Fear-Avoidant Adults Have Worse Clinical Outcomes and Recovery Time After Concussion.

OBJECTIVE

To compare initial multidomain clinical outcomes and recovery time between fear-avoidant (FA) and nonfear-avoidant (NFA) adults after concussion.

DESIGN

Prospective cohort study.

SETTING

Specialty concussion clinic.

PARTICIPANTS

Adults aged 18 to 50 years within 30 days of a diagnosed concussion. Based on clinical cutoffs for the Fear Avoidance Components Scale at the initial clinic visit, participants were categorized into FA (41-100; moderate to severe) and NFA (0-40; none to mild) groups. A total of 74 participants (N=74) (M=28.7±8.4y, 68.9% women) were included, 37 (50.0%) in the FA and 37 (50.0%) in the NFA group.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: (1) Clinical intake and interview, (2) Fear Avoidance Components Scale, (3) Concussion Clinical Profiles Screening Tool (CP Screen), (4) Postconcussion Symptom Scale, (5) Immediate Postconcussion Assessment and Cognitive Testing, (6) Vestibular/Ocular Motor Screening (VOMS), (7) Generalized Anxiety Disorder 7-Item Assessment, (8) Patient Health Questionnaire-9, (9) Patient Health Questionnaire-15, and (10) Recovery Time (days to medical clearance).

RESULTS

There were no differences in demographics, medical history, or injury characteristics between groups. The FA group had worse CP Screen anxiety/mood (P=.04), cognitive (P=.04), and total symptoms (P=.04); Immediate Postconcussion Assessment and Cognitive Testing reaction time (P=.01); VOMS visual motion sensitivity (P=.03) and total VOMS (P=.04); Generalized Anxiety Disorder 7-Item Assessment (P<.01); and Patient Health Questionnaire-9 (P<.01) scores than the NFA group. Results from a Cox proportional hazards model demonstrated that the FA group had a 62% lower instantaneous recovery likelihood on any given day than the NFA group (hazard ratio=0.38; 95% confidence interval, 0.15-0.96; P=.04) while controlling for CP Screen total.

CONCLUSIONS

FA adults demonstrated worse concussion symptoms, reaction time, and vestibular impairments compared with NFA adults after concussion. Moreover, after controlling for initial symptom severity, FA adults took significantly longer to recover than NFA adults. Future research should explore potential mechanisms underlying the relationship between fear avoidance and poor outcomes, including reduced adherence to treatment recommendations.