Trajectories of fear avoidance behavior and recovery after mild traumatic brain injury: Findings from the Toronto...

Fear avoidance behavior is associated with more severe postconcussion symptoms after mild traumatic brain injury (mTBI). However, it remains unclear when after injury fear avoidance behavior becomes a barrier to recovery. This study investigated changes in early fear avoidance behavior after mTBI and its associations with postconcussion symptoms.

Adults with concussion (N = 308) were prospectively recruited from an outpatient concussion clinic in Ontario, Canada. They completed measures assessing fear avoidance behavior (Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire) and postconcussion symptoms (Sport Concussion Assessment Tool-5) at Weeks 2 and 8 postinjury (N = 216).

Based on normative reference values, the two most common postconcussion trajectories of fear avoidance behavior were those with persistently low and those with initially elevated but decreasing fear avoidance behavior. Using linear regression, we found an interaction effect between fear avoidance behavior at Weeks 2 and 8, indicating that participants with persistently elevated fear avoidance behavior (at Weeks 2 and 8) had more severe postconcussion symptoms at Week 8, whereas participants with initially elevated but decreasing fear avoidance behavior tended to recover well.

Early fear avoidance behavior often decreases, but when it does not, it is associated with worse recovery from mTBI. These findings may inform the timing and design of interventions targeting fear avoidance behavior in patients with mTBI. (PsycInfo Database Record (c) 2026 APA, all rights reserved).