TY - JOUR
T1 - The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion
AU - D’Alonzo, Bernadette A.
AU - Bretzin, Abigail C.
AU - Wiebe, Douglas J.
AU - Fiore, Russell
AU - VanPatten, Bryn
AU - Levine, William N.
AU - Desai, Natasha
AU - Wentzel, David C.
AU - Sucheski-Drake, Amy
AU - Karlson, Kristine A.
AU - Wang, Frank
AU - Richardson, Lars
AU - Port, Nicholas L.
AU - Saffarian, Mathew
AU - Vesci, Brian
AU - Gay, Michael
AU - Day, Carly
AU - Putukian, Margot
AU - Esopenko, Carrie
AU - Wheeler, Matthew B.
AU - Ballard, Randy A.
AU - Peterson, Andy
AU - Klossner, David
AU - Moore, Erin M.
AU - Maerlender, Art
AU - Savage, Cary R.
AU - Sennett, Brian J.
AU - Arlis-Mayor, Stephanie
N1 - Funding Information:
The authors wish to acknowledge the efforts of Katy Harris, ATC, and David Wentzel, DO, from Cornell University whose passion and interest in this topic at our annual Traumatic Brain Injury Summit meeting motivated work on this project. Also, the authors acknowledge the athletic staff, research staff, and faculty study contacts at each site for their contributions to the study, including (listed alphabetically by institution) Beth Conroy, MS, ATC, Brian Daigneault, ATC, JJ Trey Crisco, PhD, and Matthew Culp, MA, ATC (Brown University); Jim Gossett, MS, ATC, Alexander Goldberg, and Doug Straley, MS, ATC (Columbia University); Katy Harris, ATC (Cornell University); Meredith Cockerell, MS, ATC, and Scott Roy, MS, ATC (Dartmouth College); Taylor Ashcraft, MS, ATC, Chloe Amaradio, MS, ATC, Bridget Hunt, MSAT, ATC, Brynn Johnson, MAT, ATC, and Brant Berkstresser, MS, LAT, ATC (Harvard University); Lauren Wilkins and Jacob Thayer (Indiana University); Katy Rogers, ATC, Chandler Castle, MS, ATC, Tamaria Hibbler, MS, ATC, and Vincent Delvalle, MS, ATC (Michigan State University); Jeff Mjannes, MD, and Danielle Colegrove, MS (Northwestern University); Pete Seidenberg, MD (Pennsylvania State University); Shasha Steinlight, MD, Addam Reynolds, MSW, Neeta Bauer, BS, Bridget Hunt, MS, ATC, and George O’Neil, MS, ATC (Princeton University); Kyle Brostrand, MS, ATC (Rutgers University); Paul Schmidt, MS, ATC, and Aaron Anderson, PhD, MS (University of Illinois); Kathryn Berger (Staiert), ATC (University of Iowa); Rebecca Hu and Chris Lacsamana, MEd, ATC (University of Maryland); Suzanne Hecht, MD, and Joi Thomas, MS, ATC (University of Minnesota); Todd Caze, MEd, MA, and Elliot Carlson, BA (University of Nebraska-Lincoln); Emily Dorman, MS, ATC, Jenna Ratka, MS, ATC, and Theresa Soya, MPH (University of Pennsylvania); Lindsay Snecinski, MS, ATC, Wendy Brunetto, MPH, Kristen Moriarty, MEd, ATC, Matthew Lynch, MD and Andrew Gotlin, MD (Yale University); and Erin McQuillan, MS, ATC (University of Wisconsin). The authors are grateful for the support from the leadership of the Big Ten-Ivy League Traumatic Brain Injury Research Collaboration for the contributions from the leadership and study teams at each site, and for the student-athletes for participating. Also, the authors thank Julia Orchinik, MA, MPH, and Andrew Belfiglio, MPH, for study coordination and data management. The authors acknowledge the Big Ten-Ivy League Traumatic Brain Injury Research Collaboration board members: Carolyn Campbell-McGovern, MBA (the Ivy League); Martha Cooper (Big Ten Academic Alliance); Katherine Galvin, JD (Big Ten Academic Alliance); Robin Harris (Ivy League); Kerry Kenny (Big Ten Conference); David Klossner, PhD (University of Maryland); Keith Marshall, PhD (Big Ten Academic Alliance); Nathan Meier (University of Nebraska-Lincoln); Margot Putukian, MD (Princeton University); Chris Sahley, PhD (Purdue University); Sam Slobounov, PhD (Pennsylvania State University); Douglas H. Smith, MD (University of Pennsylvania); and Philip Stieg, PhD, MD (Weill Cornell Medical College). The authors give special thanks to Martha Cooper (Big Ten Academic Alliance, assistant director and study liaison) and to members of the study advisory committee: Carolyn Campbell-McGovern; Martha Cooper; Emily Dorman, MEd, ATC; Carrie Esopenko, PhD; Kerry Kenny; Art Maerlender, PhD; James Noble, MD, MS; Margot Putukian, MD; Cary Savage, PhD; Jim Torner, PhD, MS; and David Wentzel, DO.
Publisher Copyright:
© 2022 The Author(s).
PY - 2022/7
Y1 - 2022/7
N2 - Background: There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited. Purpose/Hypothesis: To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery. Study Design: Cohort study; Level of evidence, 3. Methods: Using SRC data from the Ivy League–Big Ten Epidemiology of Concussion Study among varsity athletes through February 2020, we identified the 4 affective symptoms from the Sport Concussion Assessment Tool symptom inventory. We modeled the relationship between a 4-category affective symptom variable and time to symptom resolution, RTP, and RTP progression, adjusting for nonaffective symptom prevalence and concussion history. Cox regressions were used to estimate hazard ratios for time to event outcomes, and linear regressions were used to evaluate mean differences for continuous outcomes. Results: Among 2077 student-athletes (men, 63.5%) with SRC symptoms, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%, respectively. When comparing women with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with affective symptoms, and women with nervous-anxious symptoms spent significantly longer in RTP progression. When comparing men with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms, and affective symptoms were not associated with time in RTP progression. Conclusion: Student-athletes with affective symptoms and nervous-anxious symptoms exhibited delayed clinical recovery and RTP timelines, particularly for time in RTP. Symptom prevalence and concussion history contributed to this; however, unmeasured confounding remains, as indicated by the poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.
AB - Background: There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited. Purpose/Hypothesis: To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery. Study Design: Cohort study; Level of evidence, 3. Methods: Using SRC data from the Ivy League–Big Ten Epidemiology of Concussion Study among varsity athletes through February 2020, we identified the 4 affective symptoms from the Sport Concussion Assessment Tool symptom inventory. We modeled the relationship between a 4-category affective symptom variable and time to symptom resolution, RTP, and RTP progression, adjusting for nonaffective symptom prevalence and concussion history. Cox regressions were used to estimate hazard ratios for time to event outcomes, and linear regressions were used to evaluate mean differences for continuous outcomes. Results: Among 2077 student-athletes (men, 63.5%) with SRC symptoms, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%, respectively. When comparing women with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with affective symptoms, and women with nervous-anxious symptoms spent significantly longer in RTP progression. When comparing men with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms, and affective symptoms were not associated with time in RTP progression. Conclusion: Student-athletes with affective symptoms and nervous-anxious symptoms exhibited delayed clinical recovery and RTP timelines, particularly for time in RTP. Symptom prevalence and concussion history contributed to this; however, unmeasured confounding remains, as indicated by the poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.
KW - affective symptoms
KW - anxiety
KW - athletics
KW - female
KW - mild TBI
KW - symptomology
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85131416766&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85131416766&partnerID=8YFLogxK
U2 - 10.1177/03635465221098112
DO - 10.1177/03635465221098112
M3 - Article
C2 - 35647797
AN - SCOPUS:85131416766
VL - 50
SP - 2258
EP - 2270
JO - The Journal of sports medicine
JF - The Journal of sports medicine
SN - 0363-5465
IS - 8
ER -