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Psychological Contributions to Symptom Provocation Testing After Concussion.

Alex R Terpstra1, Dennis R Louie, Grant L Iverson

  • 1Departments of Psychology (Mr Terpstra, Ms Picon, and Dr Silverberg) and Physical Therapy (Dr Louie), University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada (Drs Louie and Silverberg); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Iverson); Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts (Dr Iverson); MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts (Dr Iverson); and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts (Dr Iverson); Department of Psychology, University of Calgary (Dr Yeates), Alberta Children's Hospital Research Institute (Dr Yeates), and Hotchkiss Brain Institute (Dr Yeates), Calgary, Alberta, Canada; and UBMD Orthopaedics and Sports Medicine, SUNY Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (Dr Leddy).

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Summary

Psychological factors like anxiety and catastrophizing may influence concussion symptom provocation test results, particularly for vestibular/oculomotor challenges. These findings suggest caution in interpreting test failures as solely indicative of brain injury.

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Area of Science:

  • Neuroscience
  • Psychology
  • Rehabilitation Medicine

Background:

  • Concussion can lead to persistent symptoms like headache and dizziness, which may worsen with exertion.
  • Standardized tests assess symptom increases after aerobic, cognitive, or vestibular/oculomotor challenges.
  • Psychological factors, including anxiety and misinterpretation of sensations, may contribute to symptom provocation outcomes.

Purpose of the Study:

  • To investigate the role of psychological factors in symptom provocation testing after concussion.
  • To determine if anxiety, catastrophizing, fear avoidance, or somatization influence symptom increases during standardized exertion tests.

Main Methods:

  • Adults (N=79) with persistent post-concussion symptoms completed questionnaires on psychological factors.
  • Participants underwent symptom provocation testing: aerobic (Buffalo Concussion Bike Test; BCBT), cognitive (NIHTB-CB), and vestibular/oculomotor (VOMS).
  • Primary outcomes were self-reported symptom changes during each test.

Main Results:

  • Anxiety, catastrophizing, fear avoidance, and somatization were associated with increased symptoms during the VOMS in univariate analyses.
  • These psychological variables did not significantly predict symptom change during the BCBT or NIHTB-CB.
  • Associations were not significant in a multivariable model including all covariates.

Conclusions:

  • Symptom provocation test failure may be influenced by psychological factors, not solely neurophysiological recovery.
  • Results suggest caution in interpreting VOMS outcomes, as they might reflect psychological maladjustment.
  • Further research is needed to differentiate between neurophysiological and psychological contributions to post-concussion symptoms.