ABSTRACT
OBJECTIVE: To 1) identify the range of evidence for relationships between psychological factors using the Fear Avoidance Model (FAM) as a guiding framework and relevant clinical outcomes in adult patients with persisting symptoms after concussion (PSaC), 2) develop a comprehensive understanding of psychological factors that have been identified as predictors of clinical outcomes for PSaC, and 3) contribute to the theoretical framework of the FAM for PSaC. DATA SOURCES: Six databases (CINAHL, Embase, PsycINFO, PubMed, SportDiscus, and Web of Science) were searched by a librarian for empirical and theoretical publications, and experimental and quasi experimental study designs. The literature search was not limited by publication date restrictions. Grey literature, with the exception of doctoral dissertations, was excluded. STUDY SELECTION: Studies in the English language consisting of human participants 18 years and older. Articles must have included both outcomes pertaining to PSaC (greater than or equal to three months post-injury) and psychological constructs. DATA EXTRACTION: One reviewer extracted data from the resulting studies using a standardized data extraction form designed for this review. Two reviewers independently assessed risk of bias using the Quality in Prognosis Studies tool. DATA SYNTHESIS: This review found numerous psychological constructs, some directly linked to the FAM, that have potential prognostic relationships with PSaC. However, research remains limited and some psychological factors central to FAM were only identified in a small number of studies (catastrophizing, cogniphobia, avoidance) while other psychological factors were studied more extensively (anxiety, depression). CONCLUSIONS: There is the need for additional evidence and this integrative review provides an adaptation of the FAM for PSaC to be used as a guiding preliminary framework for future research. Future research should aim to include psychological factors proposed in this modified FAM to fully understand PSaC.
ABSTRACT
Background: Persisting symptoms after concussion (PSaC) include physical, cognitive, and psychological symptoms which contribute to rehabilitation challenges. Previous research has not thoroughly investigated the association between PSaC and pain-related psychological factors. Therefore, there is an opportunity to use current pain models, such as the Fear Avoidance Model (FAM), as a framework to explore these relationships. The goals of this integrative review are to (1) identify and describe range of evidence that explores relationships between psychological factors and clinical outcomes in patients with PSaC, and (2) develop a comprehensive understanding of FAM-specific psychological factors that have been identified as potential predictors of clinical outcomes in patients with PSaC. Methods: This review will be based on principles and stages of an integrative review which will allow for inclusion of diverse methodologies: (1) problem formulation, (2) literature search, (3) data evaluation, (4) data analysis, and (5) presentation. Methods for reporting this review will be informed by the 2020 PRISMA guidelines for systematic reviews. Discussion: The findings from this integrative review will inform healthcare professionals working in post-concussion rehabilitation settings regarding relationships between FAM psychological factors and PSaC-an area that until recently has not been thoroughly explored. Additionally, this review will inform the development of other reviews and clinical studies to further investigate relationships between FAM psychological factors and PSaC. Integrative Review Registration: OSF DOI 10.17605/OSF.IO/CNGPW.
ABSTRACT
OBJECTIVE: The aim of the study was to describe cross-sectional relationships between postconcussion symptom catastrophizing and patient-level factors in a postconcussion cohort. DESIGN: This cross-sectional study was conducted in an outpatient rehabilitation hospital concussion clinic and consisted of adults undergoing a neuropsychological evaluation. Cronbach α assessed internal consistency for Post-Concussion Symptom Catastrophizing Scale total scores. Pearson r correlation coefficients assessed construct validity among emotional function measures and Post-Concussion Symptom Catastrophizing Scale total scores at initial evaluation. Hierarchical regression models were used to assess criterion validity. RESULTS: Excellent internal consistency was observed for Post-Concussion Symptom Catastrophizing Scale total scores (α = 0.953). The Post-Concussion Symptom Catastrophizing Scale was significantly correlated with cause of injury ( r = -0.223, P < 0.01), litigation consideration ( r = 0.309, P < 0.05), and history of psychiatric illness ( r = 0.198, P < 0.01). The Post-Concussion Symptom Catastrophizing Scale was significantly correlated with emotional functioning (Patient Health Questionnaire [ r = 0.600, P < 0.05]; Generalized Anxiety Disorder [ r = 0.602, P < 0.05]), symptom rating (Sports Concussion Assessment Tool [Fifth Edition, r = 0.477, P < 0.05]), and cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status [ r = -0.238, P < 0.05]) measures. The final regression model explained 64.7% variance in Post-Concussion Symptom Catastrophizing Scale total scores and included the Generalized Anxiety Disorder ( b = 1.038, ß = 0.466, P = 0.001) as a unique predictor. CONCLUSIONS: Results indicate strong, positive relationships between anxiety and catastrophizing at initial neuropsychological evaluation in a postconcussion sample.
