Fear-Avoidant Adults Have Worse Clinical Outcomes and Recovery Time Following Concussion.

IF 3.7 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2025-10-04 DOI:10.1016/j.apmr.2025.09.024

Alicia M Trbovich, Aaron J Zynda, Anne Mucha, Nacona Bunker, Courtney Perry, Michael W Collins, Anthony P Kontos

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引用次数: 0

Abstract

Objective: To compare initial multidomain clinical outcomes and recovery time between fear-avoidant (FA) and non-fear-avoidant (NFA) adults following concussion.

Setting: Specialty concussion clinic.

Participants: Adults aged 18-50 years within 30 days of a diagnosed concussion. Based on clinical cutoffs for the Fear Avoidance Components Scale (FACS) at the initial clinic visit, participants were categorized into FA (41-100; moderate to severe) and NFA (0-40; none to mild) groups.

Design: Prospective cohort study.

Main measures: 1) Clinical intake and interview, 2) FACS, 3) Concussion Clinical Profiles Screening Tool (CP-Screen), 4) Post-Concussion Symptom Scale (PCSS), 5) Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), 6) Vestibular/Ocular Motor Screening (VOMS), 7) Generalized Anxiety Disorder 7-Item Assessment (GAD-7), 8) Patient Health Questionnaire (PHQ-9), 9) Patient Health Questionnaire (PHQ-15), 10) Recovery Time (days to medical clearance).

Results: 74 participants (M=28.7 ± 8.4 years, 68.9% female) were included, 37 (50.0%) in the FA and 37 (50.0%) in the NFA group. There were no differences in demographics, medical history, or injury characteristics between groups. The FA group had worse CP Screen anxiety/mood (p=0.04), cognitive (p=0.04), and total (p=0.04); ImPACT reaction time (p=0.01); VOMS visual motion sensitivity (p=0.03) and total (p=0.04); GAD-7 (p<0.01); and PHQ-9 (p<0.01) scores than the NFA group. Results from a Cox proportional hazards model demonstrated that the FA group had a 62% lower instantaneous recovery likelihood on any given day than the NFA group (HR=0.38, 95% CI: 0.15-0.96, p=0.04) while controlling for CP Screen total.

Conclusions: Fear-avoidant adults demonstrated worse concussion symptoms, reaction time, and vestibular impairments compared to non-fear-avoidant adults following concussion. Moreover, after controlling for initial symptom severity, fear-avoidant adults took significantly longer to recover than non-fear-avoidant adults. Future research should explore potential mechanisms underlying the relationship between fear avoidance and poor outcomes, including reduced adherence to treatment recommendations.

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逃避恐惧的成年人脑震荡后的临床结果和恢复时间更差。

目的：比较恐惧回避型（FA）和非恐惧回避型（NFA）成人脑震荡后最初的多领域临床结果和恢复时间。地点：专业脑震荡诊所。参与者：年龄在18-50岁之间，在确诊脑震荡后30天内。根据首次临床访问时恐惧回避成分量表（FACS）的临床截止值，参与者被分为FA（41-100；中度至重度）和NFA（0-40；无至轻度）组。设计：前瞻性队列研究。主要测量方法：1)临床摄入与访谈，2)FACS, 3)脑震荡临床特征筛查工具（CP-Screen）， 4)脑震荡后症状量表（PCSS）， 5)脑震荡后立即评估与认知测试（ImPACT）， 6)前庭/眼运动筛查（VOMS）， 7)广泛性焦虑障碍7项评估（GAD-7）， 8)患者健康问卷（PHQ-9）， 9)患者健康问卷（PHQ-15）， 10)康复时间（医学检查结束前的时间）。结果：纳入74例患者（M=28.7±8.4岁，女性68.9%），FA组37例（50.0%），NFA组37例（50.0%）。两组之间在人口统计学、病史或损伤特征方面没有差异。FA组CP屏幕焦虑/情绪（p=0.04）、认知（p=0.04）和总分（p=0.04）较差；冲击反应时间（p=0.01）；VOMS视动灵敏度（p=0.03）和总灵敏度（p=0.04）；结论：与不回避恐惧的成年人相比，回避恐惧的成年人在脑震荡后表现出更严重的脑震荡症状、反应时间和前庭损伤。此外，在控制了初始症状的严重程度后，恐惧回避的成年人比非恐惧回避的成年人需要更长的时间才能恢复。未来的研究应该探索恐惧回避和不良结果之间关系的潜在机制，包括降低对治疗建议的依从性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.