TY - JOUR
T1 - Trajectories of Fatigue, Psychological Distress, and Coping Styles After Mild Traumatic Brain Injury
T2 - A 6-Month Prospective Cohort Study
AU - Rakers, Sandra E.
AU - Timmerman, Marieke E.
AU - Scheenen, Myrthe E.
AU - de Koning, Myrthe E.
AU - van der Horn, Harm J.
AU - van der Naalt, Joukje
AU - Spikman, Jacoba M.
N1 - Funding Information:
Supported by the Dutch Brain Foundation (grant no. Ps2012-06). The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report or in the decision to submit for publication. S.E.R., M.E.T., M.E.S., M.E.K., H.J.H., J.N., and J.M.S. had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication.
Publisher Copyright:
© 2021 The Authors
PY - 2021/10
Y1 - 2021/10
N2 - Objective: To analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery trajectories and investigate influencing factors, including emotional distress and coping styles. Design: An observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and coping at 2 weeks and 3 and 6 months postinjury. Setting: Three level 1 trauma centers. Participants: Patients with mild TBI (N=456). Interventions: Not applicable. Main Outcome Measures: Fatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25). Results: From the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%) and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavorable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%) and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often women and more often experiencing sleep disturbances and pain. Conclusions: The prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury based on the presence of high fatigue, high passive coping, and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of disease-related processes over time.
AB - Objective: To analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery trajectories and investigate influencing factors, including emotional distress and coping styles. Design: An observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and coping at 2 weeks and 3 and 6 months postinjury. Setting: Three level 1 trauma centers. Participants: Patients with mild TBI (N=456). Interventions: Not applicable. Main Outcome Measures: Fatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25). Results: From the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%) and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavorable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%) and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often women and more often experiencing sleep disturbances and pain. Conclusions: The prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury based on the presence of high fatigue, high passive coping, and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of disease-related processes over time.
KW - Brain concussion
KW - Fatigue
KW - Psychological distress
KW - Rehabilitation
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85111260040&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2021.06.004
DO - 10.1016/j.apmr.2021.06.004
M3 - Article
C2 - 34217729
AN - SCOPUS:85111260040
SN - 0003-9993
VL - 102
SP - 1965
EP - 1971
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 10
ER -