Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurology. 2008;7:728–741. doi:
    1. Te Ao B, Brown P, Tobias M, Ameratunga S, Barker-Collo S, Theadom A, et al. Cost of traumatic brain injury in New Zealand: Evidence from a population-based study. Neurol. 2014;83(18):1645–1652.
    1. Røe C, Sveen U, Alvsåker K, Bautz-Holter E. Post-concussion symptoms after mild traumatic brain injury: influence of demographic factors and injury severity in a 1-year cohort study. Disabil Rehabil. 2009;31(15):1235–1243. doi:
    1. Potter S, Leigh E, Wade D, Fleminger S. The Rivermead Post Concussion Symptoms Questionnaire: a confirmatory factor analysis. J Neurol. 2006;253(12):1603–1614. doi:
    1. Theadom A, Barker-Collo S, Jones K, Kahan M, Te Ao B, McPherson K, et al. Work limitations four years following mild traumatic brain injury: A cohort study. Arch Phys Med Rehabil. 201798(8) 1560–1566. doi:
    1. van der Naalt J, van Zomeren AH, Sluiter SW, Minderhoud JM. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol, Neurosurg, Psychiatr. 1999;66:207–213.
    1. Kirsch NL, de Leon MB, Maio RF, Millis SR, Tan-Schriner CU, Frederiksen S. Characteristics of a mild head injury subgroup with extreme, persisting distress on the Rivermead Postconcussion Symptoms questionnaire. Arch Phys Med Rehabil. 2010;91(1):35–42. doi:
    1. Theadom A, Parag V, Dowell T, McPherson K, Starkey N, Barker-Collo S, et al. Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. BJGP. 2016;66(642):e16–23. doi:
    1. Barker-Collo S, Jones K, Theadom A, Starkey N, Dowell A, McPherson K, et al. Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury: A population-based New Zealand study. Brain Inj. 2015;29(13–14):1604–1616. doi:
    1. Dikmen S, Machamer J, Temkin N. Mild Traumatic Brain Injury: Longitudinal Study of Cognition, Functional Status, and Post-Traumatic Symptoms. J Neurotrauma. 2017. 34(8):1524–1530. doi:
    1. Sigurdardottir S, Andelic N, Roe C, Jerstad T, Schanke AK. Post-concussion symptoms after traumatic brain injury at 3 and 12 months post-injury: a prospective study. Brain Inj. 2009;23(6):489–497. doi:
    1. Ponsford J, Wilmott C, Rothwell A, Cameron P, Kelly AM, Nelms R, et al. Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc. 2000;6:568–579.
    1. Wäljas M, Iverson GL, Lange RT, Hakulinen U, Dastidar P, Huhtala H, et al. A prospective biopsychosocial study of the persistent post-concussion symptoms following mild traumatic brain injury. J Neurotrauma. 2015;32(8):534–547. doi:
    1. Theadom A, Barker-Collo S, Feigin V, Starkey N, Jones K, Jones A, et al. The spectrum captured: a methodological approach to studying incidence and outcomes of traumatic brain injury on a population level. Neuroepidemiol. 2012;38(1):18–29.
    1. Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG, WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004;43 Suppl:113–125.
    1. King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. 1995;242(9):587–592.
    1. Whiteneck GG, Dijkers MP, Heinemann AW, Bogner JA, Bushnik T, Cicerone KD, et al. Development of the participation assessment with recombined tools-objective for use after traumatic brain injury. Arch Phys Med Rehabil. 2011;92(4):542–551. doi:
    1. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatr Res. 1989;28(2):193–213. Epub 1989/05/01.
    1. Fichtenberg NL, Putnam SH, Mann NR, Zafonte RD, Millard AE. Insomnia screening in postacute traumatic brain injury: utility and validity of the Pittsburgh Sleep Quality Index. Am J Phys Med Rehabil. 2001;80(5):339–345.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370.
    1. Whelan-Goodinson R, Ponsford J, Schonberger M. Validity of the Hospital Anxiety & Depression Scale to assess depression & anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. J Affect Disord. 2008;114:94–102. doi:
    1. Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941–948. doi:
    1. Hopkins WG. A scale of magnitudes for effect statistics. In: (ed) H W, editor. A New View of Statistics, 2002.
    1. Sveen U, Søberg HL, Østensjø S. Biographical disruption, adjustment and reconstruction of everyday occupations and work participation after mild traumatic brain injury. A focus group study. Disabil Rehabil. 2016;38(23):2296–2304. doi:
    1. Matuseviciene G, Eriksson G, DeBoussard CN. No effect of an early intervention after mild traumatic brain injury on activity and participation: A randomized controlled trial. J Rehabil Med. 2016;48(1):19–26. doi:
    1. Iverson GL. Outcome from mild traumatic brain injury. Curr Opin Psychiatry. 2005;18(3):301–317. doi:
    1. McMahon P, Hricik A, Yue JK, Puccio AM, Inoue T, Lingsma HF, et al. Symptomatology and Functional Outcome in Mild Traumatic Brain Injury: Results from the Prospective TRACK-TBI Study. J Neurotrauma. 201431(1):26–33. doi:
    1. Hiploylee C, Dufort PA, Davis HS, Wennberg RA, Tartaglia MC, Mikulis D, et al. Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers. J Neurotrauma. 2017;34(8):1511–1523. doi:
    1. Manley GT, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, et al. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med. 2017;51(12):969–977. doi:
    1. Snell DL, Surgenor LJ, Hay-Smith EJ, Siegert RJ. A systematic review of psychological treatments for mild traumatic brain injury: an update on the evidence. J Clin Exp Neuropsychol. 2009;31(1):20–38. doi:
    1. Silverberg ND, Gardner AJ, Brubacher JR, Panenka WJ, Li JJ, Iverson GL. Systematic review of multivariable prognostic models for mild traumatic brain injury. J Neurotrauma. 2015;32(8):517–26. doi:
    1. van der Naalt J, Timmerman ME, de Koning ME, van der Horn HJ, Scheenen ME, Jacobs B, et al. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol. 2017;16(7):532–540. doi:
    1. McKinlay A, Grace RC, Horwood LJ, Fergusson DM, Ridder EM, MacFarlane MR. Prevalence of traumatic brain injury among children, adolescents and young adults: prospective evidence from a birth cohort. Brain Inj. 2008;22(2):175–181. doi:
    1. Iverson GL, Echemendia RJ, Lamarre AK, Brooks BL, Gaetz MB. Possible lingering effects of multiple past concussions. Rehabil Res Pract. 2012;316575 doi:
    1. Gilworth G, Eyres S, Carey A, Bhakta B, Tennant A. Working with a brain injury: personal experiences of returning to work following a mild or moderate brain injury. J Rehabil Med. 2008;40:334–339. doi:
    1. Cameron CM, Purdie DM, Kliewer EV, McClure RJ. Ten year outcomes following traumatic brain injury: A population-based cohort. Brain Inj 2008;22(6):437–449. doi:

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi