Impact of Somatic Vulnerability, Psychosocial Robustness and Injury-Related Factors on Fatigue following Traumatic Brain Injury—A Cross-Sectional Study (original) (raw)
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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 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.
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.
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.
Resilience Is Associated With Fatigue After Mild Traumatic Brain Injury
Journal of Head Trauma Rehabilitation, 2014
Objective: To examine resilience as a predictor of change in self-reported fatigue after mild traumatic brain injury (MTBI). Participants: A consecutive series of 67 patients with MTBI and 34 orthopedic controls. Design: Prospective longitudinal study. Main Measures: Resilience Scale, Beck Depression Inventory-Second Edition, and Pain subscale from Ruff Neurobehavioral Inventory 1 month after injury and Barrow Neurological Institute Fatigue Scale 1 and 6 months after injury. Results: Insomnia, pain, and depressive symptoms were significantly correlated with fatigue, but even when these variables were controlled for, resilience significantly predicted the change in fatigue from 1 to 6 months after MTBI. In patients with MTBI, the correlation between resilience and fatigue strengthened during follow-up. In controls, significant associations between resilience and fatigue were not found. Conclusion: Resilience is a significant predictor of decrease in self-reported fatigue following MTBI. Resilience seems to be a relevant factor to consider in the management of fatigue after MTBI along with the previously established associated factors (insomnia, pain, and depressive symptoms).
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
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...
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.
Systematic Review of Interventions for Fatigue After Traumatic Brain Injury
Journal of Head Trauma Rehabilitation, 2014
To conduct a systematic review of the evidence on interventions for posttraumatic brain injury fatigue (PTBIF). Methods: Systematic searches of multiple databases for peer-reviewed studies published in English on interventions targeting PTBIF as a primary or secondary outcome through January 22, 2014. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies. Results: The searches yielded 1526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study. Conclusions: Despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF.