ABSTRACT
Objective: Fatigue is a common symptom following acquired brain injury although the severity and course differs for many individuals. This longitudinal study aimed to identify latent trajectory classes of fatigue and associated outcomes following mild brain injury.
Methods: 204 adults with mild traumatic brain injury (159; 78%) or minor stroke (45; 22%) were assessed 4 times over 1 year. Subjective measures of fatigue, anxiety, depression, cognitive complaints and societal participation were collected. Multivariate Latent Class Growth Analysis identified classes of participants with similar longitudinal patterns. Demographic and injury characteristics were used to predict class membership.
Results: Analysis revealed four classes. Class 1 (53%) had mild, decreasing fatigue with no other problems. Class 2 (29%) experienced high persistent fatigue, moderate cognitive complaints and societal participation problems. Class 3 (11%) had high persistent fatigue with anxiety, depression, cognitive complaints and participation problems. Class 4 (7%) experienced decreasing fatigue with anxiety and depression but no cognitive or participation problems. Women and older individuals were more likely to be in class 2.
Conclusion: Half the participants had a favourable outcome while the remaining classes were characterised by persistent fatigue with cognitive complaints (class 2), decreasing fatigue with mood problems (class 4) or fatigue with both cognitive and mood problems (class 3). Fatigue treatment should target combinations of problems in such individual trajectories after mild brain injury.
REFERENCES
Norrie J, Heitger M, Leathem J, Anderson T, Jones R, Flett R. Mild traumatic brain injury and fatigue: a prospective longitudinal study. Brain Inj 2010; 24: 1528-1538. DOI: 10.3109/02699052.2010.531687
https://doi.org/10.3109/02699052.2010.531687 DOI: https://doi.org/10.3109/02699052.2010.531687
Ramírez-Moreno JM, Muñoz-Vega P, Alberca SB, Peral-Pacheco D. Health-related quality of life and fatigue after transient ischemic attack and minor stroke. J Stroke Cerebrovasc Dis 2019; 28: 276-284.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.046 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.046
Ahman S, Saveman BI, Styrke J, Bjornstig U, Stalnacke BM. Long-term follow-up of patients with mild traumatic brain injury: a mixed-method study. J Rehabil Med 2013; 45: 758-764. DOI: 10.2340/16501977-1182
https://doi.org/10.2340/16501977-1182 DOI: https://doi.org/10.2340/16501977-1182
Radman N, Staub F, Aboulafia-Brakha T, Berney A, Bogousslavsky J, Annoni J-M. Poststroke fatigue following minor infarcts: a prospective study. Neurology 2012; 79: 1422-1427.
https://doi.org/10.1212/WNL.0b013e31826d5f3a DOI: https://doi.org/10.1212/WNL.0b013e31826d5f3a
Rakers SE, Timmerman ME, Scheenen ME, De Koning ME, Van Der Horn HJ, Van Der Naalt J, et al. Trajectories of fatigue, psychological distress, and coping styles after mild traumatic brain injury: a 6-month prospective cohort study. Arch Phys Med Rehabil 2021; 102: 1965-1971.e1962. DOI: 10.1016/j.apmr.2021.06.004
https://doi.org/10.1016/j.apmr.2021.06.004 DOI: https://doi.org/10.1016/j.apmr.2021.06.004
Beaulieu-Bonneau S, Ouellet M-C. Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates. Neuropsychol Rehabil 2017; 27: 983-1001.
https://doi.org/10.1080/09602011.2016.1162176 DOI: https://doi.org/10.1080/09602011.2016.1162176
Ezekiel L, Field L, Collett J, Dawes H, Boulton M. Experiences of fatigue in daily life of people with acquired brain injury: a qualitative study. Disabil Rehabil 2021; 43: 2866-2874. DOI: 10.1080/09638288.2020.1720318
https://doi.org/10.1080/09638288.2020.1720318 DOI: https://doi.org/10.1080/09638288.2020.1720318
Verberne DPJ, Ponds R, Kroese M, Wijenberg MLM, Barten DG, Pasmans R, et al. Long-term psychosocial outcome following mild traumatic brain injury and minor stroke: a direct longitudinal comparison. J Neurol 2021; 268: 2132-2140. DOI: 10.1007/s00415-020-10385-6
https://doi.org/10.1007/s00415-020-10385-6 DOI: https://doi.org/10.1007/s00415-020-10385-6
Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; Suppl 43: 113-125. DOI: 10.1080/16501960410023877
https://doi.org/10.1080/16501960410023877 DOI: https://doi.org/10.1080/16501960410023877
Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20: 864-870. DOI: 10.1161/01.str.20.7.864
https://doi.org/10.1161/01.STR.20.7.864 DOI: https://doi.org/10.1161/01.STR.20.7.864
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121-1123.
https://doi.org/10.1001/archneur.1989.00520460115022 DOI: https://doi.org/10.1001/archneur.1989.00520460115022
Lerdal A, Kottorp A. Psychometric properties of the Fatigue Severity Scale: Rasch analyses of individual responses in a Norwegian stroke cohort. Int J Nurs Stud 2011; 48: 1258-1265.
https://doi.org/10.1016/j.ijnurstu.2011.02.019 DOI: https://doi.org/10.1016/j.ijnurstu.2011.02.019
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002; 52: 69-77.
https://doi.org/10.1016/S0022-3999(01)00296-3 DOI: https://doi.org/10.1016/S0022-3999(01)00296-3
van Heugten C, Rasquin S, Winkens I, Beusmans G, Verhey F. Checklist for cognitive and emotional consequences following stroke (CLCE-24): development, usability and quality of the self-report version. Clin Neurol Neurosurg 2007; 109: 257-262.
https://doi.org/10.1016/j.clineuro.2006.10.002 DOI: https://doi.org/10.1016/j.clineuro.2006.10.002
Post MW, van der Zee CH, Hennink J, Schafrat CG, Visser-Meily JM, van Berlekom SB. Validity of the Utrecht scale for evaluation of rehabilitation-participation. Disabil Rehabil 2012; 34: 478-485.
https://doi.org/10.3109/09638288.2011.608148 DOI: https://doi.org/10.3109/09638288.2011.608148
van der Zee CH, Visser-Meily JM, Lindeman E, Jaap Kappelle L, Post MW. Participation in the chronic phase of stroke. Top Stroke Rehabil 2013; 20: 52-61.
https://doi.org/10.1310/tsr2001-52 DOI: https://doi.org/10.1310/tsr2001-52
Mol TI, van Bennekom CA, Schepers VP, Ter Hoeve N, Kruitwagen-van Reenen ET, Visser-Meily JM, et al. Differences in societal participation across diagnostic groups: secondary analyses of 8 studies using the Utrecht scale for evaluation of rehabilitation-participation. Arch Phys Med Rehabil 2021; 102: 1735-1745.
https://doi.org/10.1016/j.apmr.2021.02.024 DOI: https://doi.org/10.1016/j.apmr.2021.02.024
Muthén LK, Muthén BO. Mplus user’s guide v. 8 ed. Los Angeles, CA: Muthén & Muthén; 1998-2017.
Wedel M. Concomitant variables in finite mixture models. Statistica Neerlandica 2002; 56: 362-375.
https://doi.org/10.1111/1467-9574.t01-1-00072 DOI: https://doi.org/10.1111/1467-9574.t01-1-00072
Eriksson G, Tham K, Borg J. Occupational gaps in everyday life 1-4 years after acquired brain injury. J Rehabil Med 2006; 38: 159-165.
https://doi.org/10.1080/16501970500415322 DOI: https://doi.org/10.1080/16501970500415322
Andelic N, Røe C, Brunborg C, Zeldovich M, Løvstad M, Løke D, et al. Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study. J Neurology 2021; 268: 61-73. DOI: 10.1007/s00415-020-10022-2
https://doi.org/10.1007/s00415-020-10022-2 DOI: https://doi.org/10.1007/s00415-020-10022-2
Mikolić A, van Klaveren D, Groeniger JO, Wiegers EJ, Lingsma HF, Zeldovich M, et al. Differences between men and women in treatment and outcome after traumatic brain injury. J Neurotrauma 2021; 38: 235-251.
https://doi.org/10.1089/neu.2021.0116 DOI: https://doi.org/10.1089/neu.2021.0116
de Freitas Cardoso MG, Faleiro RM, De Paula JJ, Kummer A, Caramelli P, Teixeira AL, et al. Cognitive impairment following acute mild traumatic brain injury. Front Neurol 2019; 10: 198.
https://doi.org/10.3389/fneur.2019.00198 DOI: https://doi.org/10.3389/fneur.2019.00198
Fraser EE, Downing MG, Biernacki K, McKenzie DP, Ponsford JL. Cognitive reserve and age predict cognitive recovery after mild to severe traumatic brain injury. J Neurotrauma 2019; 36: 2753-2761.
https://doi.org/10.1089/neu.2019.6430 DOI: https://doi.org/10.1089/neu.2019.6430
Desrosiers J, Noreau L, Rochette A, Bourbonnais D, Bravo G, Bourget A. Predictors of long-term participation after stroke. Disabil Rehabil 2006; 28: 221-230.
https://doi.org/10.1080/09638280500158372 DOI: https://doi.org/10.1080/09638280500158372
de Graaf JA, van Mierlo ML, Post MW, Achterberg WP, Kappelle LJ, Visser-Meily JM. Long-term restrictions in participation in stroke survivors under and over 70 years of age. Disabil Rehabil 2018; 40: 637-645.
https://doi.org/10.1080/09638288.2016.1271466 DOI: https://doi.org/10.1080/09638288.2016.1271466
Billones R, Liwang JK, Butler K, Graves L, Saligan LN. Dissecting the fatigue experience: a scoping review of fatigue definitions, dimensions, and measures in non-oncologic medical conditions. Brain Behav Immun Health 2021; 15: 100266.
https://doi.org/10.1016/j.bbih.2021.100266 DOI: https://doi.org/10.1016/j.bbih.2021.100266
Visser-Keizer AC, Hogenkamp A, Westerhof-Evers HJ, Egberink IJ, Spikman JM. Dutch multifactor fatigue scale: a new scale to measure the different aspects of fatigue after acquired brain injury. Arch Phys Med Rehabil 2015; 96: 1056-1063.
https://doi.org/10.1016/j.apmr.2014.12.010 DOI: https://doi.org/10.1016/j.apmr.2014.12.010
Lanctôt KL, Lindsay MP, Smith EE, Sahlas DJ, Foley N, Gubitz G, et al. Canadian stroke best practice recommendations: mood, cognition and fatigue following stroke, update 2019. Int J Stroke 2020; 15: 668-688.
https://doi.org/10.1177/1747493019847334 DOI: https://doi.org/10.1177/1747493019847334
Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M. Living concussion guidelines: guideline for concussion & prolonged symptoms for adults 18 years of age or older. 2023. Available from: https://concussionsontario.org.
Königs M, Beurskens EA, Snoep L, Scherder EJ, Oosterlaan J. Effects of timing and intensity of neurorehabilitation on functional outcome after traumatic brain injury: a systematic review and meta-analysis. Arch Phys Med Rehabil 2018; 99: 1149-1159.e1141.
https://doi.org/10.1016/j.apmr.2018.01.013 DOI: https://doi.org/10.1016/j.apmr.2018.01.013
Coleman ER, Moudgal R, Lang K, Hyacinth HI, Awosika OO, Kissela BM, et al. Early rehabilitation after stroke: a narrative review. Curr Atheroscler Rep 2017; 19: 1-12.
https://doi.org/10.1007/s11883-017-0686-6 DOI: https://doi.org/10.1007/s11883-017-0686-6
TBI Rehabilitation 