Related Experiment Video
Updated: Jan 15, 2026
11:32
A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
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Fear-Avoidant Adults Have Worse Clinical Outcomes and Recovery Time After Concussion
Alicia M Trbovich1, Aaron J Zynda1, Anne Mucha2
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, PA.
Archives of Physical Medicine and Rehabilitation
|October 6, 2025
Summary
Fear-avoidant adults experience worse concussion symptoms and take longer to recover than non-fear-avoidant adults. This study highlights the impact of fear avoidance on concussion recovery timelines and outcomes.
Area of Science:
- Neuroscience
- Psychology
- Sports Medicine
Background:
- Concussion recovery can be influenced by psychological factors.
- Fear avoidance is a potential barrier to recovery after mild traumatic brain injury.
Purpose of the Study:
- To compare clinical outcomes and recovery duration between fear-avoidant (FA) and non-fear-avoidant (NFA) adults post-concussion.
- To investigate the impact of fear avoidance on multidomain concussion symptoms and recovery time.
Main Methods:
- Prospective cohort study of 74 adults (18-50 years) diagnosed with concussion within 30 days.
- Participants categorized into FA (moderate to severe fear avoidance) and NFA (none to mild fear avoidance) groups using the Fear Avoidance Components Scale.
- Assessed initial clinical outcomes using multiple validated tools including the CP Screen, Immediate Postconcussion Assessment and Cognitive Testing, and VOMS; recovery time measured by days to medical clearance.
Main Results:
- The FA group exhibited significantly worse scores in anxiety/mood, cognitive function, and overall symptoms (CP Screen).
- FA participants showed poorer reaction time (Immediate Postconcussion Assessment and Cognitive Testing) and increased vestibular/ocular motor screening (VOMS) impairments.
- Fear avoidance was associated with higher anxiety (GAD-7) and depressive symptoms (PHQ-9); FA adults had a 62% lower likelihood of daily recovery compared to NFA adults.
Conclusions:
- Fear-avoidant adults present with more severe concussion symptoms, cognitive deficits, and vestibular issues.
- Fear avoidance significantly prolongs concussion recovery time, even after accounting for initial symptom severity.
- Further research is needed to understand the mechanisms linking fear avoidance to poor concussion outcomes, potentially including treatment adherence.
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