Rivermead Post-Concussion Questionnaire Research Articles

Анализ симптоматики и функционального исхода легкой черепно-мозговой травмы

The consequences of TBI are most often grouped into the so-called Post-concussion Syndrome (PCS). At present, there is no clear understanding of the evolution, duration, or resolution of the symptoms of PCS after mild traumatic brain injury (mTBI). Aim of the study. A prospective characterization of the frequency and evolution of PCS symptoms and outcomes of patients after mTBI for 3, 6, and 12 months in a large prospective cohort of patients in the emergency department. Material and methods. A total of 375 patients met the inclusion criteria. Patients were evaluated using the PCS checklist, as well as the Extended Glasgow Outcome Scale (EGOS), the Short List of Symptoms-18 (SLS-18), the Rivermead Post-Concussion Questionnaire (RPCQ), and the Life Satisfaction Scale (LSS). Results. The population was 70.1% male, with a median age of 44 years. Approximately 44% of the population were considered to have complicated mTBI, having positive results of computed tomography (CT). The average injury severity score (ISS), calculated only for patients admitted to the hospital, was 9.37±9.72 (279 in total). ISS was significantly higher in patients with positive CT (16.5±8.39) compared to patients with negative CT (3.8±6.6). Conclusion. Patients with negative CT scans had significantly increased rates of neurological problems, prior TBI, and alcohol use, which may contribute to increased symptoms and a deterioration in BSI-18 scores. After examining only those patients with a negative history of the disease, there was no significant difference between the groups with positive and negative results for any indicator of outcome.

Feasibility of an Interactive Coaching App to Enhance Post-concussion Outpatient Care.

Objectives: To determine the feasibility of patients to use a web-based health app for management of post-concussion (mTBI) symptoms in an out-patient setting.Participants: Seven (7) patients who were referred to an outpatient specialist clinic (physiatry) with persisting symptoms following a concussion. Participants had to be 18 years of age or older and more than 3 months post injury.Design: This was a prospective cohort study using a web-based platform for chronic disease management to guide patients in managing symptoms based on individual clinical recommendations. Each patient received weekly Symptom Management Plans created by a health coach and a physician specialist, designed to reinforce positive progress with clinical recommendations.Main Measures: Adherence to tracking daily recommendations and symptoms (data collected through the web-interface), The Rivermead Post-Concussion Questionnaire (self report) and a Satisfaction Questionnaire (self report).Results: Adherence to assigned clinical recommendations was close to 100%. Pre-post results on the patient reported outcome measure (Rivermead Post Concussion Tool) showed improvement for most patients in their experience of symptoms. The Satisfaction Questionnaire showed high rates of satisfaction with the App and the intervention in general.Conclusions: Use of a web-based health app with a health coach is feasible in this patient population from both the patient and clinician perspective based on high adherence. There is also some evidence of improvement of symptoms with this intervention over time. Further exploration of the use of this type of intervention with post-concussion patients could potentially impact long-term outcomes.

Persistent postconcussive symptoms in children and adolescents with mild traumatic brain injury receiving initial head computed tomography.

The aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment. Patients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13-15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire. A total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001). Adolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.

Post-concussion symptoms in sports-related mild traumatic brain injury compared to non-sports-related mild traumatic brain injury.

To compare post-concussion symptoms in patients who sustained a sports-related mild traumatic brain injury (TBI) to those with non-sports-related mild TBIat 7 and 90 days post-injury. This prospective multicentre cohort study took place in seven Canadian Emergency Departments (ED). Non-hospitalized patients aged ≥ 14years with a documented mild TBI that occurred ≤ 24h of ED visit and a Glasgow Coma Scale score ≥ 13 were included. Main outcome measure was the presence of ≥ 3 symptoms on the Rivermead Post-concussion Questionnaire at 90days post-injury. Secondary outcomes were the prevalence of (1) individual Rivermead Post-concussion Questionnaire symptom, (2) total Rivermead Post-concussion Questionnaire score ≥ 21 and (3) return to normal daily activities. Adjusted risk ratios (RR) were calculated. 1727 patients were included, 363 (21.0%) sustained a sports-related mild TBI. Similar proportions of patients with ≥ 3 symptoms, a Rivermead Post-concussion Questionnaire score ≥ 21 and those who returned to their normal daily activities were observed at 7 and 90days post-injury. Sports-related mild TBI patients were at higher risk of poor concentration [RR: 1.3 (95% CI 1.05-1.54)] and non-return to sports activities [RR: 2.2 (95% CI 1.69-2.94)] at 7days post-injury. At 90days, sports-relate -mild TBI patients reported less fatigue [RR: 0.7 (95% CI 0.51-0.98)] and feeling of dizziness [RR: 0.6 (95% CI 0.35-0.99)]. Patients who sustained sports-related mild TBI could be at lower risk of experiencing symptoms such as fatigue and dizziness 90days post-injury. Clinicians should be mindful that non-sports-related mild TBI patients may experience more post-concussion symptoms and that the level of physical activity may influence the patient's rehabilitation.

Effect of Transcranial Low-Level Light Therapy vs Sham Therapy Among Patients With Moderate Traumatic Brain Injury

Preclinical studies have shown that transcranial near-infrared low-level light therapy (LLLT) administered after traumatic brain injury (TBI) confers a neuroprotective response. To assess the feasibility and safety of LLLT administered acutely after a moderate TBI and the neuroreactivity to LLLT through quantitative magnetic resonance imaging metrics and neurocognitive assessment. A randomized, single-center, prospective, double-blind, placebo-controlled parallel-group trial was conducted from November 27, 2015, through July 11, 2019. Participants included 68 men and women with acute, nonpenetrating, moderate TBI who were randomized to LLLT or sham treatment. Analysis of the response-evaluable population was conducted. Transcranial LLLT was administered using a custom-built helmet starting within 72 hours after the trauma. Magnetic resonance imaging was performed in the acute (within 72 hours), early subacute (2-3 weeks), and late subacute (approximately 3 months) stages of recovery. Clinical assessments were performed concomitantly and at 6 months via the Rivermead Post-Concussion Questionnaire (RPQ), a 16-item questionnaire with each item assessed on a 5-point scale ranging from 0 (no problem) to 4 (severe problem). The number of participants to successfully and safely complete LLLT without any adverse events within the first 7 days after the therapy was the primary outcome measure. Secondary outcomes were the differential effect of LLLT on MR brain diffusion parameters and RPQ scores compared with the sham group. Of the 68 patients who were randomized (33 to LLLT and 35 to sham therapy), 28 completed at least 1 LLLT session. No adverse events referable to LLLT were reported. Forty-three patients (22 men [51.2%]; mean [SD] age, 50.49 [17.44] years]) completed the study with at least 1 magnetic resonance imaging scan: 19 individuals in the LLLT group and 24 in the sham treatment group. Radial diffusivity (RD), mean diffusivity (MD), and fractional anisotropy (FA) showed significant time and treatment interaction at 3-month time point (RD: 0.013; 95% CI, 0.006 to 0.019; P < .001; MD: 0.008; 95% CI, 0.001 to 0.015; P = .03; FA: -0.018; 95% CI, -0.026 to -0.010; P < .001).The LLLT group had lower RPQ scores, but this effect did not reach statistical significance (time effect P = .39, treatment effect P = .61, and time × treatment effect P = .91). In this randomized clinical trial, LLLT was feasible in all patients and did not exhibit any adverse events. Light therapy altered multiple diffusion tensor parameters in a statistically significant manner in the late subacute stage. This study provides the first human evidence to date that light therapy engages neural substrates that play a role in the pathophysiologic factors of moderate TBI and also suggests diffusion imaging as the biomarker of therapeutic response. ClinicalTrials.gov Identifier: NCT02233413.

Magnetic Resonance Imaging Biomarkers of Brain Connectivity in Predicting Outcome after Mild Traumatic Brain Injury: A Systematic Review.

There is growing interest in developing magnetic resonance imaging (MRI) biomarkers of brain connectivity from resting-state functional (rs-fMRI) and diffusion tensor imaging (DTI) to aid in the diagnosis and management of patients with mild traumatic brain injury (mTBI). To determine whether early MRI biomarkers of brain connectivity are useful in predicting outcome after mTBI, we conducted a systematic review using the following inclusion criteria: 1) patients aged >16 years with mTBI, 2) MRI performed during the first month post-injury, 3) outcome measure available, 4) control group, and 5) original article published in a peer-reviewed journal. Of the 1351 citations identified, 14 studies met inclusion criteria (5 rs-fMRI and 10 DTI; 680 patients with mTBI vs. 436 controls) including those where MRI was performed from <12 h to 1 month post-injury. The most common clinical outcome measure used in these studies was symptom burden using the Rivermead Post-Concussion Questionnaire. The most frequently studied brain connectivity MRI biomarkers were global functional connectivity, default-mode network, and fractional anisotropy (FA). Despite the scant evidence and considerable methodological heterogeneity observed among studies, we conclude that brain connectivity MRI biomarkers obtained within 1 month of injury may be potentially useful in predicting outcome in mTBI. Further longitudinal studies are needed to evaluate the effect of mTBI on MRI-based brain connectivity biomarkers and examine how incorporation of these tests can inform the clinical care of individual mTBI patients.

The Rivermead Post-Concussion Questionnaire score is associated with disability and self-reported recovery six months after mild traumatic brain injury in older adults

ABSTRACTBackground/Objectives: Post-concussion syndrome refers to the adverse group of symptoms following a mild traumatic brain injury (mTBI). The Rivermead post-concussion syndrome questionnaire (RPQ) is a common clinical tool for assessing baseline post-concussion syndrome symptomology; however, it is unknown if scores on this questionnaire are associated with future disability. Therefore, the goal of this study was to determine the association between baseline RPQ scores and future disability in older adults with mTBI.Methods and Findings: This study used a prospective cohort design, using the RPQ to measure baseline post-concussion syndrome symptomatology. Disability at 6 months was measured using the Glasgow Outcome Scale-Extended (GOSE; disability), short-form 12 (SF-12; physical and mental quality of life), and self-reported recovery. Linear and logistic models adjusted for confounding factors were estimated using 200 bootstrapped samples. Individuals with higher levels of baseline symptomatology were more likely to have poor GOSE scores (RR = 2.13, 95% CI [1.51, 2.31]) and self-reported recovery (RR = 2.64, 95% CI [1.31, 8.98]) 6 months later.Conclusions: High levels of baseline symptomatology may be associated with overall disability and individual perceptions of recovery 6 months post-MTBI. While the RPQ is valid in assessing a patient’s post-concussive symptoms following mTBI, it may not predict long-term physical or mental health in older adults.

Correlation between Ocular and Vestibular Abnormalities and Convergence Insufficiency in Post-Concussion Syndrome

ABSTRACT The vestibular and oculomotor/visual systems are commonly affected in post-concussion syndrome (PCS). Convergence insufficiency (CI) is the most common ocular abnormality after concussion. Electrovestibulography (EVestG) is a relatively new non-invasive method that measures the peripheral vestibular responses; it has shown abnormal vestibular responses in a PCS. Here, we report the results of investigating the correlation between the vestibular and oculomotor systems in PCS population using EVestG and CI measures. Forty-eight PCS patients were tested using EVestG, out of which 20 also completed the Rivermead post-concussion questionnaire (RPQ). An EVestG feature (Field Potential (FP)-area) was extracted from the stationary part of the EVestG signals. A neuro-ophthalmologist (author BM) measured participants’ CI at near vision using cross-cover examination and a prism-bar. Results indicate: (1) vestibular abnormality (i.e. FP-area) and CI values are significantly correlated in PCS (R = 0.68, p < .01), and (2) there are significant correlations between severity of concussion (i.e. RPQ3) and CI (R = 0.70, p < .01) and between RPQ3 and FP-area (R = −0.56, p < .02). To the best of our knowledge, this is the first study that objectively demonstrates a significant positive correlation between the CI and vestibular systems’ abnormality. These findings are scientifically important as they help localise the pathology of PCS, and are clinically valuable as they help physicians in their decision-making about PCS diagnosis and rehabilitation strategies.

Clinical Gestalt for Early Prediction of Delayed Functional and Symptomatic Recovery From Mild Traumatic Brain Injury Is Inadequate

Clinical Gestalt for Early Prediction of Delayed Functional and Symptomatic Recovery From Mild Traumatic Brain Injury Is Inadequate

LO48: Similarities and differences between sports and recreation-related concussions and concussions from non-sport activities

Introduction: Patients with concussion often present to the emergency department (ED). Although sports and recreation (SR) activities account for less than half of all adult concussions, guidelines developed for management of SR-related concussions (SRC) are widely used for all concussion patients. This study aimed to identify whether there are clinically relevant differences in patient and injury characteristics between SRC and those occurring outside of SR activities. Methods: Adults ( &amp;gt;17 years) presenting from April 2013 to April 2015 with a concussion to one of three EDs with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, lifestyle, relevant medical history), ED presentation (i.e., EMS arrival, hours since injury, CTAS, Glasgow Coma Scale score) and injury characteristics (i.e., activity leading to injury, loss of consciousness [LOC], signs and symptoms [scored using the Rivermead Post-Concussion Questionnaire], and health-related quality of life [from the 12-Item Short Form Health Survey [SF-12]) were collected from structured interviews and the ED chart. Dichotomous and categorical variables were compared using Fisher's exact test; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Results: In total, 248 patients were enrolled (47% male, median [IQR] age: 35 [23, 49]). Patients with SRC were younger (median: 23.5 years vs 35 years; p &amp;lt; 0.001), more likely to be a student (31% vs 8%; p &amp;gt; 0.001), and more likely to exercise regularly (89% vs 66%; p = 0.001). Patients with SRC were less likely to present during the daytime (66% vs. 77%; p = 0.022), less likely to have a history of mental health issues (18% vs 33%; p = 0.011) and had significantly higher median SF-12 physical components scores (55.5 [IQR: 51.4 to 57.8] vs. 53.5 [IQR: 45.5 to 56.7]; p = 0.025). All other characteristics were similar between the two groups. Conclusion: Although differences in demographics and lifestyle have been identified between patients sustaining a SRC and those concussed during other activities, injury characteristics, such as presentation acuity, proxies for severity, and signs and symptoms, were similar in both groups. Further analysis to assess whether the demographic and lifestyle differences affect clinical outcomes, such as time to symptom resolution, between these two groups is required to assess if sport-based treatment guidelines are appropriate for all patients.

Description of the predictors of persistent post-concussion symptoms and disability after mild traumatic brain injury: the SHEFBIT cohort

Introduction: Several patients who suffer Mild Traumatic Brain Injury (mTBI) develop Persistent Post-Concussion Symptoms (PPCS) and long-term disability. Current prognostic models for mTBI have a large unexplained variance, which limits their use in a clinical setting.Aim: This study aimed to identify background demographics and mTBI details that are associated with PPCS and long-term disability.Methods: Patients from the SHEFfield Brain Injury after Trauma (SHEFBIT) cohort with mTBI in the Emergency Department (ED) were analysed as part of the study. PPCS and long-term disability were measured using the Rivermead Post-Concussion Questionnaire and the Rivermead Post-Injury Follow-up Questionnaire respectively, during follow up brain injury clinics.Results: A representative mTBI sample of 647 patients was recruited with a follow-up rate of 89%. Non-attenders were older (p < 0.001), a greater proportion were retired (p < 0.001) and had a greater burden of comorbidity (p = 0.009). Multivariate analysis identified that female gender, previous psychiatric history, GCS <15, aetiology of assault and alcohol intoxication, were associated with worse recovery.Conclusion: These findings will support and add to current understanding of MBTI recovery in pursuit of developing a validated prognostic model. This will allow for more accurate prognostication and eventual improved treatment for sufferers of this complex disorder.

Investigating the validity and reliability of Electrovestibulography (EVestG) for detecting post-concussion syndrome (PCS) with and without comorbid depression

Features from Electrovestibulography (EVestG) recordings have been used to classify and measure the severity of both persistent post-concussion syndrome (PCS) and major depressive disorder. Herein, we examined the effect of comorbid depression on the detection of persistent PCS using EVestG. To validate our previously developed EVestG classifier for PCS detection, the classifier was tested with a new blind dataset (N = 21). The unbiased accuracy for identifying the new PCS from controls was found to be >90%. Next, the PCS group (N = 59) was divided into three subgroups: PCS with no-depression (n = 18), PCS with mild-depression (n = 27) and PCS with moderate/severe-depression (n = 14). When moderate/severe depression was present, PCS classification accuracy dropped to 83%. By adding an EVestG depression feature from a previous study, separation accuracy of each PCS subgroup from controls was >90%. A four and three-group (excluding mild-depression subgroup) classification, achieved an accuracy of 74% and 81%, respectively. Correlation analysis indicated a significant correlation (R = 0.67) between the depression feature and the MADRS depression score as well as between the PCS-specific feature and Rivermead Post-Concussion Questionnaire (RPQ) (R = −0.48). No significant correlation was found between the PCS-specific feature and the MADRS score (R = 0.20) or between RPQ and the depression feature (R = 0.12). The (PCS-specific and depression-specific) EVestG features used herein have the potential to robustly detect and monitor changes, relatively independently, in both persistent PCS and its depression comorbidity. Clinically, this can be particularly advantageous.

LO46: Sex-based differences in concussion symptom reporting and self-reported outcomes in a general adult ED population

Introduction: Patients with concussion frequently present to the emergency department (ED). Studies of athletes and children indicate that concussion symptoms are often more severe and prolonged in females compared with males. To-date, study of sex-based concussion differences in general adult populations have been limited. This study examined sex-based differences in concussion outcomes. Methods: Adult (&gt;17 years) patients presenting to one of three urban EDs in Edmonton, Alberta with Glasgow coma scale score 13 within 72 hours of a concussive event were recruited by on-site research assistants. Follow-up calls at 30 and 90 days post ED discharge captured extent of PCS using the Rivermead Post-Concussion questionnaire (RPQ), effect on daily living activities measured by the Rivermead Head Injury Questionnaire (RHIQ), and overall health-related quality of life using the 12-item Short Form Health Survey (SF-12). Dichotomous and categorical variables were compared using Fishers exact test; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Results: Overall, 130/250 enrolled patients were female. The median age was 35 years; men trended towards being younger (median=32 years; IQR: 23, 45) than women (median=40 years; IQR: 22, 52). Compared to women, more men were single (56% vs 38% (p=0.007) and employed (82% vs 71% (p=0.055). Men and women experienced different injury mechanisms (p=0.007) with more women reporting injury due to a fall (44% vs 26%), while more men were injured at work (16% vs 7%) or due to an assault (11% vs. 3%). Men had a higher return to ED rate (13% vs. 5%; p=0.015). Women had higher RPQ scores at baseline (p&lt;0.001) and 30-day follow-up (p=0.001); this difference was not significant by 90 days (p=0.099). While women reported on the RHIQ at 30 days that their injury affected their usual activities significantly more than men (Median=5, IQR: 0, 11 vs. median=0.5, IQR: 0.5, 7; p=0.004), both groups had similar scores on the SF-12 physical composite and mental composite scales at all three measurement points. Conclusion: In a general ED concussion population, demographic differences exist between men and women. Based on self-reported and objective outcomes, womens usual activities may be more affected by concussion and PCS than men. Further analysis of these differences is required in order to identify different treatment options and ensure adequate care and treatment of injury.

Mild traumatic brain injury in New Zealand: factors influencing post-concussion symptom recovery time in a specialised concussion service.

INTRODUCTION By 2020, traumatic brain injuries (TBIs) are predicted to become the third largest cause of disease burden globally; 90% of these being mild traumatic brain injury (mTBI). Some patients will develop post-concussion syndrome. AIM To determine whether the time between sustaining a mTBI and the initial assessment by a specialised concussion service, along with the post-concussion symptoms reported at the assessment, affected recovery time. METHODS A retrospective medical record review of clients who had completed the Rivermead Post-Concussion Questionnaire (RPQ) at their initial assessment and were discharged from a large metropolitan concussion service in New Zealand was undertaken over a 6-month period in 2014 (n = 107). Using correlations, General Linear Mixed-effects Models (GLMM) and linear regressions, we explored associations between factors including ethnicity, gender and accident type, along with individual RPQ symptom scores and cluster scores, with time from injury to initial assessment by the specialised concussion service and initial assessment to discharge. RESULTS Time from injury to initial assessment by a specialist concussion service was correlated with proportionally more psychological symptoms present at initial assessments (r = 0.222, P = 0.024); in particular, feeling depressed or tearful (r = 0.292, P = 0.003). Time to discharge was correlated with individual RPQ symptom proportions present at initial assessment for headaches (r = -0.238, P = 0.015), sensitivity to noise (r = 0.220, P = 0.026), feeling depressed or tearful (r = 0.193, P = 0.051) and feeling frustrated or impatient (r = 0.252, P = 0.003), along with the psychological cluster proportion (r = 0.235, P = 0.017) and the total RPQ score (r = 0.425, P < 0.001). CONCLUSION Prompt diagnosis and treatment of mTBI may minimise the severity of post-concussion symptoms, especially symptoms associated with mental health and wellbeing.

Heart Rate Variability of Athletes Across Concussion Recovery Milestones

To assess heart rate variability (HRV) in athletes with concussion across three phases of recovery. A prospective matched control group design included the collection of HRV and symptoms measured by the Rivermead Post-Concussion Questionnaire. These measures were taken at 3 phases of recovery [(1) symptomatic; (2). asymptomatic; and (3) one-week after return-to-play (RTP)]. The same protocol was completed by noninjured athletes. Interuniversity sports teams at a single institution. 11 athletes, across 7 sports, diagnosed with concussion, and 11 matched-athlete controls volunteered for the study. Physician diagnosed concussion and a sitting to standing protocol for HRV monitoring. The frequency, time, and nonlinear domains of HRV were assessed along with the absolute difference between sitting and standing for each. A 2 x 3 (group x phase) repeated-measures analysis of variance revealed significant interactions for sitting High Frequency (HF) norm, sitting Low Frequency (LF) norm, the difference between sitting and standing HF norm, and difference between sitting and standing LF norm. Acutely, athletes with concussion displayed increased LF norm and decreased HF norm while sitting and a decreased change in their HF and LF norm measures between sitting and standing. A significant group effect for sample entropy when standing was detected, with the concussed group displaying decreased values compared with the matched controls. Athletes with concussion displayed autonomic dysfunction in some measures of HRV that persisted beyond RTP and were related to a previous history of concussion.

Predicting Outcome 12 Months after Mild Traumatic Brain Injury in Patients Admitted to a Neurosurgery Service.

Accurate outcome prediction models for patients with mild traumatic brain injury (MTBI) are key for prognostic assessment and clinical decision-making. Using multivariate machine learning, we tested the unique and added predictive value of (1) magnetic resonance imaging (MRI)-based brain morphometric and volumetric characterization at 4-week postinjury and (2) demographic, preinjury, injury-related, and postinjury variables on 12-month outcomes, including global functioning level, postconcussion symptoms, and mental health in patients with MTBI. A prospective, cohort study of patients (n = 147) aged 16-65 years with a 12-month follow-up. T1-weighted 3 T MRI data were processed in FreeSurfer, yielding accurate cortical reconstructions for surface-based analyses of cortical thickness, area, and volume, and brain segmentation for subcortical and global brain volumes. The 12-month outcome was defined as a composite score using a principal component analysis including the Glasgow Outcome Scale Extended, Rivermead Postconcussion Questionnaire, and Patient Health Questionnaire-9. Using leave-one-out cross-validation and permutation testing, we tested and compared three prediction models: (1) MRI model, (2) clinical model, and (3) MRI and clinical combined. We found a strong correlation between observed and predicted outcomes for the clinical model (r = 0.55, p < 0.001). The MRI model performed at the chance level (r = 0.03, p = 0.80) and the combined model (r = 0.45, p < 0.002) were slightly weaker than the clinical model. Univariate correlation analyses revealed the strongest association with outcome for postinjury factors of posttraumatic stress (Posttraumatic Symptom Scale-10, r = 0.61), psychological distress (Hospital Anxiety and Depression Scale, r = 0.52), and widespread pain (r = 0.43) assessed at 8 weeks. We found no added predictive value of MRI-based measures of brain cortical morphometry and subcortical volumes over and above demographic and clinical features.

The Norwegian version of the QOLIBRI \u2013 a study of metric properties based on a 12\xa0month follow-up of persons with traumatic brain injury

BackgroundConsequences after Traumatic brain injury (TBI) affect the injured person’s self-image and quality of life. The purpose was to assess the health related quality of life (HRQoL) at 12 months after a TBI in patients admitted to regional trauma centres, and to evaluate the metric properties of the Norwegian version of the Quality of Life After Brain Injury (QOLIBRI) questionnaire.MethodsTwo hundred four patients with TBI of all severities were included. HRQoL at 12 months post-injury was measured by the QOLIBRI. It has a total scale and 6 subscales (satisfied with Cognition, Self, Daily Life and Autonomy and Social Relationships, and bothered by Emotions and Physical Problems). Demographic and injury related data were registered. Disability was registered by Glasgow Outcome Scale Extended (GOSE) and Rivermead Post-Concussion Questionnaire, and mental health by Hospital Anxiety and Depression Scale. Descriptive statistics, internal consistency by Cronbach’s alpha and Corrected Item-Total Correlations were calculated. Rasch analysis, Principal Component Analysis (PCA) and Structural Equation Modelling (SEM) were applied.ResultsMean age was 37.6 (SD 15.4) years; 72% were men, and 41% had higher education. Over 60% were severely injured. Mean Glasgow Coma Scale score was 9.3 (SD 4.5). According to the GOSE 5.9% had severe disability, 45.5% had moderate disability, and 48.5% had good recovery at 12 months post-injury. The QOLIBRI scales had a high internal consistency (α = 0.75–0.96), and only Physical Problems had an α < 0.85. In the Rasch analysis all subscales and their items fit the Rasch model, except for the depression item in the Emotion subscale. PCA and SEM analyses supported a six-factor structure in a second-order latent model. The QOLIBRI supports an underlying unidimensional HRQoL model. The SEM model fit statistics of the second-order model indicated a moderate fit to the observed data (CFI = 0.86, TLI = 0.85, RMSEA = 0.076, SRMR = 0.061, χ2 = 1315.76, df = 623, p-value < 0.001).ConclusionThe Norwegian QOLIBRI has favourable psychometric properties, but there were some weaknesses related to its measurement properties of the total score when tested on a TBI population where many had severe TBI, and many had good recovery.

White matter abnormalities are associated with chronic postconcussion symptoms in blast-related mild traumatic brain injury.

Blast-related mild traumatic brain injury (mTBI) is a common injury among Iraq and Afghanistan military veterans due to the frequent use of improvised explosive devices. A significant minority of individuals with mTBI report chronic postconcussion symptoms (PCS), which include physical, emotional, and cognitive complaints. However, chronic PCS are nonspecific and are also associated with mental health disorders such as posttraumatic stress disorder (PTSD). Identifying the mechanisms that contribute to chronic PCS is particularly challenging in blast-related mTBI, where the incidence of comorbid PTSD is high. In this study, we examined whether blast-related mTBI is associated with diffuse white matter changes, and whether these neural changes are associated with chronic PCS. Ninety Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans were assigned to one of three groups including a blast-exposed no--TBI group, a blast-related mTBI without loss of consciousness (LOC) group (mTBI--LOC), and a blast-related mTBI with LOC group (mTBI + LOC). PCS were measured with the Rivermead Postconcussion Questionnaire. Results showed that participants in the mTBI + LOC group had more spatially heterogeneous white matter abnormalities than those in the no--TBI group. These white matter abnormalities were significantly associated with physical PCS severity even after accounting for PTSD symptoms, but not with cognitive or emotional PCS severity. A mediation analysis revealed that mTBI + LOC significantly influenced physical PCS severity through its effect on white matter integrity. These results suggest that white matter abnormalities are associated with chronic PCS independent of PTSD symptom severity and that these abnormalities are an important mechanism explaining the relationship between mTBI and chronic physical PCS.

Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury: A population-based New Zealand study

Objective: The relationship between moderate/severe traumatic brain injury (TBI) and cognitive deficits is well known. The nature, duration and predictors of cognitive difficulties post-mild TBI remain unclear. This study examined cognitive, mood and post-concussion outcomes of mild TBI over 1-year post-injury.Method: Adults (>15 years) with mild TBI (n = 260) completed neuropsychological (CNS-Vital Signs, Behavioural Dyscontrol Scale), mood (Hospital Anxiety Depression Scale) and behavioural assessments (Cognitive Failures Questionnaire, Rivermead Post-Concussion Questionnaire) at baseline, 1-, 6- and 12-months post-injury.Results: Over the 12-months post-injury self-reported cognition (p = 0.027), post-concussion symptoms (p < 0.001), depression (p < 0.001), anxiety (p < 0.001) and dyscontrol (p = 0.025) improved significantly. Assessments of memory, processing speed, executive function, psychomotor speed/reaction time, complex attention and flexibility also improved significantly. At baseline >20% of individuals produced very low scores on executive ability, complex attention and cognitive flexibility. At 1- and 6-month follow-ups >20% of participants were very low for complex attention, with 16.3% remaining so at 12-months. Executive abilities and speed were related to post-concussion symptoms, mood and self-reported cognition at 12-months.Conclusions: Whilst significant improvements were noted across measures over time, a significant proportion of individuals still perform poorly on neuropsychological measures 12-months after mild TBI; and these were linked to post-concussion symptoms, mood and self-reported cognitive outcomes. This implies a longer trajectory for recovery than has previously been suggested, which has implications for provision of assessment and rehabilitation services for more extended periods.

Detecting Migraine in Patients with Mild Traumatic Brain Injury Using Three Different Headache Measures.

Posttraumatic migraine may represent an important subtype of headache among the traumatic brain injury (TBI) population and is associated with increased recovery times. However, it is underdiagnosed in patients with mild traumatic brain injury (mTBI). This study examined the effectiveness of the self-administered Nine-Item Screener (Nine-Item Screener-SA), the Headache Impact Test- 6 (HIT-6), the 3-Item Migraine Screener, and the Rivermead Post-Concussion Questionnaire (RPQ) at discriminating between mTBI patients with (n = 23) and without (n = 20) migraines. The Nine-Item Screener demonstrated significant differences between migraine patients with and without migraine on nearly every question, especially on Question 9 (disability), sensitivity: 0.95 and specificity: 0.65 (95% CI, 0.64–0.90). The HIT-6 demonstrated significant differences between migraine and no-migraine patients on disability and pain severity, with disability having a sensitivity of 0.70 and specificity of 0.75 (95% CI, 0.54–0.83). Only Question 3 of the 3-Item ID Migraine Screener (photosensitivity) showed significant differences between migraine and no-migraine patients, sensitivity: 0.84 and specificity: 0.55 (CI, 0.52–0.82). The RPQ did not reveal greater symptoms in migraine patients compared with those without. Among headache measures, the Nine-Item Screener-SA best differentiated between mTBI patients with and without migraine. Disability may best identify migraine sufferers among the TBI population.