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

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

Author information

1
a Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , the Netherlands.
2
b Limburg Brain Injury Centre , Limburg , The Netherlands.
3
c Department of Medical Psychology , Zuyderland Medical Centre , Sittard-Geleen , The Netherlands.
4
d Adelante, Centre of Expertise in Rehabilitation and Audiology , Hoensbroek , The Netherlands.
5
e Department of Rehabilitation Medicine, Research School CAPHRI , Maastricht University , Maastricht , The Netherlands.
6
f Monash-Epworth Rehabilitation Research Centre , Epworth Hospital , Richmond , Victoria , Australia.
7
g Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience , Maastricht University , Maastricht , The Netherlands.

Abstract

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.

KEYWORDS:

Catastrophizing; Traumatic brain injury; chronic phase; fear avoidance behaviour; persistent symptoms; post concussional syndrome

PMID:
28980825
DOI:
10.1080/02699052.2017.1366551
[Indexed for MEDLINE]

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