Recovery Trajectories of Patients with Mild Traumatic Brain Injury

Abstract

Within the mild traumatic brain injury (mTBI) population, there is heterogeneity both in symptom presentation and recovery patterns. Components of the fear-avoidance model (FAM) may be useful in understanding this heterogeneity. This longitudinal study aimed to identify latent trajectory classes of postconcussion symptoms (PCS) and evaluate how these classes differ on components of the FAM, following mTBI compared with controls. Participants included 185 patients with mTBI and 180 patients with orthopedic injury. PCS, catastrophizing, activity avoidance, somatic focus, depression, participation restrictions and satisfaction were measured 2 weeks, 3, 6, and 12 months post-injury. Multivariate latent class growth analysis identified classes of participants with similar longitudinal trajectories on three variables: cognitive, emotion, and somatic symptoms. Demographic and injury characteristics were used to predict class membership. Class membership was used to predict FAM outcomes. In the mTBI group, Class 1 (C1, 5.9%) had very high maintained symptoms. Class 2 (C2, 20.5%) had high decreasing symptoms. Class 3 (C3, 19.5%) had moderate decreasing symptoms. Class 4 (C4, 54%) experienced low decreasing symptoms. Belonging to class 1 or 2 predicted worse outcomes, including higher catastrophizing, activity avoidance, depression, and participation dissatisfaction. In the control group, two classes were found. Findings highlight the heterogeneity within the mTBI population and the universal disabling impact of person-related behavioral characteristics across medical conditions. Persistent symptoms management and education after mTBI should target those with higher emotion and somatic symptoms, catastrophizing, and depression at 2 weeks post-injury. Interventions targeting catastrophizing, avoidance behaviors, and emotional health may assist in recovery.

Keywords: fear-avoidance model; mild traumatic brain injury; multivariate latent class growth analysis; orthopedic injury; persistent postconcussion symptoms; recovery trajectories.