Anxiety, pain, and fear of pain: predictors of postural stability after concussion.

Abstract

Concussion can lead to anxiety, pain, kinesiophobia, and/or postural control deficits. We conducted a cross-sectional study evaluating adolescents with a recent concussion. We hypothesized that those reporting higher levels of anxiety, pain-interference, and kinesiophobia would perform worse on postural control tests. Participants completed anxiety, pain-interference, and kinesiophobia ratings, and postural control tests (single/dual-task tandem gait [TG], modified balance error scoring system [mBESS]). Using multivariable linear regression model, we evaluated the relationship between anxiety, pain-interference, and kinesiophobia (predictors) with postural control measures (TG and mBESS, outcomes), adjusting for sex and anxiety history. We enrolled 128 participants (53% female, age=15.4±1.7 years, 9.3±4.0 days post-concussion). Higher anxiety was weakly correlated with slower dual-task TG time (r=0.31; p=0.001) and more mBESS errors (r=0.22; p=0.01). Multivariable modeling indicated that a higher post-concussion anxiety rating was associated with slower dual-task TG time (β=0.21, 95% CI=0.01, 0.41; p=0.04). Female sex was associated with slower single-task tandem gait (β=-3.01, 95% CI= -6.01, -0.01; p=0.049). Adolescents with higher anxiety post-concussion performed worse on dual-task tandem gait assessments, while pain-interference and kinesiophobia were not associated with postural control. Anxiety and impaired postural control are independently associated with poor concussion outcomes; thus, this association may inform individualized concussion care strategies.