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- Matusevičienė, Giedrė
(författare)
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Assessment and management of patients at risk for persisting disability after mild traumatic brain injury
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is a lack of evidence-based interventions for patients with persisting problems after mild traumatic brain injury (mTBI). The interventions needed should focus on patients at particular risk for persisting disability after mTBI and target modifiable factors. After initial studies of an early educational intervention unexpectedly gave negative results (studies I, II), a renewed focus on possible targets for interventions was needed: studies III, IV explored associations with self-reported and objectively measured visual disturbances, self-rated and objectively measured fatigue, and correlations between fatigue, visual functions and attention. Study design and participants: Randomized controlled intervention study (studies I, II), and exploratory prospective observational study (studies III, IV). In studies I, II, patients with an estimated high risk for persisting disability were randomized to an early interventional visit (EIV) to physician or to Treatment as usual (TAU). All 173 patients, including the non-randomized group were followed up at 3 months after the injury. Studies III, IV, compared patients with mTBI to patients with minor orthopedic trauma and non-injured controls, with 15 in each group. Participants were assessed sub-acutely and after approximately 3 months. Outcome measures: Multimodal outcome measures related to the ICF-framework incorporating: 1.Self-reported data on symptoms (Rivermead Post Concussion Symptoms Questionnaire (RPQ)), activity and participation (Occupational Gap Questionnaire, Rivermead Head Injury Follow-up Questionnaire), and quality of life (SF-36) (studies I, II). 2. Findings from visual examination (accommodation, convergence, visual acuity, saccades), and visual symptoms (Convergence Insufficiency Symptoms Survey (CISS) and RPQ (study III). 3. Self- reported data on fatigue: acquired fatigue, (RPQ-f), and trait fatigue (Fatigue Severity Scale) and objectively measured cognitive fatigability (DSST-f) and saccades (study IV). Results: The intervention was not found to have an effect on symptoms, activity, participation or quality of life (studies I, II). Patients with few symptoms early after the mTBI continued to report few problems at follow-up. Visual findings showed that accommodative amplitude was lower in the mTBI group compared to non-injured controls at sub-acute stage; near point of convergence in the mTBI group was receded at sub-acute stage, but improved at follow-up; patients with mTBI reported a higher CISS score than persons in the control groups (study III). Acquired fatigue was present more often after mTBI and correlated to cognitive fatigability. Associations were found between acquired fatigue and some saccade measures, but not with other visual measures. Conclusions: An early intervention to patients at risk for persisting disability had no effect on symptoms, activity, participation or quality of life. Patients with few symptoms early after mTBI are likely to have a good outcome. Some transient measurable visual changes regarding convergence were found in patients with mTBI during the sub-acute period after the injury. Some support for the suggested value of assessing different aspects of fatigue have been found.
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| 2. |
- Matuseviciene, Giedre, et al.
(författare)
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Early intervention for patients at risk for persisting disability after mild traumatic brain injury : A randomized, controlled study
- 2013
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Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 27:3, s. 318-324
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: To investigate the effect of an early intervention visit in addition to written information and treatment as usual for patients with an estimated high risk for persisting disability after a mild traumatic brain injury (MTBI). Research design: Randomized controlled trial. Methods: One hundred and seventy-three patients, aged 15-70 years with a Glasgow Coma Scale of 14-15 were included. All received written information about MTBI. Ninety-seven patients who reported three or more symptoms according to the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 10 days after the injury were considered as high-risk patients and were randomized to either early visit to a doctor or to treatment as usual (TAU); all patients including the 76 low-risk patients were followed-up at 3 months. Completion rate was 83%. Outcome measures included RPQ and the Hospital Anxiety and Depression Scale. Results: RPQ symptoms decreased significantly in both randomized groups, but were not significantly different in the groups at 3 months. At 3 months, anxiety and depression scores did not differ between groups. Conclusions: An early intervention, offered to patients with an estimated high risk for persisting disability, had no additional effect on symptom level at 3 months after MTBI as compared to TAU.
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| 3. |
- Matuseviciene, Giedre, et al.
(författare)
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No effect of an early intervention after mild traumatic brain injury on activity and participation : A randomized controlled trial.
- 2016
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Ingår i: Journal of Rehabilitation Medicine. - Stockholm : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 48:1, s. 19-26
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate measures of activity, participation and quality of life 3 months after mild traumatic brain injury and the effect of an early intervention for patients with an estimated high risk for problems after mild traumatic brain injury.PATIENTS: Consecutive patients attending the emergency room with mild traumatic brain injury.DESIGN: Randomized controlled trial.METHODS: Patients reporting < 3 symptoms after 10 days were considered to have a low risk for prolonged problems. Patients with ≥ 3 symptoms (high-risk patients) were randomized to a visit to a physician or treatment-as-usual. Data on self-reported limitations in activity, restrictions in participation, and quality of life were collected for all patients at 3 months.RESULTS: At 3 months post-injury, low-risk patients reported good quality of life and significantly fewer problems in everyday life compared with high-risk patients. The intervention had no effect on activity, participation or quality of life.CONCLUSION: Patients who report few symptoms early after mild traumatic brain injury are likely to have a good outcome regarding activity and participation. The intervention offered in this study, focusing on reassurance of a good outcome and treatment of comorbidities, had no effect.
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