Long-term mental fatigue after traumatic brain injury and impact on employment status (original) (raw)
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Predictors for Return to Work in Subjects with Mild Traumatic Brain Injury
Behavioural Neurology, 2016
Objective. To predict return to work (RTW) at 12 months for patients who either were sick-listed or were at risk to be sick-listed with persistent postconcussion symptoms (PCS) at six to eight weeks after injury.Method. A prospective cohort study of 151 patients with mild traumatic brain injury (MTBI) admitted consecutively to outpatient clinics at two University Hospitals in Norway. The study was conducted as part of a randomised clinical trial. Injury characteristics were obtained from the medical records. Sick leave data from one year before to one year after MTBI were obtained from the Norwegian Labour and Welfare Service. Self-report questionnaires were used to obtain demographic and symptom profiles.Results. We observed a significant negative association between RTW at 12 months and psychological distress, global functioning, and being sick-listed at two months after MTBI, as well as having been sick-listed the last year before injury.Conclusion. Psychological distress, global...
Patterns of Fatigue and Its Correlates Over the First 2 Years After Traumatic Brain Injury
Journal of Head Trauma Rehabilitation, 2008
This study used a prospective longitudinal design to quantify fatigue and associated factors during the first 2 years after traumatic brain injury (TBI). Fifty-one individuals were assessed at 3 time points: within the first 6, 12, and 18-24 months after TBI. Self-reported fatigue improved during the first year, as did pain, sleep quality, cognitive independence, and involvement in productive activity. Further changes up to 2 years after TBI were not observed. The subset of individuals who reported significant increases in fatigue over the first 2 years demonstrated poorer outcomes in cognition, motor symptoms, and general functioning than those with decreased or stable fatigue.
Journal of Head Trauma Rehabilitation, 2008
Fatigue is a well-recognized issue for individuals with traumatic brain injury (TBI). This prospective study examined the rate and types of fatigue that are experienced by a cohort of individuals with TBI within the first 2 years, using a multidimensional fatigue scale. The impact of factors such as demographics, injury severity indices, and concomitant psychosocial variables was also examined. Using 2 measures of overall fatigue, 16%-32% at Year 1 and 21%-34% at Year 2 reported significant levels of fatigue. Fatigue did not appear to change between 1 and 2 years post-TBI. Sleep quality was the most prevalent concomitant disturbance followed by depression and pain.
Fatigue and traumatic brain injury
Annales de réadaptation et de médecine physique : revue scientifique de la Société française de rééducation fonctionnelle de réadaptation et de médecine physique, 2006
Fatigue is frequent and disabling in patients with traumatic brain injury (TBI). Its mechanisms are complex and multifactorial. We performed a literature review of reports of the condition using the following key words: brain injury, depression, neuroendocrine dysfunction, and treatment. Five scales have been used to evaluate fatigue in TBI patients: the Fatigue Severity Scale, the visual analog scale (VAS) for fatigue, the Fatigue Impact Scale, the Barrow Neurological Institute (BNI) Fatigue Scale and the Cause of Fatigue (COF) Questionnaire. The BNI Fatigue Scale and the COF Questionnaire have been designed specifically for brain-injured patients. Fatigue is present in 43-73% of patients and is one of the first symptoms for 7% of them. Fatigue does not seem to be significantly related to injury severity not to time since injury. It can be related to mental effort necessary to overcome attention deficit and slowed processing ("coping hypothesis"). It can also be related t...
Journal of Neurology
Background Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities. Methods Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subjective fatigue was measured by single item on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), administered at baseline, three and 6 months postinjury. Patients were categorized by clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU). Injury severity, preinjury somatic- and psychiatric conditions, depressive and sleep problems were registered at baseline. For prediction of fatigue changes, descriptive statistics and mixed effect logistic reg...
Journal of Rehabilitation Medicine
Fatigue is a common complaint following brain injury. This study investigated the impact of injury localization, diagnosis and depression on subjective fatigue experience in a group of patients in a rehabilitation unit. Patients with posterior and non-specific lesions were more fatigued than those with subcortical and frontal injuries. Stroke patients were less likely to experience fatigue than patients with other diagnoses. However, the differences in fatigue between injury localization and diagnostic groups were overshadowed by the strong relationship between depression and fatigue. Objective: Fatigue after acquired brain injury may be related to the subcortico-frontal attention network. Depression is also strongly related to fatigue. This study investigates whether injury localization, diagnosis and depression are related to self-rated mental fatigue in patients with an acquired brain injury. Design: Retrospective cross-sectional cohort study. Subjects: Sixty-one patients diagnosed with stroke, subarachnoidal haemorrhage, traumatic brain injury, or brain tumour were included in the study. Methods: Patients who underwent a multidisciplinary team assessment during September 2011 to June 2012, and who were assessed with the Mental Fatigue Scale, were included in the study. Results: A significantly higher number of patients with posterior and non-specific lesions experienced fatigue compared with those with subcortical/ frontal injuries. Fewer stroke patients experienced fatigue compared with the other patient groups. How ever, after logistic regression, only depression remained as an explanatory variable for self-rated fatigue. Nevertheless, although all patients with depression were fatigued, not all fatigued patients were depressed. Conclusion: Although depression explains a high degree of fatigue after an acquired brain injury, mental fatigue after brain injury should be viewed as a condition partly separate from depression. Future extensive comparative studies are required, preferably including neuropsychological measures.
Objective Measurement of Fatigue Following Traumatic Brain Injury
Journal of Head Trauma Rehabilitation, 2008
Objectives: To quantify posttraumatic brain injury (post-TBI) mental fatigue objectively by documenting changes in performance on neuropsychological tests as a result of sustained mental effort and to examine the relationship between objectively measured mental fatigue and self-reported situational and day-today fatigue. Participants: The study included 202 community-dwelling individuals with mild-severe TBI and 73 noninjured controls. Measures: Measures included Cambridge Neuropsychological Test Automated Battery, Global Fatigue Index, and situational fatigue rating. Method: Subjects were administered a 30-minute computerized neuropsychological test battery 3 times. The second and third administrations of the battery were separated by approximately 2 hours of interviews and administration of self-report measures. Results: The neuropsychological test scores were factor analyzed, yielding 3 subscales: speed, accuracy, and executive function. Situational fatigue and day-today fatigue were significantly higher in individual with TBI group than in individuals without TBI and were associated with speed subscale scores. Individuals with TBI evidenced a significant decline in performance on the accuracy subscale score. These declines in performance related to sustained mental effort were not associated with subjective fatigue in the TBI group. While practice effects on the speed and accuracy scores were observed in non-brain-injured individuals, they were not evidenced in individuals with TBI. Conclusions: Findings were largely consistent with previous literature and indicated that while subjective fatigue is associated with poor performance in individuals with TBI, it is not associated with objective decline in performance of mental tasks.
Chronic Stress and Fatigue-Related Quality of Life After Mild to Moderate Traumatic Brain Injury
Journal of Head Trauma Rehabilitation, 2011
Objective-To determine relationships between chronic stress, fatigue-related quality of life (QOL-F) and related covariates after mild-to-moderate traumatic brain injury (TBI). Design-Observational and cross-sectional Participants-A total of 84 community-dwelling individuals with mild-to-moderate TBI recruited from multiple outpatient rehabilitation clinics assessed on average 15 months after injury. Method-Data were collected with self-report surveys and chart abstraction. Measures-Neurofunctional Behavioral Inventory, Perceived Stress Scale-14, Impact of Events Scale, McGill Pain Short-form Scale, and modified version of the Fatigue Impact Scale. Results-Fatigue-related quality of life was associated with somatic symptoms, perceived situational stress, but not with event-related stress (PTSD symptoms) related to index TBI, preinjury demographic, or post-injury characteristics. Somatic symptoms and chronic situational stress accounted for 42% of the variance in QOL (F). Conclusions-QOL (F) in community-dwelling individuals with mild-to-moderate TBI is associated with chronic situational stress and somatic symptoms. Symptom management strategies may need to include general stress management to reduce fatigue burden and improve quality of life. Keywords traumatic brain injury; fatigue; quality of life; stress; psychological While fatigue is present in 14-22% of the general population, estimates among individuals with traumatic brain injury (TBI) range much higher: from 21% to as high as 70%. 1,2. While fatigue occurs after TBI regardless of the severity of brain injury, 1-5 an effort to understand the variability of its frequency is found in comparison studies focused on those with mild TBI (MTBI). For example, Ponsford and associates 6 noted significantly higher fatigue levels at 1 week post mild TBI (MTBI) compared to a trauma control group, but these differences
Neuropsychological Rehabilitation, 2016
BACKGROUND: Post-traumatic brain injury fatigue (PTBIF) is a major problem in the years after traumatic brain injury (TBI), yet little is known about its persistence and resolution. OBJECTIVE: To identify factors related to PTBIF remission and resolution. METHODS: TBI Model System registrants at 5 centers who participated in interviews at either 1 and 2 years postinjury (Y1-2 Cohort), or 2 and 5 years post injury (Y2-5 Cohort). Characteristics of participants with PTBIF remission were compared to those with PTBIF persistence. Variables studied included the presence of and changes in disability, sleep dysfunction, mood, and community participation. RESULTS: Functional independence Measure did not differ significantly between groups or over time. In the Y1-2 Cohort the Fatigue Resolved group scored significantly better on the Disability Rating Scale and Pittsburgh Sleep Quality Index. In the Y2-5 Cohort the Fatigue Resolved group scored significantly higher on a measure of community participation. CONCLUSIONS: Less than half of the sample in each cohort experienced a remission of PTBIF between time points. Persistence of PTBIF from one to two years post-injury is associated with disability, sleep disturbance, and depression while persistence of fatigue beyond two years post-injury appears to be related to participation level, underscoring the potential impact of effective surveillance, assessment, and treatment of this condition in optimizing life after TBI. Differences in fatigue progression may point to the presence of different types of PTBIF.