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Citation
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Rakers SE, Timmerman ME, Scheenen ME, de Koning ME, van der Horn HJ, van der Naalt J, Spikman JM. Arch. Phys. Med. Rehabil. 2021; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: To analyse fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery trajectories and investigate influencing factors, including emotional distress and coping styles.
DESIGN: An observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, post-traumatic stress and coping at 2 weeks, 3 and 6 months post-injury. SETTING: Three level-1 trauma-centers. PARTICIPANTS: Mild TBI patients (n=456). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum scores 8-56). Subsequently, three clinical categories were created: high (40-56), moderate (26-38) and low (8-25).
RESULTS: From the entire mild TBI group, four patient clusters with distinct patterns for fatigue, emotional distress and coping styles were found with LCGA. Clusters 1 and 2 showed favourable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%), and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavourable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%), and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often female, suffering more often from sleep disturbances and pain.
CONCLUSION: The prognosis for recovery from posttraumatic fatigue is favourable for 55% of the mild TBI patients. Patients at risk for chronic fatigue can be signalled in the acute phase post-injury based on the presence of high fatigue, high passive coping and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of disease-related processes over time.
Language: en |