Losoi, H., Silverberg, N. D., Waljas, M., Turunen, S., Rosti-Otajarvi, E., Helminen, M., . . . Iverson, G. L. (2016). Recovery from Mild Traumatic Brain Injury in Previously Healthy Adults. Journal of Neurotrauma, 33(8), 766-776. doi: 10.1089/neu.2015.4070
Study design limitations have hampered progress in understanding recovery from mild traumatic brain injury (mTBI). This prospective, longitudinal study in Finland had several strengths, including prospective recruitment from an emergency department, inclusion of an orthopedic comparison group, employing multiple measurements (1, 6, and 12 months post-injury), and assessment of several different outcome domains including post-concussive symptoms (PCS), mental health symptoms, resilience, cognition (neuropsychological testing), quality of life, and return to work. The study also excluded patients with prior neurologic, neurosurgical, or psychiatric histories to reduce heterogeneity. Results indicated that patients with mTBI had greater PCS and fatigue at one month, but that only PCS differentiated the groups at 12 months (p < .07). Patients had good functional recovery, with almost all patients (96%) returning to work during the study. Patients with mTBI and reporting persistent PCS at 12 months tended to have greater cognitive impairment, more fatigue and pain, more PCS symptoms, and more severe modifiable psychological risk factors (i.e., depression, traumatic stress, and/or low resilience) at 1 month after injury. Those patients also had more fatigue, more PCS symptoms, more severe modifiable psychological risk factors, and lower quality of life at 6 months. Patients with and without mTBI who reported PCS-like symptoms at 12 months (27% and 17% respectively) tended to have depression, traumatic stress, or both despite good functional and cognitive functioning. The authors conclude that although most patients who sustain mTBI have a good prognosis, it is important to provide evidence-based treatment early in rehabilitation for those with PCS to reduce the risk of persistent mental health problems.
I CHOSE THIS ARTICLE for two reasons. First, it offers an incremental advance in our understanding of mTBI sequelae by avoiding several methodological limitations of prior research. Although study limitations were noted by the authors (e.g., no 3-month follow-up and the comparison group only received neuropsychological testing once), their design allowed for clarification that early emotional maladjustment, rather than mTBI per se, is an important risk factor for later depression and other mental health difficulties. Second, I chose this article because it highlights the importance of early identification and targeting of patients with early signs of PCS. Left for future research are determining the best method to detect those at risk, what symptoms to target (e.g., PCS-like health complaints and/or emotional distress?), and which evidence-based treatments are most effective.
THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Scott D. McDonald, PhD, Hunter Holmes McGuire VA Medical Center, Virginia Commonwealth University.