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.

中文翻译：

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运动恐惧症对脑震荡大学生运动员临床恢复时间的影响

 背景

急性症状严重程度、病前焦虑和抑郁等几个因素与脑震荡恢复有关。运动恐惧症升高与肌肉骨骼疾病的恢复以及脑震荡后反应时间增加和前庭-眼球运动功能障碍有关。然而，运动恐惧症尚未被评估为脑震荡恢复时间的修饰因素。

 目标

本研究旨在评估急性运动恐惧症水平在脑震荡大学生运动员临床恢复前几天的作用。我们假设，与数值较低的运动员相比，坦帕运动恐惧症量表 （TSK） 评分较高的大学运动员需要更多的时间才能实现临床恢复。

 方法

被诊断患有脑震荡的 I 级大学生运动员（N = 113,19.9 ± 1.5 岁，42% 女性）参加了这项描述性实验室研究。根据脑震荡后 72 小时内记录的第一个 TSK 值，参与者被分配到高 [≥ 37 （H-TSK， n = 54）] 或低 [< 37 （L-TSK， n = 59）] TSK 组。参与者还接受了修订后的头部损伤量表 （HIS-r） 以评估受伤后 72 小时内的症状严重程度。脑震荡后立即和认知测试 （ImPACT） 电池在基线时给药，用于收集人口统计变量，例如生理性别、年龄、焦虑/抑郁史和脑震荡史，并作为运动员无症状评估的一部分。使用 Mann-Whitney U 检验比较 H-TSK 组和 L-TSK 组之间临床恢复的天数。计算 Spearman 秩相关系数以确定 TSK 与临床恢复天数之间的关系，以及其他恢复修饰因素。多元线性回归用于评估临床恢复前的天数与 TSK 总分的函数关系，控制 HIS-r 和 ImPACT 变量。

 结果

与 L-TSK 组相比，H-TSK 组临床恢复前的天数显着更长 （中位差异 = 2.5 天，p < 0.001）。观察到 TSK 评分与临床恢复天数之间存在显著、中等的正相关 （ρ = 0.45，p < 0.001），这也是所有变量中最强的相关性。 我们的回归模型表明，TSK 每增加一个点，临床恢复的天数就会增加 0.23 天，同时控制总症状严重程度、年龄、脑震荡史、精神病史和生物性别 （β = 0.23，p = 0.018）。 输入回归的所有其他变量均不具有统计显著性。

 结论

我们的数据表明，与 TSK 值低于 37 的运动员相比，TSK 评分高于 37 分的运动员在脑震荡后 72 小时内距离临床恢复的天数更长。与其他已知的恢复因素（包括总症状严重程度）相比，TSK 评分与临床恢复前的天数相关性最高。TSK 评分也是临床恢复前天数的最强预测指标。总的来说，这些发现表明医疗保健专业人员应考虑 TSK 评分，以帮助为患有脑震荡的大学生运动员提供有效的管理策略。