Research Reports - Effects of fatigue, driving status, cognition, and depression on participation in adults with traumatic brain injury

Shannon B. Juengst , Candice L. Osborne , Kimberly S. Erler , and Ketki D. Raina

Physical Medicine and Rehabilitation. 2017; 1(1):4

Individuals with traumatic brain injury (TBI) often experience long-term participation
restrictions. Physical and cognitive function, depression, age, ability to drive, and fatigue
may contribute to participation restrictions post-TBI. The main objective of this study was
to examine whether the ability to drive and fatigue contribute to participation among
community-dwelling adults with TBI, after controlling for the age, cognition, and
depression. We also explored the effects of these factors in a subgroup of participants who
reporting clinically significant fatigue. This cross-sectional cohort study (n=64) included
adults with moderate to severe TBI, ranging from 6 months to 38 years post-injury.We
measured participation with the Participation Assessment with Recombined Tools, using
Rasch-adjusted scoring. We measured physical and cognitive fatigue with the Raschadjusted
scoring of the modified Fatigue Impact Scale. Participants self-identified their
ability to drive (Yes/No).Hierarchical linear regressions revealed that driving status
accounted for 4% of the variance in participation (F Δ=4.05, p=.049, R Δ=.038), and 1,59 fatigue accounted for 2% of the variance in participation (F Δ=1.77, p=.179, R Δ=.019), 1,57 after adjusting for age, depression, and cognition. The reverse was shown in the subgroup

with clinically significant fatigue (n=31); driving status accounted for only 1% of the
variance in participation (F Δ=0.71, p=.407, R Δ=.009), whereas fatigue accounted for 1,26 2
15% of the variance in participation (F Δ=3.91, p=.034, R Δ=.150). However, only physical 124 fatigue, not cognitive fatigue, was a statistically significant independent predictor of
participation. Depression, cognition, and ability to drive uniquely contributed to overall
participation post-TBI. Among those with significant fatigue, depression and physical
fatigue were the only significant predictors. The influence of personal and clinical factors
on participation post-TBI may differ based on clinical symptoms an individual is
experiencing. Personalized rehabilitation interventions selected based on clinical
symptoms and targeting these modifiable factors could improve participation and quality
of life for individuals with TBI.

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