Persistent Complaints Research Articles

Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF).

Significant progress and new insights have been gained since the Dutch Physical Therapy guideline on low back pain (LBP) in 2013 and the Cesar en Mensendieck guideline in 2009, necessitating an update of these guidelines. To update and develop an evidence-based guideline for the comprehensive management of LBP and lumbosacral radicular syndrome (LRS) without serious specific conditions (red flags) for Dutch physical therapists and Cesar and Mensendieck Therapists. Clinical practice guideline. Inpatient and outpatient. Adults with LBP and/or LRS. Clinically relevant questions were identified based on perceived barriers in current practice of physical therapy. All clinical questions were answered using published guidelines, systematic reviews, narrative reviews or systematic reviews performed by the project group. Recommendations were formulated based on evidence and additional considerations, as described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. Patients participated in every phase. The guideline describes a comprehensive assessment based on the International Classification of Functioning, Disability and Health (ICF) Core Set for LBP and LRS, including the identification of alarm symptoms and red flags. Patients are assigned to three treatment profiles (low, moderate and high risk of persistent symptoms) based on prognostic factors for persistent LBP. The guideline recommends offering simple and less intensive support to people who are likely to recover quickly (low-risk profile) and more complex and intensive support to people with a moderate or high risk of persistent complaints. Criteria for initiating and discontinuing physical therapy, and referral to a general practitioner are specified. Recommendations are formulated for information and advice, measurement instruments, active and passive interventions and behavior-oriented treatment. An evidence based physical therapy guideline for the management of patients with LBP and LRS without red flags for physical therapists and Cesar and Mensendieck therapists was developed. Cornerstones of physical therapy assessment and treatment are risk stratification, shared decision-making, information and advice, and exercises. This guideline provides guidance for clinicians and patients to optimize treatment outcomes in patients with LBP and LRS and offers transparency for other healthcare providers and stakeholders.

COVID-19 in Female and Male Athletes: Symptoms, Clinical Findings, Outcome, and Prolonged Exercise Intolerance—A Prospective, Observational, Multicenter Cohort Study (CoSmo-S)

BackgroundAn infection with SARS-CoV-2 can lead to a variety of symptoms and complications, which can impair athletic activity.ObjectiveWe aimed to assess the clinical symptom patterns, diagnostic findings, and the extent of impairment in sport practice in a large cohort of athletes infected with SARS-CoV-2, both initially after infection and at follow-up. Additionally, we investigated whether baseline factors that may contribute to reduced exercise tolerance at follow-up can be identified.MethodsIn this prospective, observational, multicenter study, we recruited German COVID elite-athletes (cEAs, n = 444) and COVID non-elite athletes (cNEAs, n = 481) who tested positive for SARS-CoV-2 by PCR (polymerase chain reaction test). Athletes from the federal squad with no evidence of SARS-CoV-2 infection served as healthy controls (EAcon, n = 501). Questionnaires were used to assess load and duration of infectious symptoms, other complaints, exercise tolerance, and duration of training interruption at baseline and at follow-up 6 months after baseline. Diagnostic tests conducted at baseline included resting and exercise electrocardiogram (ECG), echocardiography, spirometry, and blood analyses.ResultsMost acute and infection-related symptoms and other complaints were more prevalent in cNEA than in cEAs. Compared to cEAs, EAcon had a low symptom load. In cNEAs, female athletes had a higher prevalence of complaints such as palpitations, dizziness, chest pain, myalgia, sleeping disturbances, mood swings, and concentration problems compared to male athletes (p < 0.05). Until follow-up, leading symptoms were drop in performance, concentration problems, and dyspnea on exertion. Female athletes had significantly higher prevalence for symptoms until follow-up compared to male. Pathological findings in ECG, echocardiography, and spirometry, attributed to SARS-CoV-2 infection, were rare in infected athletes. Most athletes reported a training interruption between 2 and 4 weeks (cNEAs: 52.9%, cEAs: 52.4%), while more cNEAs (27.1%) compared to cEAs (5.1%) had a training interruption lasting more than 4 weeks (p < 0.001). At follow-up, 13.8% of cNEAs and 9.9% of cEAs (p = 0.24) reported their current exercise tolerance to be under 70% compared to pre-infection state. A persistent loss of exercise tolerance at follow-up was associated with persistent complaints at baseline, female sex, a longer break in training, and age > 38 years. Periodical dichotomization of the data set showed a higher prevalence of infectious symptoms such as cough, sore throat, and coryza in the second phase of the pandemic, while a number of neuropsychiatric symptoms as well as dyspnea on exertion were less frequent in this period.ConclusionsCompared to recreational athletes, elite athletes seem to be at lower risk of being or remaining symptomatic after SARS-CoV-2 infection. It remains to be determined whether persistent complaints after SARS-CoV-2 infection without evidence of accompanying organ damage may have a negative impact on further health and career in athletes. Identifying risk factors for an extended recovery period such as female sex and ongoing neuropsychological symptoms could help to identify athletes, who may require a more cautious approach to rebuilding their training regimen.Trial Registration NumberDRKS00023717; 06.15.2021—retrospectively registered.

Влияние противовирусной терапии на течение острых респи- раторных вирусных инфекций у детей в современных условиях

Aim: to assess the efficacy of antiviral therapy in the treatment of acute respiratory viral infections in children in the context of contemporary clinical practice Patients and Methods: the study employed a pharmacoepidemiologic approach, utilizing a questionnaire survey of physicians to collect data on 6,116 children aged 3 to 7 years with mild to moderate acute respiratory infections. The study group included 5,144 (84%) children who received inosine pranobex. Comparison group 1 included 654 (11%) children who received other antivirals or immunomodulators. Comparison group 2 included 318 (5%) children who did not receive any etiological therapy. The clinical manifestations of acute respiratory viral infections, their duration, disease duration, complications, therapy, and the rationale for the choice of medications by the physician were analyzed. Results: disease duration in the study group (5.97±1.57 days) was significantly lower than in comparison group 1 (6.82±1.84 days, p&lt;0.001) and comparison group 2 (6.79±1.88 days, p&lt;0.001). Persistent complaints during convalescence were observed in 288 (5.6%) children in the study group, 154 (23.5%) children in comparison group 1, and 61 (19.2%) children in comparison group 2. Complications were reported in 164 (3.2%) children of the study group (n=169), 104 children (n=107, 15.9%; p&lt;0.0001) in the comparison group 1, and 34 (n=34, 10.7%; p&lt;0.0001) children of the comparison group 2. Conclusion: inosine pranobex has been demonstrated to reduce the rate of complications, prolonged cough, runny nose, and sore throat during convalescence, as well as overall disease duration, duration of the febrile period, and catarrhal phenomena in acute respiratory viral infections in children KEYWORDS: acute respiratory viral infections, COVID-19, herpesvirus infections, inosine pranobex, nasopharyngitis, acute tonsillitis, tonsillopharyngitis, real clinical practice, children. FOR CITATION: Ruzhentsova T.A., Garbuzov A.A., Meshkova N.A., Popova R.V., Slyusar O.I. Effect of antiviral therapy on the course of acute respiratory viral infections in children in contemporary conditions. Russian Journal of Woman and Child Health. 2024;7(2):163–170 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-12.

Remodelling surgery with 3D printed patient specific surgical guides in patients with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible, a case series.

Patients with chronic diffuse sclerosing osteomyelitis/tendoperiostitis (DSO/TP) of the mandible may complain about facial asymmetry as a result of mandibular deformity, one of the characteristics of DSO/TP of the mandible. If the disease is fully extinguished, remodelling surgery could be performed to treat complaints of facial asymmetry. This study reports the results of remodelling surgery with three-dimensional (3D) designed- and -printed patient-specific surgical guides. 3D printed guides were designed and manufactured by using mirroring of the contralateral non-affected mandible. Subsequently, the surgical procedure was performed under general anaesthesia using these surgical guides. Four patients (all female) aged 15 (±2.8) years were included. They all complained about facial asymmetry and were planned for surgery with patient-specific surgical guides. Three of those surgeries were performed, of which two patients were satisfied with the result and the other patient is planned for re-surgery because of persistent aesthetical complaints. The last patient cancelled her surgery, because she eventually accepted her asymmetry with the help of a psychologist. The use of patient-specific surgical guides in remodelling surgery of the mandible could enable a more predictable and symmetrical outcome, which could minimise the chance for re-surgery and could increase patient satisfaction. Furthermore, it could minimise the chance of iatrogenic damage to the inferior alveolar nerve.

Challenges in Reforming University Curricula for Graduate Employability: Head of Academic Departments Perspective

This paper delves into the multifaceted roles of Heads of Academic Departments (HoDs) and their intricate challenges in overhauling their units' curricula to enhance graduate employability within a university college in Uganda. Originating from persistent complaints by employers and stakeholders regarding the perceived deficiency in employable skills among university graduates despite multiple curricular revisions, the study employed a qualitative methodology, gathering data from four purposefully selected HoDs through in-depth interviews. The study's findings revealed divergent interpretations of graduate employability among participants, ranging from possessing employable skills to a student's ability to complete their study programme and secure gainful employment. Additionally, participants disclosed strategies for enabling curriculum revisions, involving, and motivating stakeholders, providing effective leadership, and offering essential information and support to their staff during the curriculum review and development process. However, the study identifies several challenges participants face in revising their units' curricula, including limited stakeholder cooperation, rapidly changing societal needs, and a shortage of funds for the curriculum review and development process. Consequently, the study concludes that while HoDs are committed to reforming university curricula to promote graduate employability, their efforts are hampered by various challenges, necessitating increased institutional support to enhance their capacity to improve graduate employability effectively

CROP ATTRIBUTES, FARM DECISIONS CROP SPECIFIC POLICIES IN THE CONTEXT OF SUSTAINABILITY OF PRODUCTION IN ETHIOPIA

Ethiopia’s government has created a number of policies and programs to address the urgent issue of rising food prices. Extension and regulation initiatives aiming at influencing the production and marketing are frequently used in conjunction with them. However, lack of indices on relative importance of individual crops results poor policy outcomes. Analyzing household decision dynamics and how household decisions respond to policies is crucial to reduce persistent complaints from recipients and avoid negative policy outcomes. For this study, data from 392 randomly chosen households of Kewot woreda was used. Sorghum found with higher calorie index per profit while mung bean was found higher profit index. Crop diversification found inefficient that arise from profitability differences and return to scale. Additionally multiple objectives could be met using tradeoffs among different crop benefits. This study also summarizes major findings from previous crop-related policies and linked them to specific crop characteristics. It is advised that policies be adjusted to reflect the value, character, and utility of crops.

One year evaluation of people with persistent complaints after COVID-19 receiving treatment from a primary care allied health professional

One year evaluation of people with persistent complaints after COVID-19 receiving treatment from a primary care allied health professional

Overweight and obesity in people with persistent complaints after COVID-19: The association and predictive value of bmi with participation, fatigue and psychological well-being

Overweight and obesity in people with persistent complaints after COVID-19: The association and predictive value of bmi with participation, fatigue and psychological well-being

Risk of malnutrition and sarcopenia in people attending a primary care dietitian for persistent complaints after COVID-19

Risk of malnutrition and sarcopenia in people attending a primary care dietitian for persistent complaints after COVID-19

Neuroticism and Fibromyalgia Syndrome: A Systematic Review and Meta-analysis

Context: Neuroticism is associated with a heightened experience of bodily sensations and pain. This suggests that psychosocial factors can affect biological mechanisms. However, it is unclear whether fibromyalgia (FM) is associated with neuroticism and how these factors may be related. Objectives: This study attempted to incorporate recent studies on fibromyalgia and neuroticism to comprehensively explain it. Methods: In this systematic review and meta-analysis based on the PRISMA guidelines (2020), PubMed, Psych INFO, Social Sciences, Scopus, ProQuest, and Google Scholar were searched for quantitative studies published up to August 31, 2022. Results: Nineteen cross-sectional studies met the meta-analytic inclusion criteria, totaling 7,881 participants. The meta-analysis demonstrated high levels of neuroticism in fibromyalgia patients compared with control groups (Hedges’ g = 0.78; 95% CI = 0.54 − 1.02; P &lt; 0.001). This meta-analysis provides evidence of the role of neuroticism as a contributing factor in the development and manifestation of fibromyalgia. Meta-regression and subgroup analyses were also conducted to investigate the potential moderators that might have influenced the effect size. The results of the meta-regression and subgroup analyses revealed that the health condition of the control group and the sex of the participants were significant moderators affecting the effect size. Conclusions: The results suggest that neuroticism should be specifically assessed and targeted in fibromyalgia interventions, especially in women. Furthermore, there should be particular emphasis on the mechanisms through which neuroticism may contribute to an increased risk of persistent pain and somatic complaints. As a result, fibromyalgia patients with high neuroticism levels should receive multimodal interventions to address neuroticism.

3 Optimizing Cognitive Rehabilitation of the Injured Warfighter

Objective:Many individuals who experienced a mild traumatic brain injury (mTBI) have persistent cognitive complaints. Traditional cognitive rehabilitation (TCR) interventions were primarily developed for severe neurological injury which has limited effectiveness in rehabilitation of active duty military personnel who have the goal of returning to full military operational status. To remain on active duty, warfighters must have sufficient mental competency to safely and effectively function in complex environments such as combat. There is need for a cognitive rehabilitation approach that addresses demands of military personnel to expedite return to duty. The Strategic Memory Advanced Reasoning Training (SMART) program is novel alternative to TCR. SMART is an evidence-based advanced reasoning protocol that enhances cognitive domains essential to military readiness (e.g., mental agility, strategic learning, problem solving, and focus) and requires less than half of the treatment time. The objective of this study was to assess the efficacy of SMART compared to TCR in terms of overall recovery as well as change in specific cognitive domains.Participants and Methods:Participants were recruited from a military treatment facility. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Participants completed the Rey-15 to ensure performance validity. Final sample was SMART n = 28 and SCORE n = 19. Primary dependent measure was the Global Deficit Scale (GDS). GDS was calculated from: Hopkins Verbal Learning Test-Revised (HVLT-R); Delis Kaplan Executive Functioning System Color Word (CW) and Trail Making (TM), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores were converted to deficit scores as follows: &gt;40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, &lt;20 = 5. Deficit scores were averaged to calculate GDS. For each measure, Hohen’s g was analyzed for effect size comparisons pre-post treatment.Results:Average number of treatment hours was significantly lower in the SMART condition (SMART: M = 18.47 hours, SD = 2.17; TCR: M = 42.42 hours, SD = 3.79, p &lt;.001). A repeated measures ANOVA showed a significant change on GDS post-treatment (F = 30.25, p &lt; .001) with a large effect size (n2 = .402); however, the interventions did not differ on GDS change. Impact on cognitive domains was relatively equivalent for processing speed (SMART h = 0.67 vs TCR h = -.54) and executive function (SMART h = -0.92 vs TCR h = -.85); however, SMART had a larger impact on memory (SMART h = -0.81 vs TCR h = -.39). SMART resulted in large improvements in retention and recognition memory which were minimally impacted by TCR.Conclusions:Both TCR and SMART had comparable effectiveness in improving cognitive impairment, though SMART was completed in less than half of the treatment time. Both interventions had large effect sizes on processing speed and executive functioning; however, SMART was more effective in improving long-term memory. Memory is an integral part of military readiness. Further investigation is required to determine the relative effectiveness of these two approaches to improving cognitive readiness of the warfighter.

54 Individuals Employing Extreme Coping Behaviors Correlated with Increased Severity of Symptoms Following mTBI

Objective:Approximately 10-15% of patients with mild traumatic brain injury (mTBI) report persistent, chronic symptoms more than one month later. Coping behaviors after mTBI can range from fear avoidance (FA), or a reluctance to return to activity because of the fear of symptom exaggeration, to endurance (END), or an overly aggressive return to activity. We evaluated how coping strategy relates to self-reported symptoms in patients with prolonged recovery from mTBI.Participants and Methods:Participants were 72 individuals (age 37.8 + 18.4, 65% female) who sustained a mTBI at least one month prior to assessment (median (IQR) = 5.5 (2.0-11.3) months). Participants completed the Brain Injury Recovery Disposition Scale (BIRDS) to assess FA and END behaviors, and Sport Concussion Assessment Tool (SCAT5) Symptom Inventory. A BIRDS spectrum score was calculated as the difference between FA and END scores to determine individual coping behavior on a spectrum from extreme FA (more negative) to extreme END (more positive). SCAT5 symptoms were separated into four domain scores: somatic, cognitive, sleep, and emotion. Regressions were performed for each outcome examining their potential linear and quadratic associations to coping behavior (i.e., BIRDS spectrum score). Follow-up regressions were performed covarying for age and sex to explore the potential influence of these variables on each outcome.Results:The linear and quadratic components of the BIRDS spectrum score were not significantly related to total number of persisting concussive symptoms. For overall total symptom severity, the quadratic component of the relationship was significant (B = .24, p = 0.04). Visualization of the overall trend line suggested that symptom severity was highest on the extreme FA side of the BIRDS spectrum (highly negative BIRDS spectrum score), decreased as coping behavior become more balanced (BIRDS spectrum score surrounding “0"), plateaued, then increased abruptly on the extreme END side (highly positive BIRDS spectrum score). For cognitive symptoms, the linear component of the BIRDS spectrum score was significant (B = -.28, p = 0.02) and the quadratic component was marginally significant (B = .22, p = 0.06). The quadratic (but not linear) component was significantly related to both the severity of sleep (B = .31, p = 0.01) and emotion symptoms (B = .25, p = 0.03). Finally, neither the linear nor quadratic components were significantly related to the somatic symptom severity. After covarying for age and sex, the quadratic component remained significant for total symptom severity (p = 0.05) as well as the linear component for cognitive severity (p = 0.02).Conclusions:Both extreme “fear avoidance” and “endurance” coping styles may be related to more severe chronic mTBI symptoms, especially in domains of sleep and emotion symptoms. Patients with balance of both fear avoidance and endurance behaviors may be more likely to experience less severe symptoms even among mTBI patients with persistent complaints. Identifying coping behavior styles early after mTBI could improve prognostication and help with developing personalized treatment plans to improve patient recovery. Future research with larger sample sizes should further examine the influence of age and sex on the relationship between coping behavior and symptom severity.

51 Impact of Blast Exposures on the Cognitive Abilities of Warfighters

Objective:There is growing evidence to indicate that blast exposure military personnel experience throughout their career can have a negative impact on their brain health. The majority of research in the area of blast related neurotrauma has been focused on traumatic brain injury (TBI); however, the blast exposure may often be independent of TBI. It is common in both active duty military and veterans to report years of blast exposure from combat and training. The objective of this study was to explore the relationship between blast exposure and cognitive functioning in military personnel seeking treatment for a mild TBI.Participants and Methods:Participants were recruited from a military hospital while enrolled in a multidisciplinary treatment program for TBI. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Exclusion criteria included invalid performance on a performance validity test and a symptom validity test. 97 participants were included in the analysis with an average age of 34.0 (SD = 7.9) and average 4.0 combat deployments (SD = 3.6). Blast exposure history was measured by the overall score from the Blast Exposure Threshold Survey (BETS) which assessed the frequency and duration of use of various blast sources. Outcomes included the Neurobehavioral Symptom Inventory (NSI) and the Global Deficit Scale (GDS) an objective measure of cognitive deficiency. GDS was calculated from seven measures: Hopkins Verbal Learning Test-Revised Total and Delayed Recall (HVLT-TR and HVLT-DR); DKEFS System Color-Word Condition 3 Inhibition (CW3), Color-Word Condition 4 Switching (CW4) and Trail Making Condition 3 Letter Sequencing (TM3), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores (M=50, SD = 10) were converted to deficit scores and averaged to calculate GDS. To adjust for nonnormal distributions, non-parametric statistics were examined.Results:The BETS was not related to GDS (rho = -.055); however, there was a significant correlation between higher levels on the BETS and better performance on measures of selective attention (PASAT rho = .307) and processing speed (SDMT rho = .218). The correlation between BETS and the other neuropsychological measures were not meaningful (all rho’s &lt;.10). Those with an impaired GDS, did not differ from others on the BETS. BETS was also not associated with neurobehavioral symptoms (rho = .125). BETS had moderate correlations with number of combat deployments (rho =.483), severity of combat exposure (rho =.556). It was not related to education (rho = .004) or pre-morbid intelligence (rho =-.029).Conclusions:The BETS was not related to GDS (rho = -.055); however, there was a significant correlation between higher levels on the BETS and better performance on measures of selective attention (PASAT rho = .307) and processing speed (SDMT rho = .218). The correlation between BETS and the other neuropsychological measures were not meaningful (all rho’s &lt;.10). Those with an impaired GDS, did not differ from others on the BETS. BETS was also not associated with neurobehavioral symptoms (rho = .125). BETS had moderate correlations with number of combat deployments (rho =.483), severity of combat exposure (rho =.556). It was not related to education (rho = .004) or pre-morbid intelligence (rho =-.029).

Understanding the Relationships Between Sleep Quality and Depression and Anxiety in Neurotrauma: A Scoping Review.

Sleep problems, depression, and anxiety are highly prevalent after a spinal cord injury (SCI) and traumatic brain injury (TBI) and may worsen functional outcomes and quality of life. This scoping review examined the existing literature to understand the relationships between sleep quality, depression, and anxiety in persons with SCI and TBI, and to identify gaps in the literature. A systematic search of seven databases was conducted. The findings of 30 eligible studies reporting associations between sleep quality and depression and/or anxiety after SCI or TBI were synthesized. The included studies were mostly cross-sectional and employed a range of subjective and objective measures of sleep quality. Poor subjective sleep quality and insomnia tended to be significantly associated with increased levels of depression and/or anxiety, but no such associations were reported when sleep quality was measured objectively. Two longitudinal studies observed worsening depressive symptoms over time were related to insomnia and persistent sleep complaints. Two interventional studies found that treating sleep problems improved symptoms of depression and anxiety. The findings of this review suggest that sleep and psychopathology are related in persons with neurotraumatic injuries. This has important therapeutic implications, because individuals may benefit from therapy targeting both sleep and psychological issues. More longitudinal and interventional studies are warranted to further understand the direction and strength of the relationships and how they impact patient outcomes.

Long-term health consequences in persons with and without SARS-CoV-2 infection in Germany

Abstract Background So far, few population-based studies comprehensively examined health consequences of COVID-19 including a control group not exposed to SARS-CoV-2 infection and a long-term follow-up. This cohort study of 4817 adults from four municipalities in Germany examined health consequences among individuals more than one year after SARS-CoV-2 infection compared with non-infected individuals. Methods Exposure was the SARS-CoV-2 infection status (based on IgG antibodies, PCR test, or physician-diagnosis of COVID-19) at baseline (04/2020 to 12/2020). Outcomes assessed at follow-up (10/2021 to 01/2022) included recurrent or persistent health complaints, incident diseases, health-related quality of life (PROMIS-29), subjective health and subjective memory impairment. Regression models were adjusted for socio-demographic and lifestyle characteristics, pre-existing health conditions and follow-up time. Results Overall, 350 participants had a SARS-CoV-2 infection at baseline and 4467 had no infection at baseline or during follow-up. Individuals with an infection reported more often 7 out of 18 recurrent or persistent health complaints at follow-up: smell/taste disorders (OR 4.1, 95%−CI 2.8-6.0), shortness of breath (3.5, 2.6-4.7), pain when breathing (2.4, 1.3-4.2), fatigue (1.8, 1.4-2.2), weakness in legs (1.9, 1.3-2.8), myalgia/joint pain (1.5, 1.2-2.0) and cough (1.3, 1.0-1.7) and 3 out of 6 groups of incident diseases: liver/kidney (3.7, 1.7-8.1), lung (3.5, 1.7-7.1) and cardiovascular/metabolic (1.7, 1.0-2.7) diseases. Participants with an infection were significantly more likely to report poor subjective health, memory impairment and worse mean scores on fatigue and physical function domains of PROMIS-29 than non-infected. Conclusions Results of this population-based controlled study point to a considerable impact of SARS-CoV-2 infection on health and well-being among adults with a mainly mild course of acute infection even more than one year after infection. Key messages • After one year, individuals with SARS-CoV-2 infection showed increased risks of various health complaints, functional limitations and worse subjective health compared to those without an infection. • Long-term health consequences after a SARS-CoV-2 infection is a relevant public health concern.

P030 Understanding the relationships between sleep quality, and depression and anxiety in neurotrauma: A scoping review.

Abstract Introduction Sleep problems, depression, and anxiety are highly prevalent following a spinal cord injury (SCI) and traumatic brain injury (TBI) and may worsen functional outcomes and quality of life. This scoping review examined the existing literature to understand the relationships between sleep quality, depression, and anxiety in people with SCI and TBI, and to identify gaps in the literature. Methods A systematic search of seven databases was conducted. The findings of 30 eligible studies reporting associations between sleep quality and depression and/or anxiety following SCI or TBI were synthesised. Results The included studies were mostly cross-sectional and employed a range of subjective and objective measures of sleep quality. Poor subjective sleep quality and insomnia tended to be significantly associated with increased levels of depression and/or anxiety, but no such associations were reported when sleep quality was measured objectively. Two longitudinal studies observed worsening depressive symptoms over time were related to insomnia and persistent sleep complaints. Two interventional studies found that treating sleep problems improved symptoms of depression and anxiety. Discussion The findings of this review suggest that sleep and psychopathology are related in people with neurotraumatic injuries. This has important therapeutic implications, as individuals may benefit from therapy targeting both sleep and psychological issues. More longitudinal and interventional studies are warranted to further understand the direction and strength of the relationships, and how they impact patient outcomes.

A - 152 Won't Get Fooled Again: Factors in Persistent Complaints Following Youth Concussion.

While symptoms following youth concussion typically resolve within one month of injury, some patients report persistent post-concussive symptoms (PPCS). The current project aims to characterize a sample of sports neuropsychology patients, examine clinical outcomes, and determine relevant factors. Sports neuropsychology evaluated 38 consecutively referred patients at a rural academic medical center. The sample was 50% female, mostly White (91.9%), and ranged from 7-22years of age (M = 16.45, SD = 2.92). Most had pre-existing conditions (medical/psychiatric; 78.9%), and 63% had at least one previous concussion. Months-from-injury varied (median = 4; range = 1-29). FSIQ was average (M = 107, SD = 15.45). We analyzed relationships between factors and outcomes using correlations (Spearman's rho or Pearson's r) and stepwise linear regression to determine prediction. Only nine patients' persistent complaints were due to concussion, while medical or psychiatric etiologies explained PPCS in the majority of the sample (76.3%). Outcomes were uncorrelated with gender, age, race, IQ, or months-since-injury. Pre-existing depression (rs(37) = -0.40, p = 0.01) and migraines (rs(37) = -0.35, p = 0.02) both showed significant moderate correlations with outcome. Stepwise regression indicated that only pre-existing depression (β= -0.360, p = 0.01) significantly predicted the non-concussion clinical outcome. In our sample, the etiology of PPCS was something other than concussion in over 76% of youth seen by sports neuropsychology. Pre-existing depression and migraines were significantly correlated with this outcome, and depression was a significant predictor. These results add to the literature on PPCS in children. Neuropsychologist involvement earlier in concussion care may help prevent PPCS by rapidly connecting patients to the proper interventions, thereby reducing families' economic burden and improving patients' quality of life.

A - 72 Neuropsychological Test Performance in Mild to Moderate COVID-19 Patients with and without Subjective Cognitive Complaints.

This cross-sectional study measured cognitive performance in mild-moderate COVID-19 patients with and without self-reported persistent cognitive complaints, while accounting for demographic variables, cardiovascular (CVD) risk factors, and mood symptoms. We hypothesized that individuals with persistent cognitive complaints would demonstrate lower global cognitive composite scores compared to those without. 67 adults aged 24-83 completed in-person neuropsychological testing in a hospital setting in Phoenix, Arizona. PCR-confirmed COVID-19 within 24months before evaluation and no pre-existing neurological conditions. The Long COVID (LC) group included those with persistent cognitive symptoms 4+ weeks after infection; COVID-positive Controls (CC) included those with prior infection but without persistent cognitive symptoms. Demographic information, CVD risk factors, and psychiatric history were collected. Neuropsychological evaluation included performance validity testing and validated measures of attention, language, visuospatial ability, executive function, and memory. T-scores from each domain were averaged to create a global cognitive composite score. Gender, age, race (white/non-white), mood disorder, and CVD were equivalent across groups. Education was significantly higher in the LC group, t(65) = 2.737, p = 0.008, and was included as a covariate in the model to account for differences in cognitive reserve. With this adjustment, there was not a statistically significant difference in global composite scores between groups, F(1, 64) = 0.13, p = 0.911, partial η2 = 0.000. Cognitive performance did not differ between LC and CC groups when demographics, cardiovascular risk, and mood symptoms were held constant, suggesting that other factors influence the development of persistent cognitive complaints in mild-moderate COVID-19 patients.

A - 134 The Impact of Pre-Treatment Mental Health Symptoms on the Efficacy of Cognitive Rehabilitation for Warfighters with a History Mild TBI.

Mild traumatic brain injury (mTBI) is common among warfighters. Most have a full recovery but some have persistent cognitive complaints. Cognitive rehabilitation is the primary treatment; however, mTBI is highly co-morbid with depression and post-traumatic stress (PTS). This study investigated if high levels of mental health symptoms negatively impacted the efficacy of cognitive rehabilitation. 82 military personnel with at least one diagnosed mTBI and persistent cognitive complaints completed 4-6weeks of cognitive rehabilitation. PTS was measured by the Post-Traumatic Checklist-5 (PCL-5) and depression was measured with the Patient Health Questionnaire 8 (PHQ8); scores were dichotomized based on published cut-offs (>33 and > 10, respectively). Outcomes included change pre-post treatment on: Neurobehavioral Scale Inventory (NSI), Key Behavior Change Index (KBCI), and Global Deficit Scale (GDS). GDS was derived from: Hopkins Verbal Learning Test-Revised, Color Word, Trail Making, Paced Auditory Serial Addition Test, and the Symbol Digit Modality Test. A MANOVA revealed PTS had no effect on the NSI, KBCI, or GDS (p = 0.659). There was a significant effect for depression (p = 0.017); however, this was specific to change in GDS (p = 0.002). The average reduction was 0.98 (SD = 0.87) in high depression and 0.43 (SD = 0.68) in low depression. Depression did not impact NSI or KBCI. In contrast to the initial hypothesis, high levels of depression or PTS did not negatively impact the efficacy of cognitive rehabilitation. In fact, warfighters with high levels of depression had greater improvements in cognitive functioning.

B - 107 Exploratory Analysis of the Relationship between Health Anxiety (HA) and Neuropsychological Performance in a Validity Controlled Sample of Patients with Post-Acute Sequelae of COVID-19 (PASC).

Since the emergence of COVID-19, research has consistently indicated cognitive difficulties as a primary complaint after infection (Altuna et al., 2021). It is unclear to what extent these cognitive deficits may be attributable to, or exacerbated by, health anxiety (HA) (Venkataramani et al., 2022). This study explored the relationship between HA and cognition in a performance validity controlled sample of patients with PASC complaints. Participants included patients referred for a focused neuropsychological evaluation for persistent cognitive complaints after COVID infection (N = 19). Participants were excluded for Test of Memory Malingering scores below standard cutoff. The sample mean age was 43years (SD = 12.9), 57.9% were female, and 47.4% were from minority racial/ethnic groups. HA was assessed using the Short Health Anxiety Inventory (SHAI). Cognitive abilities were measured using the Wechsler Adult Intelligence Scale-IV (WAIS-IV: Processing Speed Index [PSI]; Letter-Number Sequencing [LNS]) and Trail Making Test Part-A (TMT-A). Regression analyses were conducted to assess the extent to which HA predicts cognitive performance. The SHAI main subscale significantly predicted TMT-A [β= -3.93, p < 0.01] and WAIS-IV PSI [β= -4.60, p = 0.04]. The SHAI negative consequences subscale significantly predicted TMT-A [β= -4.64, p = 0.04] and WAIS-IV LNS [β= 0.49, p = 0.048]. Findings suggest that general HA predicted PSI, while fear of negative health outcomes predicted LNS. Basic attention abilities were predicted by global HA. Future studies will benefit from evaluating the moderating effect of HA on the relationship between subjective symptom severity and cognition.