Investigation performed at the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Sports Med. 2022 Jul;50(8):2258-2270. doi: 10.1177/03635465221098112. Epub 2022 Jun 1.
There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited.
PURPOSE/HYPOTHESIS: To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery.
Cohort study; Level of evidence, 3.
Using SRC data from the Ivy League-Big Ten Epidemiology of Concussion Study among varsity athletes through February 2020, we identified the 4 affective symptoms from the Sport Concussion Assessment Tool symptom inventory. We modeled the relationship between a 4-category affective symptom variable and time to symptom resolution, RTP, and RTP progression, adjusting for nonaffective symptom prevalence and concussion history. Cox regressions were used to estimate hazard ratios for time to event outcomes, and linear regressions were used to evaluate mean differences for continuous outcomes.
Among 2077 student-athletes (men, 63.5%) with SRC symptoms, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%, respectively. When comparing women with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with affective symptoms, and women with nervous-anxious symptoms spent significantly longer in RTP progression. When comparing men with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms, and affective symptoms were not associated with time in RTP progression.
Student-athletes with affective symptoms and nervous-anxious symptoms exhibited delayed clinical recovery and RTP timelines, particularly for time in RTP. Symptom prevalence and concussion history contributed to this; however, unmeasured confounding remains, as indicated by the poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.
运动相关性脑震荡（SRC）后出现情感症状的运动员越来越受到关注和临床重视，因为这些症状可能会导致整体症状，并代表更长恢复时间的可改变风险因素。然而，其对整个重返赛场（RTP）轨迹的影响的证据，尤其是在女性和男性中，是有限的。
目的/假设：检查情绪症状报告与 SRC 后 Division 1 运动员队列中 RTP 进展之间的关系。我们假设，那些表现出情感症状的运动员，特别是神经焦虑症状，在 RTP 进展和恢复过程中花费的时间更多。
队列研究；证据水平，3 级。
利用常春藤联盟-十大联盟大学生脑震荡流行病学研究中 SRC 数据，对 2020 年 2 月前的校队运动员进行研究，我们从运动性脑震荡评估工具症状清单中确定了 4 种情感症状。我们对 4 类情感症状变量与症状缓解、RTP 和 RTP 进展之间的关系进行建模，同时调整了非情感症状的患病率和脑震荡史。使用 Cox 回归估计事件时间结果的风险比，使用线性回归评估连续结果的平均差异。
在 2077 名患有 SRC 症状的运动员（男性，63.5%）中，情感症状的患病率分别为女性和男性的 47.6%和 44.3%，神经焦虑的患病率分别为 24.2%和 22.5%。当比较女性运动员中是否存在共发情感症状时，那些共发情感症状的女性运动员的症状缓解和 RTP 率明显更低，而那些有神经焦虑症状的女性运动员在 RTP 进展中花费的时间明显更长。当比较男性运动员中是否存在共发情感症状时，那些共发情感症状的男性运动员的症状缓解和 RTP 率明显更低，而情感症状与 RTP 进展时间无关。
患有情感症状和神经焦虑症状的运动员表现出明显的临床恢复和 RTP 时间延迟，尤其是在 RTP 时间上。症状的患病率和脑震荡史促成了这一点；然而，由于模型拟合不佳，表明仍存在未测量的混杂因素。这项研究促使未来的工作探索情感症状和 RTP 时间轨迹，同时考虑随时间变化的焦虑和风险/保护因素。
