Resilience and recovery from sports related concussion in adolescents and young adults

ABSTRACT

Introduction

Recovery and return to play are important milestones for athletes who sustain sport-related concussions (SRC). Several factors have been shown to influence resolution of post-concussion related symptoms (PCS), but resilience, a trait that reflects the ability to overcome adversity, is another factor that may influence recovery. The aim of this study was to determine the relationship of resilience with resolution of symptoms during recovery in adolescents and young adults following SRC.

Method

This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N = 332) aged 13 to 25 years who sustained a SRC within 10 days of presenting to clinic were evaluated at two time points: initial clinical visit and three-month follow-up. Resilience was measured by the self-report Brief Resilience Survey (BRS) and PCS by the Sport Concussion Assessment Tool-5 Symptom Evaluation Post-Concussion Symptom Scale (PCSS). Recovery was determined by self-reported return to sports/physical activity and percent back to normal.

Results

Repeated measures ANCOVA and linear regression models showed that lower resilience ratings at initial visit were associated with a greater number and severity of PCSS symptoms along with higher levels of anxiety and depression symptoms during recovery from SRC. At three months, subjects with lower initial resilience ratings were less likely to report feeling back to normal and had greater aggravation of symptoms from physical and cognitive activity even when they had returned to sports/physical activity.

Conclusions

Lower resilience was associated with greater symptoms and delayed recovery from SRC. Results suggest that resilience may be another important factor to address in recovery from SRC. Future research is needed to examine the extent to which resilience measured after SRC reflects pre-injury characteristics and to better inform the development of interventions to promote resilience during recovery.

KEYWORDS:

• Concussion
• resilience
• symptoms
• recovery
• SCAT-5

Acknowledgments

The authors wish to thank the cooperating institutions in the North Texas Concussion Registry (ConTex): UT Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Children’s Medical Center Dallas, and Texas Health Resources. Assistance in the development of this manuscript was provided by Sarah Sprinkle, John J. Straub, and Henry H. Wang.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Statement of clinical relevance

This study found that low resilience was associated with higher post-concussion and emotional symptoms following SRC and should be considered at initial evaluation and when managing SRC recovery.

Additional information

Funding

The North Texas Concussion Registry (ConTex) was funded by a grant from the Texas Institute for Brain Injury and Repair (TIBIR), a state-funded initiative as part of the Peter J. O’Donnell Jr. Brain Institute at The University of Texas Southwestern Medical Center. Support for the use of REDCap came from the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105.