Research Reports - Does the fear avoidance model explain persistent symptoms after traumatic brain injury?

Brain Inj. 2017;31(12):1597-1604. doi: 10.1080/02699052.2017.1366551. Epub 2017
Oct 5.

Wijenberg MLM(1)(2), Stapert SZ(1)(3), Verbunt JA(4), Ponsford JL(5)(6), Van
Heugten CM(1)(2)(7).

BACKGROUND: A minority of patients with mild traumatic brain injury (mTBI)
experience a persistent symptom complex also known as post-concussion syndrome.
Explanations for this syndrome are still lacking.
OBJECTIVE: To investigate if the fear avoidance model, including catastrophizing
thoughts and fear avoidance behaviour, poses a possible biopsychosocial
explanation for lingering symptoms and delay in recovery after traumatic brain
injury (TBI) with special focus on mTBI.
DESIGN: Cross-sectional study.
PARTICIPANTS: 48 patients with TBI, of which 31 patients with mTBI, had
persistent symptoms (mean time since injury 48.2 months); 92% of the entire
sample fulfilled the criteria for post-concussion syndrome.
OUTCOME VARIABLES: catastrophizing, fear-avoidance, depression and
post-concussion symptoms.
RESULTS: High levels of catastrophizing were found in 10% and high levels of fear
avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour,
depressive symptoms and post-concussion symptoms correlated significantly with
each other (p < 0.05).
CONCLUSION: The fear-avoidance model proposes a possible explanation for
persistent symptoms. Validation and normative data are needed for suitable
measures of catastrophizing and fear avoidance of post-concussion symptoms after
TBI. Longitudinal prospective cohort studies are needed to establish its causal
and explanatory nature. 

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