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Mild traumatic brain injury recovery: a growth curve modelling analysis over 2 years.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Carroll, Ellen L 
Outtrim, Joanne G 
Forsyth, Faye 
Manktelow, Anne E 
Hutchinson, Peter JA 

Abstract

BACKGROUND: An improved understanding of the trajectory of recovery after mild traumatic brain injury is important to be able to understand individual patient outcomes, for longitudinal patient care and to aid the design of clinical trials. OBJECTIVE: To explore changes in health, well-being and cognition over the 2 years following mTBI using latent growth curve (LGC) modelling. METHODS: Sixty-one adults with mTBI presenting to a UK Major Trauma Centre completed comprehensive longitudinal assessment at up to five time points after injury: 2 weeks, 3 months, 6 months, 1 year and 2 years. RESULTS: Persisting problems were seen with neurological symptoms, cognitive issues and poor quality of life measures including 28% reporting incomplete recovery on the Glasgow Outcome Score Extended at 2 years. Harmful drinking, depression, psychological distress, disability, episodic memory and working memory did not improve significantly over the 2 years following injury. For other measures, including the Rivermead Post-Concussion Symptoms and Quality of Life after Brain Injury (QOLIBRI), LGC analysis revealed significant improvement over time with recovery tending to plateau at 3-6 months. INTERPRETATION: Significant impairment may persist as late as 2 years after mTBI despite some recovery over time. Longitudinal analyses which make use of all available data indicate that recovery from mTBI occurs over a longer timescale than is commonly believed. These findings point to the need for long-term management of mTBI targeting individuals with persisting impairment.

Description

Keywords

Cognitive impairment, Latent growth curve modelling, Mild traumatic brain injury, Outcome, Adult, Brain Concussion, Brain Injuries, Disabled Persons, Humans, Quality of Life

Journal Title

J Neurol

Conference Name

Journal ISSN

0340-5354
1432-1459

Volume Title

267

Publisher

Springer Science and Business Media LLC

Rights

All rights reserved
Sponsorship
Academy of Medical Sciences (unknown)
European Commission (270259)
This work was partially funded by the European Commission under the 7th Framework Programme (FP7-270259-TBIcare), the UK National Institute of Health Research (NIHR) Biomedical Research Centre at Cambridge and the Technology Platform funding provided by the UK Department of Health. PJH was supported by the NIHR (Research Professorship and Cambridge BRC). JPP received funding from the Academy of Finland (grant #17379), Government’s Special Financial Transfer tied to academic research in Health Sciences (Finland), the Emil Aaltonen Foundation, the Finnish Brain Foundation and the Maire Taponen Foundation. BJS receives funding from the NIHR Brain Injury MedTech Co-operative, Cambridge and the NIHR Cambridge Biomedical Research Centre (Mental Health Theme). DKM was supported by the NIHR through the NIHR Cambridge Biomedical Research Centre grant and a Senior Investigator Award. VFJN was funded by a Health Foundation/Academy of Medical Sciences Clinician Scientist Fellowship.