Variability in daily self-reported emotional symptoms and fatigue measured over eight weeks in community dwelling individuals with traumatic brain injury

ABSTRACT

Objective: To investigate within-person variability in daily self-reported emotional and fatigue symptoms and factors associated with high within-person variability among individuals with chronic traumatic brain injury (TBI).

Design: This was a prospective descriptive pilot study of n = 18 adults with chronic TBI (2–27 years post-injury) who owned and could independently use an Apple or Android device.

Methods: Participants completed daily assessments for 8 weeks via smartphone. Outcome measures included the Positive and Negative Affect Schedule, Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, and a 7-point fatigue rating. We examined within-person variability over time using individual Multilevel Linear Models. We categorized within-person variability as High or Low based on individual standard deviations in relationship to sample standard deviation.

Results: Significant temporal within-person variability occurred for all measures. High variability was associated with more symptom reporting versus Low variability, and variability was associated with sex (High variability: 88% women; Low variability 90% men).

Conclusions: Symptom measurement at a single time point among adults with chronic TBI may not capture day-to-day symptom fluctuation and may misidentify individuals in need of intervention. Assessing symptom profiles over time to capture temporal and individual variability may provide a more ecologically valid measure for managing long-term symptoms after TBI.

KEYWORDS:

• Traumatic brain injury
• emotions
• fatigue
• smartphone
• ecological momentary assessment

Disclosure Statement

The authors report no conflicts of interest. This manuscript was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research under Grant #90DP0041.

Additional information

Funding

The National Institute on Disability, Independent Living, and Rehabilitation Research under Grant 90DP0041 supported this work.

Notes on contributors

Shannon B. Juengst

Shannon B. Juengst, PhD, CRC is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at the UT Southwestern. She has over 15 years of experience in research, with extensive training in research design and methodology, advanced statistics, clinical trials design, and psychometric development and evaluation in health care research. Dr. Juengst’s research focuses on behavioral and emotional outcomes of traumatic brain injury, investigating biopsychosocial relationships, innovative telehealth methods, and evidence-based interventions. Her broader research agenda is to situate behavior and emotion at the center of the bench to bedside to community program of research and to investigate behavior and emotion as a modifiable targets, between neurological injury and community integration, for rehabilitation intervention.

Lauren Terhorst

Lauren Terhorst, PhD, is a doctoral-prepared statistician and methodological consultant with over 10 years of research experience who has served on several NIH funded grants as a co-investigator and statistician. She has also collaborated with many researchers in the health sciences to produce peer-reviewed presentations and publications. Dr. Terhorst’s research interests include but are not limited to psychometric analyses, linear mixed models, regression analyses, and ecological momentary assessment.

Chung Lin Kew

Chung Lin Kew is a Master’s in Clinical Rehabilitation Counseling candidate at UT Southwestern, slated to graduate in the Summer of 2019.  Novelle has worked with Dr. Juengst on research related to symptom measurement after TBI and self-management interventions for care partners of adults with acquired disabilities.

Amy K. Wagner

Amy K. Wagner, MD, is a a physiatry trained physician scientist with transdisciplinary research that spans from experimental models to clinical care and to the community. Her work seeks to identify a better understanding of the neurobiology of TBI recovery and TBI rehabilitation strategies. She developed the concept of Rehabilomics, or to the collection and study of rehabilitation relevant outcomes, in conjunction with a transdisciplinary evaluation of biomarkers, in order to better understand the biology, function, prognosis, complications, treatments, adaptation, and recovery for persons with disabilities.