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Does the fear avoidance model explain persistent symptoms after traumatic brain injury?

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BACKGROUND: A minority of patients with mild traumatic brain injury (mTBI) experience a persistent symptom complex also known as post-concussion syndrome. Explanations for this syndrome are still lacking.

OBJECTIVE: To investigate if the fear avoidance model, including catastrophizing thoughts and fear avoidance behaviour, poses a possible biopsychosocial explanation for lingering symptoms and delay in recovery after traumatic brain injury (TBI) with special focus on mTBI.

DESIGN: Cross-sectional study.

PARTICIPANTS: 48 patients with TBI, of which 31 patients with mTBI, had persistent symptoms (mean time since injury 48.2 months); 92% of the entire sample fulfilled the criteria for post-concussion syndrome.

OUTCOME VARIABLES: catastrophizing, fear-avoidance, depression and post-concussion symptoms.

RESULTS: High levels of catastrophizing were found in 10% and high levels of fear avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour, depressive symptoms and post-concussion symptoms correlated significantly with each other (p < 0.05).

CONCLUSION: The fear-avoidance model proposes a possible explanation for persistent symptoms. Validation and normative data are needed for suitable measures of catastrophizing and fear avoidance of post-concussion symptoms after TBI. Longitudinal prospective cohort studies are needed to establish its causal and explanatory nature.

    Research areas

  • Journal Article, HEAD-INJURY, MUSCULOSKELETAL PAIN, Traumatic brain injury, DEPRESSION SCALE, CONCUSSION SYMPTOMS, Catastrophizing, chronic phase, HOSPITAL ANXIETY, POSTCONCUSSIVE SYMPTOMS, CHRONIC TINNITUS, MULTIPLE-SCLEROSIS, PAIN CATASTROPHIZING SCALE, CROSS-VALIDATION, fear avoidance behaviour, post concussional syndrome, persistent symptoms
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Original languageEnglish
Pages (from-to)1597–1604
Number of pages8
JournalBrain Injury
Issue number12
Early online date5 Oct 2017
Publication statusPublished - Oct 2017