Relationships between Post-Concussion Symptoms and Functional Performance among Persons with Mild Traumatic Brain Injury in Wenzhou, China
Main Article Content
Abstract
OBJECTIVES: The study in Wenzhou, China aimed to describe post-concussion symptoms (PCS) and functional performance (FP) among mild traumatic brain injury (mTBI) persons during two weeks after trauma and determine the relationships between physical symptoms, cognitive symptoms, and behavioral symptoms with FP.
MATERIALS AND METHODS: This study used a correlational cross-sectional design among 108 randomly selected persons with first-ever mTBI during their follow-up visits at the neurosurgery clinic of a university hospital in China. Data was collected utilizing a demographic questionnaire, and two self-report questionnaires during August to December 2021. Data analysis used descriptive statistics and Pearson correlation.
RESULTS: Participants experienced a mild level of physical symptoms (0.47 ± 0.51), cognitive symptoms (0.55 ± 0.84), and behavioral symptoms (0.55±0.90). They also had a mild impaired FP (0.55 ± 0.70). The results revealed that the physical symptoms, cognitive symptoms, and behavioral symptoms had positive correlations with FP (r = 0.68, r = 0.58, r = 0.76, p < 0.001, respectively).
CONCLUSION: These findings provide scientific evidence for healthcare providers especially nurses to identify mTBI persons with high-risk symptoms and make targeted PCS management in the early stage to promote FP. In conclusion, it supports the roles of nurses in evaluating each dimension of PCS and developing individualized nursing interventions.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
Haarbauer-Krupa J, Pugh MJ, Prager EM, et al. Epidemiology of chronic effects of traumatic brain Injury. J Neurotrauma. 2021;38(23):3235-47. doi: 10.1089/neu.2021.0062.
Mikolić A, Polinder S, Steyerberg EW, et al. Prediction of Global Functional Outcome and post-concussive symptoms after mild traumatic brain Injury: external validation of prognostic models in the collaborative european neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI) Study. J Neurotrauma. 2021;38(2):196-209. doi: 10.1089/ neu.2020.7074.
Lefevre-Dognin C, Cogné M, Perdrieau V, et al. Definition and epidemiology of mild traumatic brain injury. Neurochirurgie. 2021;67(3):218-21. doi: 10.1016/j.neuchi.2020.02.002.
Gao G, Wu X, Feng J, et al. Clinical characteristics and outcomes in patients with traumatic brain injury in China: a prospective, multicentre, longitudinal, observational study. The Lancet Neurology. 2020;19(8):670-7. doi:10.1016/S1474- 4422(20)30182-4.
Feng J, van Veen E, Yang C, et al. Comparison of care system and treatment approaches for patients with traumatic brain injury in China versus Europe: A CENTER-TBI survey study. J Neurotrauma. 2020;37(16):1806-17. doi: 10.1089/ neu.2019.6900.
Zhang M, Chen G, Dai X, et al. Prevalence of human papillomavirus in Wenzhou, China: a cross-sectional study of 127 938 outpatient women. BMJ open. 2022;12(12):e066698. doi: 10.1136/bmjopen-2022-066698.
Asselstine J, Kristman VL, Armstrong JJ, et al. The Rivermead Post-Concussion Questionnaire score is associated with disability and self-reported recovery six months after mild traumatic brain injury in older adults. Brain Inj 2020;34(2): 195-202. doi: 10.1080/02699052.2019.1682670.
Skjeldal OH, Skandsen T, Kinge E, et al. Long-term postconcussion symptoms. Tidsskr Nor Laegeforen 2022;142(12). doi:10.4045/tidsskr.21.0713.
Balakrishnan B, Rus RM, Chan KH, et al. Prevalence of Postconcussion Syndrome after mild traumatic brain injury in young adults from a single neurosurgical center in east coast of Malaysia. Asian J Neurosurg 2019;14(1):201-5. doi: 10.4103/ajns.AJNS_49_18.
Lenz ER, Pugh LC, Milligan RA, et al. The middle-range theory of unpleasant symptoms: an update. ANS Adv Nurs Sci 1997;19(3):14-27. doi: 10.1097/00012272-199703000-00003.
Herrold AA, Smith B, Aaronson AL, et al. Relationships and Evidence-based theoretical perspectives on persisting yymptoms and functional impairment among mild traumatic brain injury and behavioral health conditions. Mil Med 2019;184(Suppl 1):138-47. doi: 10.1093/milmed/usy306.
Yue JK, Levin HS, Suen CG, et al. Age and sex-mediated differences in six-month outcomes after mild traumatic brain injury in young adults: a TRACK-TBI study. Neurol Res 2019;41(7):609-23. doi: 10.1080/01616412.2019.1602312.
Nelson LD, Temkin NR, Dikmen S, et al. Recovery after mild traumatic brain injury in patients presenting to US level I Trauma Centers: A transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) Study. JAMA Neurol 2019;76(9):1049-59. doi: 10.1001/jamaneurol.2019.1313.
Mikolić A, Steyerberg EW, Polinder S, et al. Prognostic models for global functional outcome and post-concussion symptoms following mild traumatic brain injury: A collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. J Neurotrauma 2023;40(15-16):1651-70. doi: 10.1089/ neu.2022.0320.
Permenter CM, Fernández-de Thomas RJ, Sherman AL. Postconcussive Syndrome. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. PMID: 30521207.
Cheng P, Yin P, Ning P, et al. Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study. PLoS Med 2017;14(7):e1002332. doi: 10.1371/journal.pmed.1002332.
Guty E, Riegler K, Meyer J, et al. Symptom factors and neuropsychological performance in collegiate athletes with chronic concussion symptoms. Arch Clin Neuropsychol 2021;36(5):746-56. doi: 10.1093/arclin/acaa092.
Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009;41(4):1149-60. doi: 10.3758/BRM.41.4.1149.
Guty E, Arnett P. Post-concussion Symptom Factors and neuropsychological outcomes in collegiate athletes. J Int Neuropsychol Soc 2018;24(7):684-92. doi: 10.1017/ S135561771800036X.
King NS, Crawford S, Wenden FJ, et al. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 1995;242(9):587-92. doi: 10.1007/BF00868811.
Zong L, Zhu S, editors. The study of the incidence of postconcussion symptoms and its related influencing factors. National Academic Conference of Psychiatry of Chinese Medical Association; 2011.
Crawford S, Wenden FJ, Wade DT. The Rivermead head injury follow up questionnaire: a study of a new rating scale and other measures to evaluate outcome after head injury. J Neurol Neurosurg Psychiatry 1996;60(5):510-4. doi: 10.1136/ jnnp.60.5.510.
Chen DY, Hsu HL, Kuo YS, et al. Effect of age on working memory performance and cerebral activation after mild traumatic brain Injury: a functional mr imaging study. Radiology 2016;278(3):854-62. doi: 10.1148/radiol.2015150612.
de Guise E, Bélanger S, Tinawi S, et al. Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury. Appl Neuropsychol Adult 2016;23(3):213-22. doi: 10.1080/23279095.2015.1038747.
Bedaso A, Geja E, Ayalew M, et al. Post-concussion syndrome among patients experiencing head injury attending emergency department of Hawassa University Comprehensive specialized hospital, Hawassa, southern Ethiopia. J Headache Pain 2018;19(1):112. doi: 10.1186/s10194-018-0945-0.
Karr JE, Iverson GL, Berghem K, et al. Complicated mild traumatic brain injury in older adults: Post-concussion symptoms and functional outcome at one week post injury. Brain Injury 2 0 2 0 ; 3 4 ( 1 ) : 2 6 - 3 3 . d o i : 10.1080/02699052.2019.1669825.
Skandsen T, Stenberg J, Follestad T, et al. Personal factors associated with postconcussion symptoms 3 months after mild traumatic brain injury. Arch Phys Med Rehabil 2021;102(6):1102-12. doi: 10.1016/j.apmr.2020.10.106.
Barker-Collo S, Theadom A, Starkey N, et al. Factor structure of the Rivermead Post-Concussion Symptoms Questionnaire over the first year following mild traumatic brain injury. Brain Inj 2018;32(4):453-8. doi: 10.1080/02699052.2018.1429659.
Merritt VC, Greenberg LS, Meyer JE, et al. Loss of Consciousness is Associated with elevated cognitive intra-individual variability following sports-related concussion. J Int Neuropsychol Soc 2021;27(2):197-203. doi: 10.1017/ S1355617720000727.
McMahon P, Hricik A, Yue JK, et al. Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma 2014;31(1):26-33. doi: 10.1089/neu.2013.2984.
Kasch H, Jensen LL. Minor head injury symptoms and recovery from whiplash injury: a 1-year prospective study. Rehabil Process Outcome 2019;8:1179572719845634. doi: 10.1177/1179572719845634.
Li F, Lu L, Chen H, et al. Disrupted brain functional hub and causal connectivity in acute mild traumatic brain injury. Aging 2019;11(22):10684-96. doi: 10.18632/aging.102484.
Losoi H, Silverberg ND, Wäljas M, et al. Recovery from mild traumatic brain injury in previously healthy adults. J Neurotrauma 2016;33(8):766-76. doi: 10.1089/neu.2015.4070.
Killgore WDS, Vanuk JR, Shane BR, et al. A randomized, double-blind, placebo-controlled trial of blue wavelength light exposure on sleep and recovery of brain structure, function, and cognition following mild traumatic brain injury. Neurobiol Dis 2020;134:104679. doi: 10.1016/j. nbd.2019.104679.
Westfall DR, West JD, Bailey JN, et al. Increased brain activation during working memory processing after pediatric mild traumatic brain injury (mTBI). J Pediatr Rehabil Med 2015;8(4):297-308. doi: 10.3233/PRM-150348.
Gorgoraptis N, Zaw-Linn J, Feeney C, et al. Cognitive impairment and health-related quality of life following traumatic brain injury. NeuroRehabilitation 2019;44(3):321-31. doi: 10.3233/NRE-182618.
Kim GU, Park S, Kim S. Functional health in korean middleaged women with poor sleep quality. Int J Nurs Knowl 2020;31(4):232-9. doi: 10.1111/2047-3095.12275.
van der Naalt J, Timmerman ME, de Koning ME, et al. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol 2017;16(7):532-40. doi: 10.1016/S1474-4422(17)30117-5.
Blakeman JR. An integrative review of the theory of unpleasant symptoms. J Adv Nurs 2019;75(5):946-61. doi: 10.1111/ jan.13906.