Keller Army Hospital, West Point, New York, USA.
Investigation performed at Keller Army Hospital, West Point, New York, USA.
Am J Sports Med. 2023 Sep;51(11):2996-3007. doi: 10.1177/03635465231189211. Epub 2023 Aug 8.
The endorsement of symptoms upon initiation of a graduated return-to-activity (GRTA) protocol has been associated with prolonged protocols. It is unclear whether there are specific symptom clusters affecting protocol durations.
To describe the endorsement of specific concussion symptom clusters at GRTA protocol initiation and examine the association between symptom cluster endorsement and GRTA protocol duration.
Cohort study; Level of evidence, 2.
This study was conducted among cadets enrolled at 3 US service academies. Participants completed an evaluation upon GRTA protocol initiation. Participants endorsing symptoms were binarized based on 6 symptom clusters (cognitive, emotional, insomnia, physical, sensitivity, and ungrouped). The primary outcome of interest was GRTA protocol duration based on symptom cluster endorsement severity. Prevalence rates were calculated to describe symptom cluster endorsement. Kaplan-Meier survival estimates and univariate and multivariable Cox proportional hazards regression models were calculated for all 6 symptom clusters to estimate GRTA protocol duration while controlling for significant covariates.
Data from 961 concussed participants were analyzed. Of these, 636 participants were asymptomatic upon GRTA protocol initiation. Among the 325 symptomatic participants, the physical symptom cluster (80%) was most endorsed, followed by the cognitive (29%), insomnia (23%), ungrouped (19%), sensitivity (15%), and emotional (9%) clusters. Univariate results revealed a significant association between endorsing cognitive (hazard ratio [HR], 0.79; = .001), physical (HR, 0.84; < .001), insomnia (HR, 0.83; = .013), sensitivity (HR, 0.70; < .001), and ungrouped (HR, 0.75; = .005) symptom clusters and GRTA protocol duration. Endorsing physical (HR, 0.84; < .001) and sensitivity (HR, 0.81; = .036) clusters maintained a significant association with GRTA protocol duration in the multivariable models.
Participants endorsing physical or sensitivity symptom clusters displayed GRTA protocols prolonged by 16% to 19% compared with participants not endorsing that respective cluster after controlling for significant covariates.
在启动分级重返活动（GRTA）方案时对症状的认可与延长方案有关。目前尚不清楚是否存在影响方案持续时间的特定症状群。
描述 GRTA 方案启动时特定脑震荡症状群的认可情况，并探讨症状群认可与 GRTA 方案持续时间之间的关系。
队列研究；证据水平，2 级。
本研究在美国 3 所军事院校的学员中进行。参与者在 GRTA 方案启动时完成评估。根据 6 个症状群（认知、情绪、失眠、身体、敏感和未分组）对有症状的参与者进行二分法。主要结局是根据症状群认可的严重程度来衡量 GRTA 方案的持续时间。计算患病率来描述症状群的认可情况。对所有 6 个症状群进行 Kaplan-Meier 生存估计和单变量及多变量 Cox 比例风险回归模型，以在控制重要协变量的情况下估计 GRTA 方案的持续时间。
分析了 961 名脑震荡参与者的数据。其中，636 名参与者在 GRTA 方案启动时无症状。在 325 名有症状的参与者中，身体症状群（80%）的认可程度最高，其次是认知（29%）、失眠（23%）、未分组（19%）、敏感（15%）和情绪（9%）症状群。单变量结果显示，认知（危险比[HR]，0.79；<.001）、身体（HR，0.84；<.001）、失眠（HR，0.83；=.013）、敏感（HR，0.70；<.001）和未分组（HR，0.75；=.005）症状群与 GRTA 方案的持续时间之间存在显著关联。在多变量模型中，身体（HR，0.84；<.001）和敏感（HR，0.81；=.036）症状群的认可仍与 GRTA 方案的持续时间显著相关。
在控制了重要的协变量后，与未认可相应症状群的参与者相比，认可身体或敏感症状群的参与者的 GRTA 方案延长了 16%至 19%。
