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Trajectories of Fatigue, Psychological Distress, and Coping Styles After Mild Traumatic Brain Injury: A 6-Month Prospective Cohort Study

ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION(2021)

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Abstract
Objective: To analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery tra-jectories and investigate influencing factors, including emotional distress and coping styles. Design: An observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and cop-ing at 2 weeks and 3 and 6 months postinjury. Setting: Three level 1 trauma centers. Participants: Patients with mild TBI (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 score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25). Results: From the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable 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 unfavorable 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 women and more often experiencing sleep disturbances and pain. Conclusions: The prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury 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 dis-ease-related processes over time. Archives of Physical Medicine and Rehabilitation 2021;102:1965-71 (c) 2021 The Authors. Published by Elsevier Inc. on behalf of The American Congress of Rehabilitation Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
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Key words
Brain concussion,Fatigue,Psychological distress,Rehabilitation,Traumatic brain injury
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