Psychological and Lifestyle Factors That Influence the Serial Reporting of Postconcussion-like Symptoms in a Non-concussed Population.
BACKGROUND
Symptoms related to concussion are generally nonspecific in nature, as they are also reported by non-concussed individuals. What is currently not known is whether the symptoms vary over time, and whether they are also influenced by a multitude of factors.


OBJECTIVE
The aim of this study was to investigate the potential influence of psychological, lifestyle, and situational factors on the change in postconcussion-like symptoms reported over 7 consecutive days in a cohort of normal individuals.


METHODS
This was a longitudinal observational study.


METHODS
The setting was a real-world context.


METHODS
A convenience sample of 180 non-concussed university students were enrolled. Of these, 110 participants provided data for the entire period of the study.


METHODS
An experience-sampling methodology was used to document the symptoms reported over time. Stepwise multivariate linear mixed-effects modeling was performed to identify the predictors contributing to the serially reported symptoms.


METHODS
Independent variables considered were gender, time of the day, location, primary activity, and type of interactant (person) of the participant, physical activity status, trouble sleeping, alcohol consumption, caffeine consumption, stress, anxiety, depression, mental and physical fatigue, and life stressors.


METHODS
The key outcome measures were the change in total symptom score (TSSchange) and symptom severity score (SSSchange) reported over 7 consecutive days.


RESULTS
The predictors of location at the time of reporting, physical fatigue (estimate: -0.98, P < .001) and mental fatigue (estimate: -0.53, P < .001) contributed to the TSSchange. Post hoc analysis of the variable of location at the time of reporting revealed that participants reported increased TSSchangewhen they were at a café/restaurant compared to a flat/college or university.


CONCLUSIONS
A number of factors within the context of daily life influenced the postconcussion-like symptoms reported over time. These findings indicate that clinicians need to be cautious when interpreting the serially assessed symptom scores to track the recovery profile of a concussed athlete to make decisions on return-to-play. Additional investigation is warranted to examine the change in symptom scores reported over time by concussed individuals, considering that this study was conducted in a nonconcussed cohort.


METHODS
Not applicable.
Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand; University of Oslo, Forskningsveien 3A, Harald Schjelderups hus, 0373, Oslo, Norway(∗). Electronic address: a.p.balasundaram@medisin.uio.no.
Arun Prasad
AP
Balasundaram
Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand(†).
Josie
J
Athens
School of Human, Health & Social Sciences, Central Queensland University, Branyan, Australia(‡).
Anthony Gerard
AG
Schneiders
The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Victoria, Australia(§).
Paul
P
McCrory
Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand(‖).
Stephen John
SJ
Sullivan
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology / Q000503:physiopathology; D001265:Athletic Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D001924:Brain Concussion / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D011581:Psychological Tests; D012016:Reference Values; D000068958:Return to Sport; D018570:Risk Assessment; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult