Relationship between competency in activities, injury severity, and post-concussion symptoms after traumatic brain injury

Abstract

Objective: To determine to what extent injury severity and post-concussion symptoms after 3 months predict ability in activities 12 months after traumatic brain injury (TBI) and assess the frequency of problems in daily activities. Methods: A one-year cohort of 63 persons with mild to severe TBI was assessed on admission, after three and 12 months. Injury severity was assessed using the Glasgow Coma Scale, Abbreviated Injury Scale for the head and Injury Severity Score. Post-concussion symptoms were reported using the Rivermead Post Concussion Symptoms Questionnaire after three months. The Patient Competency Rating Scale (PCRS), a self-rating scale of ability in activities, was applied 12 months post-injury. The PCRS consists of the domains interpersonal/emotional and cognitive competency, and instrumental ADL. Multiple backward regression models were performed with the three subscales of PCRS as dependent variables. Results: Activity problems at 12 months were related to perceived cognitive and interpersonal/emotional competency. Post-concussion symptoms reported at three-month follow-up were main predictors of cognitive and interpersonal/emotional competency at 12 months. Injury severity predicted only cognitive competency. Conclusion: Symptoms evolving after the trauma seem to be the strongest predictor of perceived ability in activities in this population. This underlines the need for follow-up after TBI to identify persons at risk of developing long-term activity limitations.

Key words::

• Activities of daily living
• competency
• functioning
• instrumental ADL
• post-concussion symptoms
• traumatic brain injury

Acknowledgements

The authors would like to thank all the participants in this study, Liv Bråthen, Cathrine Advocaat, Malin Mongs, and Inger Seip for helpful assistance with the registrations, and Terje Sprenger for stimulating discussions. They would also like to thank the staff at the Neurosurgical Department for their support during the inclusion period, and Susan Schanche for skilful help with the English language. The Norwegian Foundation for Health and Rehabilitation provided a grant for the study.