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The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories Following Sport-related Concussion
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7 2022
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Source: Am J Sports Med. 50(8):2258-2270
[PDF-1.20 MB]
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Alternative Title:Am J Sports Med
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Description:Background:
There is growing awareness and clinical interest in athletes with affective symptoms following sport-related concussion (SRC), as these 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:
To examine the relationship between affective symptom reporting and RTP progression following SRC among a cohort of Division 1 student-athletes. We hypothesized those endorsing affective symptoms, and nervous-anxious symptom specifically, spend more time in RTP progression and recovery.
Study Design:
Descriptive epidemiology study.
Setting:
College varsity sports.
Methods:
Using SRC data from the Ivy League-Big Ten Epidemiology of Concussion Study among varsity-athletes through February 2020, we identified the four affective symptoms from the SCAT 22-symptom-inventory. We modeled the relationship between a 4-category affective symptom variable and time-to-symptom resolution, return-to-full play (RTP), and in-RTP-progression, adjusting for non-affective symptom prevalence and concussion history. Cox regressions estimated hazard ratios for time-to-event outcomes; linear regressions estimated mean differences for continuous outcomes.
Results:
In 2,077 student-athletes (men, 63.5%) with SRC, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%. In women, rates of symptom resolution and RTP were significantly lower in those with affective symptoms compared to not, and women with nervous-anxious symptom spent significantly longer in RTP progression. In men, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms compared to not, affective symptoms were not associated with time in RTP progression.
Conclusion:
Student-athletes with affective symptoms and nervous-anxious symptom exhibited delayed clinical recovery and RTP timelines; particularly for time in RTP. Symptom prevalence, concussion history contributed to this, however unmeasured confounding remains, indicated by poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.
Clinical Relevance:
Longer clinical recovery for student-athletes experiencing affective and nervous-anxious symptoms following concussion may be modified with directed/targeted treatment.
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Pubmed ID:35647797
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Pubmed Central ID:PMC10898515
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