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Abstract
Objective: To determine the degree to which preinjury and acute postinjury psychosocial and injury-related variables predict symptom duration following sport-related concussion.
Methods: A total of 2,055 high school and collegiate athletes completed preseason evaluations. Concussed athletes (n = 127) repeated assessments serially (<24 hours and days 8, 15, and 45) postinjury. Cox proportional hazard modeling was used to predict concussive symptom duration (in days). Predictors considered included demographic and history variables; baseline psychological, neurocognitive, and balance functioning; acute injury characteristics; and postinjury clinical measures.
Results: Preinjury somatic symptom score (Brief Symptom Inventory–18 somatization scale) was the strongest premorbid predictor of symptom duration. Acute (24-hour) postconcussive symptom burden (Sport Concussion Assessment Tool–3 symptom severity) was the best injury-related predictor of recovery. These 2 predictors were moderately correlated (r = 0.51). Path analyses indicated that the relationship between preinjury somatization symptoms and symptom recovery was mediated by postinjury concussive symptoms.
Conclusions: Preinjury somatization symptoms contribute to reported postconcussive symptom recovery via their influence on acute postconcussive symptoms. The findings highlight the relevance of premorbid psychological factors in postconcussive recovery, even in a healthy athlete sample relatively free of psychopathology or medical comorbidities. Future research should elucidate the neurobiopsychosocial mechanisms that explain the role of this individual difference variable in outcome following concussive injury.
GLOSSARY
- BESS=
- Balance Error Scoring System;
- BSI-18=
- Brief Symptom Inventory–18;
- CI=
- confidence interval;
- DSM-V=
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition;
- HR=
- hazard ratio;
- ImPACT=
- Immediate Post-Concussion Assessment and Cognitive Testing;
- MSVT=
- Medical Symptom Validity Test;
- SAC=
- Standardized Assessment of Concussion;
- SCAT3=
- Sport Concussion Assessment Tool, 3rd edition;
- SRC=
- sport-related concussion;
- SS=
- standard score;
- SWLS=
- Satisfaction With Life Scale
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1852
Supplemental data at Neurology.org
- Received October 22, 2015.
- Accepted in final form January 12, 2016.
- © 2016 American Academy of Neurology
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