Kinesiophobia Is Related to Acute Musculoskeletal Injury Incidence Following Concussion
Abstract: Context: Athletes with a history of sport concussion (SC) have an increased risk of musculoskeletal injury (MSK); however, the underlying mechanisms have yet to be determined. The purpose of our study was to evaluate kinesiophobia in college athletes with or without a time-loss MSK within 180 days of unrestricted return to play following a SC. Design: This was a retrospective cohort study within a sports medicine facility. Methods: Participants were eligible if they were diagnosed with a SC, completed the Tamp… Show more
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Cited by 3 publications
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The Influence of Kinesiophobia on Time to Clinical Recovery in Collegiate Athletes with Concussion
Background Several factors such as acute symptom severity, premorbid anxiety, and depression have been associated with concussion recovery. Elevated kinesiophobia has been associated with recovery from musculoskeletal conditions, as well as increased reaction time and vestibular–ocular motor dysfunction following concussion. However, kinesiophobia has yet to be evaluated as a modifier of concussion recovery time. Objectives This study was designed to evaluate the role of acute kinesiophobia levels on days until clinical recovery in collegiate athletes with concussion. We hypothesized that collegiate athletes with elevated Tampa Scale of Kinesiophobia (TSK) scores would take a greater number of days to achieve clinical recovery compared with athletes with lower values. Methods Division I collegiate athletes diagnosed with a concussion (N = 113, 19.9 ± 1.5 years, 42% female) participated in this descriptive laboratory study. Participants were assigned to high [≥ 37 (H-TSK, n = 54)] or low [< 37 (L-TSK, n = 59)] TSK groups on the basis of the first TSK values recorded within 72 h of their concussion. Participants were also administered the Revised Head Injury Scale (HIS-r) to assess symptom severity within 72 h of injury. The Immediate Postconcussion and Cognitive Test (ImPACT) battery was administered at baseline and used to gather demographic variables such as biological sex, age, history of anxiety/depression, and concussion history, and as part of the athletes’ symptom-free assessment. Days until clinical recovery between H-TSK and L-TSK groups were compared using a Mann–Whitney U test. Spearman’s rank correlation coefficients were calculated to determine the relationship between TSK and days until clinical recovery in addition to other modifiers of recovery. Multiple linear regression was used to evaluate days until clinical recovery as a function of the TSK total score, controlling for the HIS-r and ImPACT variables. Results Days until clinical recovery was significantly longer in the H-TSK group (median difference = 2.5 days, p < 0.001) compared with the L-TSK group. A significant, moderate positive correlation between the TSK score and days to clinical recovery (ρ = 0.45, p < 0.001) was observed, which was also the strongest correlation among all variables. Our regression model demonstrated that for every point increase on the TSK, days until clinical recovery increased by 0.23 while controlling for total symptom severity, age, concussion history, psychiatric history, and biological sex (β = 0.23, p = 0.018). All other variables entered into the regression were not statistically significant. Conclusions Our data suggest that athletes with TSK scores above 37 within 72 h of a concussion had a greater number of days until clinical recovery when compared with athletes with TSK values below 37. The TSK score had the highest correlation with days until clinical recovery when compared with other known modifiers of recovery, including total symptom severity. The TSK score was also the strongest predictor of days until clinical recovery. Collectively, these findings suggest that the TSK score should be considered by healthcare professionals to help inform effective management strategies for collegiate athletes with concussion.
The Influence of Kinesiophobia on Time to Clinical Recovery in Collegiate Athletes with Concussion
Background Several factors such as acute symptom severity, premorbid anxiety, and depression have been associated with concussion recovery. Elevated kinesiophobia has been associated with recovery from musculoskeletal conditions, as well as increased reaction time and vestibular–ocular motor dysfunction following concussion. However, kinesiophobia has yet to be evaluated as a modifier of concussion recovery time. Objectives This study was designed to evaluate the role of acute kinesiophobia levels on days until clinical recovery in collegiate athletes with concussion. We hypothesized that collegiate athletes with elevated Tampa Scale of Kinesiophobia (TSK) scores would take a greater number of days to achieve clinical recovery compared with athletes with lower values. Methods Division I collegiate athletes diagnosed with a concussion (N = 113, 19.9 ± 1.5 years, 42% female) participated in this descriptive laboratory study. Participants were assigned to high [≥ 37 (H-TSK, n = 54)] or low [< 37 (L-TSK, n = 59)] TSK groups on the basis of the first TSK values recorded within 72 h of their concussion. Participants were also administered the Revised Head Injury Scale (HIS-r) to assess symptom severity within 72 h of injury. The Immediate Postconcussion and Cognitive Test (ImPACT) battery was administered at baseline and used to gather demographic variables such as biological sex, age, history of anxiety/depression, and concussion history, and as part of the athletes’ symptom-free assessment. Days until clinical recovery between H-TSK and L-TSK groups were compared using a Mann–Whitney U test. Spearman’s rank correlation coefficients were calculated to determine the relationship between TSK and days until clinical recovery in addition to other modifiers of recovery. Multiple linear regression was used to evaluate days until clinical recovery as a function of the TSK total score, controlling for the HIS-r and ImPACT variables. Results Days until clinical recovery was significantly longer in the H-TSK group (median difference = 2.5 days, p < 0.001) compared with the L-TSK group. A significant, moderate positive correlation between the TSK score and days to clinical recovery (ρ = 0.45, p < 0.001) was observed, which was also the strongest correlation among all variables. Our regression model demonstrated that for every point increase on the TSK, days until clinical recovery increased by 0.23 while controlling for total symptom severity, age, concussion history, psychiatric history, and biological sex (β = 0.23, p = 0.018). All other variables entered into the regression were not statistically significant. Conclusions Our data suggest that athletes with TSK scores above 37 within 72 h of a concussion had a greater number of days until clinical recovery when compared with athletes with TSK values below 37. The TSK score had the highest correlation with days until clinical recovery when compared with other known modifiers of recovery, including total symptom severity. The TSK score was also the strongest predictor of days until clinical recovery. Collectively, these findings suggest that the TSK score should be considered by healthcare professionals to help inform effective management strategies for collegiate athletes with concussion.
Trunk and Lower Extremity Biomechanics in Female Athletes With and Without a Concussion History
Context: Athletes with a history of concussion are at a greater risk for lower extremity musculoskeletal injury. Female athletes may be at an even greater risk. Previous landing biomechanics research post-concussion has focused on the lower extremities, but the trunk plays a crucial role as an injury risk factor. Objective: To compare lower extremity and trunk biomechanics during jump landing and cutting maneuvers between female athletes with and without a concussion history. Design: Cross-sectional. Setting: Biomechanics laboratory. Participants: Our study included 26 athletes with (age:19.0±1.3years, BMI:22.6±2.0kg/m2, time since most recent concussion: median=37.5 months [interquartile range (25.0, 65.8)]), and 38 athletes without (age:19.0±1.1years, BMI:22.1±1.8kg/m2) a concussion history. Main Outcome Measures: Peak kinetics (vertical ground reaction force, vertical loading rate, external knee abduction moment, external knee flexion moment) and kinematics (trunk flexion angle, trunk lateral bending angle, dorsiflexion angle, knee flexion angle, knee abduction angle, hip flexion angle) were obtained during the eccentric portion of the task. Separate 2 (group) × 2 (limb) between-within analyses of covariance compared outcomes between groups. We covaried for time since most recent concussion and limb which had a history of musculoskeletal injury. Results: Athletes with a concussion history displayed a greater nondominant knee abduction angle compared to their dominant limb (p=0.010, np2=0.107) and athletes without a concussion history nondominant limb (p=0.023, np2=0.083) during the jump landing. Athletes with a concussion history displayed less trunk lateral bending during cutting compared with athletes without a concussion history (p=0.005, np2=0.126). Conclusions: Our results indicate landing biomechanics are different between female athletes with and without a concussion history. This may be due to impairments in neuromuscular control post-concussion which may ultimately increase the risk of subsequent lower extremity injury, although further research is warranted given the cross-sectional nature of our study.
False-Positive Rates, Risk Factors, and Interpretations of the Vestibular/Ocular Motor Screening in Collegiate Athletes
Context: Biological sex and history of motion sickness are known modifiers associated with a false-positive baseline Vestibular Ocular Motor Screen (VOMS). However, other factors may associate with a false-positive VOMS in collegiate athletes. Objective: Identify contributing factors to false-positive VOMS assessments using population specific criteria. We also critically appraised previously reported interpretation criterion. Design: Descriptive Laboratory. Setting: Single site collegiate athletic training clinic. Patients or other Participants: NCAA Division 1 athletes (n=462[41% female]) who were 18.8±1.4 years old. Main Outcome Measures: Participants completed the Athlete Sleep Behavior Questionnaire (ASBQ), Generalized Anxiety Index (GAD-7), the ImPACT battery, Patient Health Questionnaire (PHQ-9), Revised Head Injury Scale (HIS-r), the Sensory Organization Test (SOT), and the VOMS as part of a multidimensional baseline concussion assessment. Participants were classified into two groups based on whether they had a total symptom score of ≥8 following VOMS administration, excluding the baseline checklist. Chi-squared (χ2) and independent t-tests compared group demographics. A binary logistic regression with adjusted odds ratios (OR) evaluated the influence of sex, corrected vision, ADHD, ImPACT composite scores, concussion history, a history of treatment for headache and/or migraine, GAD-7, PHQ-9, ASBQ, and SOT Equilibrium Score, and Somatosensory, Visual, and Vestibular sensory ratios on false-positive rates. Results: Approximately 9.1% (42/462 [30 females]) met criteria for a false-positive VOMS. A significantly greater proportion of females had false-positives (χ2(1) = 18.37, p < 0.001). Female sex (OR=2.79, 95% CI [1.17-6.65], p =.02) and history of treatment for headache (OR=4.99, 95% CI [1.21-20.59], p=0.026) were the only significant predictors of false-positive VOMS. Depending on cutoff interpretation, false-positive rates using our data ranged from 9.1%-22.5%. Conclusions: Our results support the most recent interpretation guidelines for the VOMS in collegiate athletes due to a low false-positive rate and ease of interpretation. Biological sex and history of headaches should be considered when administering the VOMS in the absence of a baseline.
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