Journal of Head Trauma Rehabilitation最新文献

{"title":"Geographic Variation in Inpatient Rehabilitation Outcomes After Traumatic Brain Injury.","authors":"Nathan Darji, Bei Zhang, Richard Goldstein, Shirley L Shih, Mary Alexis Iaccarino, Jeffrey C Schneider, Ross Zafonte","doi":"10.1097/HTR.0000000000001033","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001033","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether regional variations exist in functional outcomes of patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation facilities (IRFs) across the United States, while controlling for demographic and clinical variables.</p><p><strong>Setting: </strong>Inpatient rehabilitation facilities (IRFs) across 4 U.S. regions: West, Midwest, South, and East.</p><p><strong>Participants: </strong>Adult patients with open or closed TBI (Rehabilitation Impairment Codes 2.21 or 2.22) discharged from an IRF between 2016 and 2019.</p><p><strong>Design: </strong>This is a retrospective analysis de-identified data from the Uniform Data System for Medical Rehabilitation. The study compared total functional independence measure (FIM) scores and discharge dispositions across the 4 regions.</p><p><strong>Main measures: </strong>Primary outcomes were FIM scores at discharge, changes in FIM scores between admission and discharge, and community discharge rates, adjusted for demographic and clinical factors. Cohen's d effect sizes were calculated to assess the clinical significance of regional differences on FIM scores. Prevalence ratios were used for discharge disposition outcomes.</p><p><strong>Results: </strong>Regional differences were identified in functional outcomes for patients with TBI. The West had the highest community discharge rate (80.9%) compared to the East (70.5%). Discharge FIM scores were significantly lower in the Midwest and East compared to the South (-1.98 and - 2.31, respectively, P < .01), while the West showed no significant difference from the South (-0.78, P = .11). Effect sizes for FIM total scores were small across regions, with Cohen's d for West versus South at 0.017, Midwest versus South at 0.047, and East versus South at 0.047. Prevalence ratios for community discharge showed minor differences: West versus South at 1.010, Midwest versus South at 0.937, and East versus South at 0.918; all without statistical significance.</p><p><strong>Conclusions: </strong>Regional disparities in functional outcomes following inpatient rehabilitation for TBI were observed, particularly in community discharge rates and total FIM scores. However, based on the effect sizes and prevalence ratios, these differences may not be clinically meaningful and could not be fully explained by demographic and clinical factors. Further studies are needed to explore region-specific factors influencing rehabilitation efficacy to improve outcomes for patients with TBI nationwide.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Pain Treatment Utilization in Rural Versus Urban/Suburban Inhabitants Following Traumatic Brain Injury.","authors":"Levi Bale, Mitch Sevigny, Jeanne M Hoffman","doi":"10.1097/HTR.0000000000001030","DOIUrl":"https://doi.org/10.1097/HTR.0000000000001030","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether there are differences in healthcare utilization for chronic pain based on location (rural vs urban/suburban) or healthcare system (civilians vs Military Service Members and Veterans [SMVs]) after moderate-severe TBI.</p><p><strong>Setting: </strong>Eighteen Traumatic Brain Injury Model Systems (TBIMS) Centers.</p><p><strong>Participants: </strong>A total of 1,741 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-up interview.</p><p><strong>Primary measures: </strong>Sociodemographic, injury, function outcome, pain, and pain treatment characteristics.</p><p><strong>Results: </strong>Participants were mostly male (72.9%), White (75.2%), civilian (76.9%), 46 years old on average, and had greater than high school education (59.9%). 32% of participants resided in rural areas and 67% in urban/suburban areas. No significant difference in healthcare utilization for chronic pain was observed between individuals living in rural versus urban/suburban locations after adjustment for relevant covariates. However, rural SMVs had odds ratios >3 for each major treatment category including medical services (OR = 3.56), exercise therapies (OR = 5.23), psychological services (OR = 4.43), complementary and alternative therapies (OR = 3.23), and pain rehabilitation program (OR = 4.16) compared to rural civilians. This same pattern of findings was seen SMVs in urban/suburban settings as well. Being married versus single, bachelor/graduate education versus high school or less, and employed versus unemployed all had odds ratios >1 for exercise therapies, psychological services, complementary and alternative therapies, and pain rehab program.</p><p><strong>Conclusion: </strong>Contrary to initial hypotheses, there were no significant differences in healthcare utilization for chronic pain treatment comparing those in rural versus urban/suburban areas. However, differences were found between SMVs and civilians across both rural and urban/suburban locations suggesting that SMVs have more access to chronic pain treatment. The improved access to social and financial services afforded by VHA programs to SMVs may serve as a model for improving healthcare utilization in similar civilian populations.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Six Specific Types of Post-Hospital Brain Injury Rehabilitation Programs.","authors":"David B Salisbury, Devan Parrott, G Joseph Walters, Claire McGrath, Daniel M Logan, Irwin M Altman, James F Malec","doi":"10.1097/HTR.0000000000000980","DOIUrl":"10.1097/HTR.0000000000000980","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate outcomes of intensive posthospital brain injury rehabilitation programs compared to supported living (SL) programs; explore variations in outcome by diagnostic category (traumatic brain injury, stroke, and other acquired brain injury [ABI]) and specific program type.</p><p><strong>Setting: </strong>Data were obtained from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation, and SL programs serving individuals with ABI.</p><p><strong>Participants: </strong>A total of 2120 individuals with traumatic brain injury, stroke, or other ABI participated in this study.</p><p><strong>Main measures: </strong>The main measures are sex, age, time since injury, and Mayo-Portland Adaptability Inventory (4th edition; MPAI-4).</p><p><strong>Design: </strong>Retrospective analyses of demographic variables and MPAI-4 Total, index, and subscale Rasch-derived T-scores on admission and discharge.</p><p><strong>Results: </strong>Gains on MPAI-4 Total T-scores were significantly greater for the intensive rehabilitation (IR) group in comparison to stable functioning in the SL group ( F = 236.69, P < .001, partial η 2  = .101) while controlling for admission/time 1 scores; similar results were found for MPAI-4 indices and subscales. For the IR cohort, discharge scores differed by diagnostic category after controlling for admission scores for the Total MPAI-4 T-score ( F = 22.65, P < .001, partial η 2  = .025), as well as all indices and subscales. A statistically significant interaction between program type and diagnostic group on discharge MPAI-4 Total T-scores ( F = 2.55, P = .018, partial η 2  = .01) after controlling for admission scores indicated that differing outcomes across diagnoses also varied by program type. Varying significant main effects and interactions were apparent for MPAI-4 indices and subscales with generally small effect sizes.</p><p><strong>Conclusions: </strong>Significant gains on MPAI-4 variables across IR program types compared to no change over a comparable period of time for SL programs supports the effectiveness of posthospital brain injury rehabilitation. This finding in the presence of small effect sizes on outcome variables for program type and for significant interactions between program type and diagnostic category suggests that participants generally were appropriately matched to program type and benefited from interventions provided through specific program types.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"27-37"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Summary of the Centers for Disease Control and Prevention's Self-reported Traumatic Brain Injury Survey Efforts.","authors":"Jill Daugherty, Alexis Peterson, Lindsey Black, Dana Waltzman","doi":"10.1097/HTR.0000000000000975","DOIUrl":"10.1097/HTR.0000000000000975","url":null,"abstract":"<p><strong>Objective: </strong>Surveillance of traumatic brain injury (TBI), including concussion, in the United States has historically relied on healthcare administrative datasets, but these methods likely underestimate the true burden of TBI. The Centers for Disease Control and Prevention (CDC) has recently added TBI prevalence questions to several national surveys. The objective of this article is to summarize their recent efforts and report TBI prevalence estimates.</p><p><strong>Setting: </strong>Surveys.</p><p><strong>Participants: </strong>Adult and youth respondents to a series of national surveys.</p><p><strong>Design: </strong>Recent nationally representative surveys with either 12-month or lifetime TBI prevalence questions were identified.</p><p><strong>Main measures: </strong>For each data source, survey methodology, TBI definition, question wording, and prevalence estimates were examined.</p><p><strong>Results: </strong>TBI prevalence varied depending on the question wording and data source. Overall 12-month prevalence of concussion/TBI among adults ranged from 2% to 12% while overall lifetime prevalence of concussion or TBI ranged from 19% to 29%. Overall 12-month prevalence of concussion/TBI among children and adolescents was 10% while 12-month prevalence of sports- and recreation-related concussion for youth ranged from 7% to 15%. Overall lifetime prevalence of TBI among youth ranged from 6% to 14%.</p><p><strong>Conclusion: </strong>Survey data based on self-reported concussions and TBIs resulted in larger prevalence estimates than would be expected based on traditional surveillance methods. Analyses of the various surveys shows that how the questions are asked and what terminology is used can notably affect the estimates observed. Efforts can be made to optimize and standardize data collection approaches to ensure consistent measurement across settings and populations.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E1-E12"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rasch Analysis of the Mayo-Portland Adaptability Inventory for Posthospital Brain Injury Rehabilitation.","authors":"James F Malec, Daniel M Logan, Claire McGrath, Devan Parrott, G Joseph Walters","doi":"10.1097/HTR.0000000000000935","DOIUrl":"10.1097/HTR.0000000000000935","url":null,"abstract":"<p><strong>Objectives: </strong>Reexamine the item structure and reliability of the Mayo-Portland Adaptability Inventory (4th ed; MPAI-4) through Rasch analysis of admission and discharge scores for a large sample of adults with acquired brain injury (ABI) who participated in various types of posthospital brain injury rehabilitation (PHBIR) programs; (2) compare differential item functioning (DIF) for traumatic brain injury (TBI), stroke and other ABI; and (3) explore the viability of more specific subscales in addition to the established indices.</p><p><strong>Setting: </strong>Data from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community, Day Treatment, and Outpatient rehabilitation programs serving individuals with ABI.</p><p><strong>Participants: </strong>A total of 2154 individuals with TBI, stroke, or other ABI.</p><p><strong>Design: </strong>Retrospective analysis of de-identified admission and discharge data from the Foundation to Advance Brain Rehabilitation (FABR) consortium database.</p><p><strong>Main measure: </strong>MPAI-4.</p><p><strong>Results: </strong>After adjusting 4 misfitting items and eliminating 20 misfitting persons, the MPAI-4 demonstrated real person reliability/separation = 0.93/3.52 and real item reliability/separation = 1.00/24.02. Independent Rasch analyses by diagnostic category found similar reliabilities and separations. Residual item correlations and principal component analysis of residuals (PCAR) indicated areas of local dependence arranged hierarchically reflecting the full-scale item hierarchy and providing the basis for 3 new subscales of Physical Abilities, Cognitive Abilities, and Autonomy. DIF across diagnostic categories revealed differences in item elevations characteristic of typical patients in each category. Measure means and SDs were very similar across categories.</p><p><strong>Conclusions: </strong>MPAI-4 items demonstrate very good person and item reliabilities for individuals with TBI, stroke, and other ABI at a level that supports individual evaluation. Variations in item calibrations across diagnostic categories reflect the differential characteristics of typical patients within categories. The entire measure provides an overall assessment of common sequalae of ABI, and standard indices used in combination with newly derived subscales provide more specific assessments of rehabilitation needs for treatment planning.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"8-16"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140059580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Letter: Concussion-Related General Startle Suppression in Adolescent Athletes.","authors":"Jessie R Oldham, Angelica DeFalco, Sarah Willwerth, Shannon Nagle, Freya Whittaker, Rebekah Mannix, William P Meehan, Daniel E Bradford","doi":"10.1097/HTR.0000000000000979","DOIUrl":"10.1097/HTR.0000000000000979","url":null,"abstract":"<p><strong>Objectives: </strong>We investigated the acoustic startle reflex in recently concussed adolescent athletes compared to healthy controls and those with concussion history (>1 year prior) but no current symptoms. We hypothesized that individuals with recent concussion would have a suppressed startle response compared to healthy controls.</p><p><strong>Methods: </strong>We conducted a cross-sectional study on 49 adolescent athletes with a recent concussion (n = 20; age: 14.6 ± 1.6 years; 60% female), a concussion history > 1 year prior (n = 16; age: 14.8 ± 2.0 years; 44% female), and healthy controls (n = 13; age: 13.3 ± 2.8 years; 54% female). We measured the eyeblink of the general startle reflex via electromyography activity of the orbicularis oculi muscle using electrodes placed under the right eye. Measurement sessions included twelve 103 decibel acoustic startle probes ~50 milliseconds in duration delivered ~15-25 seconds apart. The primary dependent variable was mean startle magnitude (µV), and group was the primary independent variable. We used a one-way analysis of variance followed by a Tukey post hoc test to compare mean startle magnitude between groups.</p><p><strong>Results: </strong>Mean startle magnitude significantly differed (F = 5.49, P = .007) among the groups. Mean startle magnitude was significantly suppressed for the concussion ( P = .01) and concussion history groups ( P = .02) compared to healthy controls. There was no significant difference between the recent concussion and concussion history groups ( P = 1.00).</p><p><strong>Conclusion: </strong>Our results provide novel evidence for startle suppression in adolescent athletes following concussion. The concussion history group had an attenuated startle response beyond resolution of their recovery, suggesting there may be lingering physiological dysfunction.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E96-E101"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Blast- and Impact-Related Concussion on Persistent Sleep Problems.","authors":"Samuel Y Chung, Elizabeth M Harrison, Robyn M Englert, Jennifer N Belding","doi":"10.1097/HTR.0000000000000974","DOIUrl":"10.1097/HTR.0000000000000974","url":null,"abstract":"<p><strong>Objective: </strong>Examine whether concussion mechanism of injury (high-level blast [HLB] vs impact) affects the likelihood of persistent sleep problems in a post-deployment military population.</p><p><strong>Setting: </strong>Post-Deployment Health Assessment and Re-Assessment survey records completed upon return from deployment and approximately 6 months later.</p><p><strong>Participants: </strong>Active duty enlisted US Marines who completed both assessments ( N = 64 464).</p><p><strong>Design: </strong>This retrospective cohort study investigated US Marines deployed between 2008 and 2012. Logistic regression was used to examine persistent sleep problems 6 months after return from deployment.</p><p><strong>Main measures: </strong>Self-reported sleep problems at reassessment were investigated as the outcome. Predictors included HLB-induced concussions (mbTBI vs none), impact-induced concussions (miTBI vs none), occupational risk of low-level blast, probable posttraumatic stress disorder (PTSD), depression, alcohol misuse, sleep problems upon deployment return, and relevant interactions, adjusting for sex and pay grade.</p><p><strong>Results: </strong>With the exception of sex, all main effects in the model were associated with greater likelihood of reporting persistent sleep problems at reassessment. Sleep problems at return from deployment showed the strongest associations with likelihood of reporting sleep problems at reassessment, followed by mbTBI. The latter was exacerbated by PTSD and depression.</p><p><strong>Conclusion: </strong>mbTBI (vs miTBI) may be more strongly associated with persistent sleep issues that warrant additional monitoring and treatment, particularly among those with probable PTSD and/or depression.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E66-E74"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Posthospital Brain Injury Rehabilitation Outcomes With Quasi-Experimental Controls.","authors":"Devan Parrott, David B Salisbury, Irwin M Altman, Daniel M Logan, Claire McGrath, G Joseph Walters, James F Malec","doi":"10.1097/HTR.0000000000000993","DOIUrl":"10.1097/HTR.0000000000000993","url":null,"abstract":"<p><strong>Objective: </strong>To further evaluate, using quasi-experimental methodologies, posthospital brain injury rehabilitation outcomes described in an accompanying report of a large observational study ( n = 2120).</p><p><strong>Setting: </strong>Data from Intensive Rehabilitation (IR: Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation) and Supported Living (SL) programs serving individuals with acquired brain injury (ABI).</p><p><strong>Participants: </strong>Two hundred twenty-eight individuals with traumatic brain injury, stroke, or other ABI in propensity score analysis; 1344 in analysis by extent of recommended treatment completed (TC) rating.</p><p><strong>Main measures: </strong>Sex, age, time since injury, Mayo-Portland Adaptability Inventory-4th edition (MPAI-4) Rasch-derived T-scores, and TC rating.</p><p><strong>Design: </strong>Analyses of covariance (1) of discharge MPAI-4 Total, index, and subscale T-scores on propensity score-matched samples of IR and SL participants controlling for admission scores and (2) of MPAI-4 T-scores by TC rating and diagnostic category.</p><p><strong>Results: </strong>Propensity score-matched groups showed superior outcomes for IR participants compared to SL participants on MPAI-4 Total T-score ( F = 77.21, P < .001; partial η 2  = 0.257) and all MPAI-4 index and subscale T-scores controlling for sex, age, and baseline scores. Participants with traumatic brain injury and stroke who completed the recommended course of rehabilitation had superior outcomes on all MPAI-4 T-scores compared to those who completed less than or much less than the recommended treatment. No additional benefit was apparent for those who completed more than the recommended course. The association between TC rating and outcome was not significant for the other ABI group.</p><p><strong>Conclusions: </strong>These analyses using quasi-experimental controls provide more scientifically rigorous evidence of the benefit of IR provided through posthospital brain injury rehabilitation programs after acute inpatient care, consistent with the results of numerous observational studies. However, improved internal validity limits external validity and generalization. The absence of a significant association between TC rating and outcomes for the other ABI group most likely reflects the difficulty prescribing rehabilitation for this highly heterogeneous group.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"38-45"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Letter: Relationship of Blood Biomarkers of Inflammation With Acute Concussion Symptoms and Recovery in the CARE Consortium.","authors":"Timothy B Meier, Daniel L Huber, Bryna D Goeckner, Jessica M Gill, Paul Pasquina, Steven P Broglio, Thomas W McAllister, Jaroslaw Harezlak, Michael A McCrea","doi":"10.1097/HTR.0000000000000956","DOIUrl":"10.1097/HTR.0000000000000956","url":null,"abstract":"<p><strong>Objective: </strong>Determine the association of inflammatory biomarkers with clinical measures and recovery in participants with concussion.</p><p><strong>Setting: </strong>Multicenter study in National Collegiate Athletic Association member institutions including military service academies.</p><p><strong>Participants: </strong>Four hundred twenty-two participants with acute concussion.</p><p><strong>Design: </strong>Clinical visits and blood draws were completed preinjury and at multiple visits postconcussion (0-12 hours, 12-36 hours, and 36-60 hours postinjury). Clinical measures included Sport Concussion Assessment Tool (SCAT) symptom severity, Balance Error Scoring System, Standardized Assessment of Concussion (SAC), Brief Symptom Inventory-18 (BSI-18) scores, time to initiation of graduated return-to-play (RTP) protocol, and time to RTP. Interleukin (IL)-6, IL-10, IL-8, IL-1 receptor antagonist (RA), tumor necrosis factor (TNF), c-reactive protein, and vascular endothelial growth factor (VEGF) were measured in serum. Prespecified analyses focused on IL-6 and IL-1RA at 0 to 12 hours; exploratory analyses were conducted with false discovery rate correction.</p><p><strong>Results: </strong>For prespecified analyses, IL-1RA at 0 to 12 hours in female participants was positively associated with more errors on the SAC (B(standard error, SE) = 0.58(0.27), P < .05) and worse SCAT symptom severity (B(SE) = 0.96(0.44), P < .05). For exploratory analyses, higher levels of IL-1RA at 12 to 36 hours were associated with higher global (B(SE) = 0.55(0.14), q < 0.01), depression (B(SE) = 0.45(0.10), q < 0.005), and somatization scores on the BSI (B(SE) = 0.46(0.12), q < 0.01) in participants with concussion; Higher TNF at 12 to 36 hours was associated with fewer errors on the SAC (B(SE) = - 0.46(0.14), q < 0.05). Subanalyses showed similar results for male participants and participants who were athletes. No associations were discovered in nonathlete cadets. Higher IL-8 at 0 to 12 hours was associated with slower RTP in female participants (OR = 14.47; 95% confidence interval, 2.96-70.66, q < 0.05); no other associations with recovery were observed.</p><p><strong>Conclusions: </strong>Peripheral inflammatory markers are associated with clinical symptoms following concussion and potentially represent one mechanism for psychological symptoms observed postinjury. Current results do not provide strong support for a potential prognostic role for these markers.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E23-E28"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Documenting Compliance and Symptom Reactivity for Ambulatory Assessment Methodology Following Concussion in Adolescents and Young Adults: Feasibility of the Mobile Neurocognitive Health (MNCH) Project.","authors":"R J Elbin, Kori J Durfee, Melissa N Womble, Sabrina Jennings, Sheri Fedor, Christina M Dollar, John M Felt, Daniel B Elbich, Jonathan G Hakun","doi":"10.1097/HTR.0000000000000977","DOIUrl":"10.1097/HTR.0000000000000977","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate compliance, symptom reactivity, and acceptability/experience ratings for an ecological momentary assessment (EMA) protocol involving ultra-brief ambulatory cognitive assessments in adolescent and young adult patients with concussion.</p><p><strong>Setting: </strong>Outpatient concussion clinic.</p><p><strong>Participants: </strong>116 patients aged 13 to 25 years with concussion.</p><p><strong>Design: </strong>Prospective research design was used to examine compliance, symptom reactivity, and acceptability/experience for the Mobile Neurocognitive Health Project (MNCH); an EMA study of environmental exposures, symptoms, objective cognitive functioning, and symptom reactivity involving 4, daily EMA surveys (7:30 am , 10:30 am , 3:00 pm , 8:00 pm ) for a period of 7 days following concussion. Overall compliance rates, symptom reactivity scores, and participant acceptability/experience ratings were described. A series of non-parametric Friedman Tests with post-hoc Wilcoxon signed-rank tests were used to examine differences in compliance and reactivity related to time of day and over the course of the protocol (first 3 days [Early Week] vs last 4 days [Late Week]).</p><p><strong>Main measures: </strong>Compliance rates, symptom reactivity scores, participant experience/acceptability.</p><p><strong>Results: </strong>Overall median compliance was 71%, and there were significantly fewer 7:30 am surveys completed compared to the 10:30 am ( Z = -4 .88, P ≤ .001), 3:00 pm ( Z = -4 .13, P ≤ .001), and 8:00 pm ( Z = -4 .68, P ≤ .001) surveys. Compliance for Early Week surveys were significantly higher than Late Week ( Z = -2 .16, P = .009). The median symptom reactivity score was 34.39 out of 100 and was significantly higher for Early Week compared to Late Week ( Z = -4 .59, P ≤ .001). Ninety-nine percent (89/90) of the sample agreed that the app was easy to use, and 18% (16/90) indicated that the app interfered with their daily life.</p><p><strong>Conclusion: </strong>Adolescents and young adults with concussion were compliant with the MNCH EMA protocol. Symptom reactivity to the protocol was low and the majority of participants reported that the app and protocol were acceptable. These findings support further investigation into applications of EMA for use in concussion studies.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E87-E95"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}