Posttraumatic Brain Injury Fatigue Research Articles

Fatigue After Traumatic Brain Injury: A Systematic Review.

To provide a systematic review of published interventions for posttraumatic brain injury fatigue (PTBIF). PubMed and OneSearch were systematically searched for PTBIF interventions published between January 1, 1989, and March 31, 2019. Search results were evaluated for inclusion based on an abstract and full-text review. Inclusion criteria were (1) an investigation of an intervention, (2) participant sample including individuals with traumatic brain injury (TBI), (3) report of fatigue outcome data among individuals with TBI, and (4) articles available in English, Spanish, French, German, Afrikaans, or Dutch. A risk of bias assessment was conducted on all included publications. The search resulted in 2343 publications, with 37 meeting inclusion criteria for this review. Categories of PTBIF interventions were pharmacological ( n = 13), psychological ( n = 9), exercise-based ( n = 4), complementary alternative medicine ( n = 5), electrotherapeutic ( n = 3), and multimodal ( n = 3). Only methylphenidate, modafinil, and cognitive behavioral therapy interventions included multiple cohorts. Pharmacological and psychological interventions represented the groups with the lowest risk of bias. This review includes 37 studies, with 21 studies published after 2014. Methylphenidate and melatonin were the only pharmacological agents found to reduce fatigue in randomized controlled trials. Creatine given to children prospectively at onset of injury reduced fatigue at follow-up. Walking and water aerobics were effective exercise interventions in isolated randomized controlled studies. One multimodal study of children after concussion was more effective at reducing fatigue and postconcussion symptoms than community standard of care. Other interventions had equivocal results. Overall, more work remains to understand and develop treatments for PTBIF.

Sleep and fatigue after TBI.

Whilst post traumatic brain injury fatigue (PTBIF) and sleep disturbance are common sequelae following brain injury, underlying mechanisms, and the potential for targeted interventions remain unclear. To present a review of recent studies exploring the epidemiology of PTBIF and sleep disturbance, the relationship and neuropsychological correlates of these issues, potential approaches to intervention, and implications for neurorehabilitation. A review of relevant literature was undertaken, with a focus on PTBIF relating to sleep disturbance, the neuropsychological correlates of these issues and implications for neurorehabilitation. This paper does not set out to provide a systematic review. Multidimensional approaches to assessment and treatment of sleep disturbance and PTBIF are required. There is a need for more robust findings in determining the complex nature of relationships between PTBIF, sleep disturbance, and correlates. Longitudinal prospective data is required to increase our understanding of the nature and course of PTBIF and sleep disturbance post TBI. Large scale clinical trials are required in evaluating the potential benefits of interventions.

Effectiveness of a self-management intervention to teach individuals management of post-traumatic brain injury fatigue

A significant proportion of individuals with traumatic brain injury (50% to 80%) experience persistent and significant fatigue that affects their daily life. The maximizing energy (MAX) intervention optimizes and individualizes occupational therapist delivered energy conservation education by using the problem-solving-therapy framework to teach individuals to self-manage their fatigue. Our objective was to test the efficacy of the MAX intervention compared to a health education attention control intervention for decreasing the impact of post-TBI fatigue. In this randomized-controlled, single-blind clinical trial, 34 participants were randomized to experimental ( n = 20) and control ( n = 14) groups. Mean duration post-injury was 58 months. Both groups received two 1:1 sessions per week for 8 wk via web cameras. The modified Fatigue Impact Scale (mFIS) and Patient Reported Outcomes Measurement Information System (PROMIS) were administered to assess fatigue impact in everyday life at baseline (T1), intervention completion (T2), and 4 wk (T3) and 8 wk (T4) after intervention completion. We used two 2 (group) × 4 (time) repeated measures analyses of variance for mFIS and PROMIS Fatigue scale scores. We conducted post-hoc analyses using paired-samples t tests. There were no significant differences between the groups for demographic variables and baseline outcome scores. The Group × Time interaction was significant for mFIS scores (F[2,32] = 3.9, P < 0.01) and PROMIS Fatigue scale scores (F[2,32] = 4.7, P < 0.01). Post-hoc tests revealed a significant difference in mFIS and PROMIS Fatigue scale T2, T3, and T4 scores compared to T1 scores for the experimental group and no differences between the times for the control group. The MAX intervention has a sustained effect on fatigue impact up to 12 weeks after intervention. It is a promising self-management intervention to help individuals manage post-TBI fatigue.

Interventions for Posttraumatic Brain Injury Fatigue: An Updated Review

To provide an updated review of empirical evidence in support of interventions for posttraumatic fatigue. A total of 360 articles were published between January 22, 2014 and September 23, 2016 with nine meeting inclusion criteria. Articles included in this review provided further support for behavioral, pharmacological, and physical activity interventions for fatigue. Behavioral interventions remain popular, but studies directly targeting fatigue have not yet been undertaken. Pharmacological agents, particularly those using dopaminergic agents, showed potential but had mixed results. Interventions incorporating physical activity were promising but require more rigorous investigation. Despite promising results, there remains a need to replicate and further refine treatments using rigorous research designs and larger samples. Future studies should continue to more clearly define fatigue and use consistent subjective and objective endpoints that better capture this construct. Including imaging techniques would establish the effectiveness and mechanisms of interventions.

Factors associated with remission of post-traumatic brain injury fatigue in the years following traumatic brain injury (TBI): a TBI model systems module study

ABSTRACTPost-traumatic brain injury fatigue (PTBIF) is a major problem in the years after traumatic brain injury (TBI), yet little is known about its persistence and resolution. The objective of the study was to identify factors related to PTBIF remission and resolution. TBI Model System registrants at five centres participated in interviews at either one and two years post-injury (Y1-2 Cohort), or two and five years post-injury (Y2-5 Cohort). Characteristics of participants with PTBIF remission were compared to those with PTBIF persistence. Variables studied included the presence of and changes in disability, sleep dysfunction, mood, and community participation. The Functional Independence Measure did not differ significantly between groups or over time. In the Y1-2 Cohort the Fatigue Resolved group scored significantly better on the Disability Rating Scale and Pittsburgh Sleep Quality Index. In the Y2-5 Cohort the Fatigue Resolved group scored significantly higher on a measure of community participation. It was concluded that fewer than half of the sample in each cohort experienced a remission of PTBIF between time points. Persistence of PTBIF 1–2 years post-injury is associated with disability, sleep disturbance, and depression while persistence of fatigue beyond 2 years post-injury appears to be related to participation level, underscoring the potential impact of effective surveillance, assessment, and treatment of this condition in optimising life after TBI. Differences in fatigue progression may point to the presence of different types of PTBIF.

Feasibility of a Cognitive Behavioral Intervention to Manage Fatigue in Individuals With Traumatic Brain Injury: A Pilot Study.

To evaluate the feasibility of conducting a randomized clinical trial of an Internet-based manualized intervention to teach individuals with traumatic brain injury to manage their fatigue. Community dwelling. Forty-one participants randomized to Maximizing Energy (MAX) intervention group (n = 20) and Health Education group (n = 21). The experimental group (MAX intervention) received an 8-week program that combined education and Problem-Solving Therapy to teach individuals to manage fatigue-related problems. The attention control group received health education. Primary outcome measures pertained to the feasibility of conducting the trial. Secondary outcomes were fatigue impact and fatigue severity assessed at baseline and postintervention. Of the 65 participants referred, 41 were enrolled (63% recruitment rate), of which 3 withdrew (92% retention rate). Participants in the experimental and control groups completed their homework 75% and 85% of the time, respectively, and were equally engaged in the sessions. Participants in the experimental group were able to learn and implement the MAX intervention steps. Effect sizes for all measures ranged from small (-0.17) to medium (-0.58) in favor of the intervention group. Findings from the study suggest that the MAX intervention is feasible to administer to individuals with post-traumatic brain injury fatigue.

Systematic review of interventions for fatigue after traumatic brain injury: a NIDRR traumatic brain injury model systems study.

To conduct a systematic review of the evidence on interventions for posttraumatic brain injury fatigue (PTBIF). Systematic searches of multiple databases for peer-reviewed studies published in English on interventions targeting PTBIF as a primary or secondary outcome through January 22, 2014. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies. The searches yielded 1526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study. Despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF.

What is post TBI fatigue?

Fatigue is among the most common sequelae of traumatic brain injury (TBI). To summarize the empirical and theoretical literature on Post TBI fatigue (PTBIF) and identify some of the challenges that continue to confront clinicians, researchers and individuals with TBI. Qualitative literature review. The epidemiology, characteristics, and correlates of PTBIF are described. Challenges in the operational definition and measurement of fatigue are discussed and the empirical literature on measurement of PTBIF and theoretical models of the potential etiology of PTBIF is summarized. Existing treatments of PTBIF and the research supporting them are reviewed. Future directions for clinical research are presented. Although PTBIF is a high incidence condition after TBI that is related to significant suffering and reduced quality of life, it remains inadequately measured and treated. Its etiology and precipitants are poorly understood and intervention research is inadequate. Further research is necessary to develop psychometrically-sound objective and subjective measures of PTBIF and examine the efficacy of treatments for fatigue. Interventions shown to improve fatigue in other populations should be considered in treating PTBIF.

Poster 25: Does Time Spent in Activities Relate to Posttraumatic Brain Injury Fatigue?

Objective: To examine self-reported fatigue following traumatic brain injury (TBI) in relation to the amount of time spent in homemaking, home maintenance, school, work, riding public transportation, and driving a private vehicle. Design: Prospective cross-sectional natural history. Setting: Individuals were interviewed in varied community settings. Participants: 140 individuals that were 1 to 20 years post of a moderate to severe TBI. Interventions: Not applicable. Main Outcome Measures: Multidimensional Fatigue Inventory, including subscales for General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation, and Mental Fatigue.

Psychological and Biological Correlates of Fatigue After Mild-to-Moderate Traumatic Brain Injury

Relationships between chronic perceived stress, cortisol response (area under the curve) and posttraumatic brain injury fatigue were examined with persons from outpatient settings. Seventy-five injured persons with traumatic brain injury and their relatives/significant others participated in this cross-sectional study. Using interviews and self-reported data from the Neurofunctional Behavioral Inventory, the Perceived Stress Scale, the Profile of Mood States-Fatigue subscale, the McGill Pain Scale, as well as self-collection of salivary cortisol over a 12-hour period (N = 50), we found that perceived chronic stress explained 40% of the variance in fatigue until depressive symptoms and pain were in the model. Hypocortisolemia was evident. Somatic symptom frequency and perceived chronic stress represented 50% of the variability in post-TBI fatigue. Fatigue and stress management interventions, as suggested in the Centers for Disease Control Acute Concussion guidelines, may be beneficial in reducing this common symptom.