轻度创伤性脑损伤后伤前回忆偏差的本质及临床意义
The Nature and Clinical Significance of Preinjury Recall Bias Following Mild Traumatic Brain Injury.
作者信息
Silverberg Noah D, Iverson Grant L, Brubacher Jeffrey R, Holland Elizabeth, Hoshino Lisa Casagrande, Aquino Angela, Lange Rael T
机构信息
Division of Physical Medicine & Rehabilitation (Dr Silverberg), Department of Psychiatry (Drs Iverson and Lange), and Department of Emergency Medicine (Dr Brubacher), Department of Psychiatry, University of British Columbia (Ms Aquino), Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia, Canada (Dr Silverberg); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr Iverson); Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston (Dr Iverson); Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada (Ms Hoshino); Defense and Veterans Brain Injury Center & National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Lange). Ms Holland is in private practice at Victoria, British Columbia, Canada.
出版信息
J Head Trauma Rehabil. 2016 Nov/Dec;31(6):388-396. doi: 10.1097/HTR.0000000000000198.
OBJECTIVE
Patients with mild traumatic brain injury (MTBI) often underestimate their preinjury symptoms. This study aimed to clarify the mechanism underlying this recall bias and its contribution to MTBI outcome.
SETTING
Level I trauma center.
PARTICIPANTS
Patients with uncomplicated MTBI (N = 88) and orthopedic injury (N = 67).
DESIGN
Prospective longitudinal.
MAIN MEASURES
Current and retrospective ratings on the British Columbia Postconcussion Symptom Inventory, completed at 6 weeks and 1 year postinjury.
RESULTS
Preinjury symptom reporting was comparable across groups, static across time, and associated with compensation-seeking. High preinjury symptom reporting was related to high postinjury symptom reporting in the orthopedic injury group but less so in the MTBI group, indicating a stronger positive recall bias in highly symptomatic MTBI patients. Low preinjury symptom reporting was not a risk factor for poor MTBI outcome.
CONCLUSION
The recall bias was stronger and more likely clinically significant in MTBI patients with high postinjury symptoms. Multiple mechanisms appear to contribute to recall bias after MTBI, including the reattribution of preexisting symptoms to MTBI as well as processes that are not specific to MTBI (eg, related to compensation-seeking).
目的
轻度创伤性脑损伤（MTBI）患者常常低估其伤前症状。本研究旨在阐明这种回忆偏差背后的机制及其对MTBI预后的影响。
设置
一级创伤中心。
参与者
单纯性MTBI患者（N = 88）和骨科损伤患者（N = 67）。
设计
前瞻性纵向研究。
主要测量指标
在伤后6周和1年完成的关于不列颠哥伦比亚省脑震荡后症状量表的当前和回顾性评分。
结果
伤前症状报告在各组间具有可比性，随时间保持稳定，且与寻求赔偿相关。在骨科损伤组中，高伤前症状报告与高伤后症状报告相关，但在MTBI组中相关性较弱，这表明症状严重的MTBI患者存在更强的正向回忆偏差。低伤前症状报告并非MTBI预后不良的危险因素。
结论
在伤后症状严重的MTBI患者中，回忆偏差更强且更可能具有临床意义。MTBI后回忆偏差似乎由多种机制导致，包括将既往症状归因于MTBI以及一些并非MTBI特有的过程（如与寻求赔偿相关的过程）。
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