Hierarchical clustering of prolonged post-concussive symptoms after 12 months: symptom-centric analysis and association with functional impairments.
Ali Alim-Marvasti, Narayan Kuleindiren, Federico Tiersen and 5 others
PMID 36529935WHAT IT FOUND
Mild sleep and fatigue symptoms were associated with the most functional impairments, including trouble with conversations and appointments.
Moderate-to-severe cognitive symptoms were linked to the greatest number of deficits. Screening for sleep issues is a priority even when symptoms are mild.
Key findings
01At mild severity levels, the sleep-fatigue symptom cluster was associated with the greatest number of functional impairments compared to other clusters.
02At moderate-to-severe levels, the cognitive symptom cluster (forgetfulness, concentration, processing speed) was associated with the most functional impairments.
03Participants reporting any functional impairment had significantly higher total post-concussion symptom scores than those reporting none.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used a convenience sample from a smartphone app, which likely selected for individuals worried about cognitive repercussions, potentially biasing the population toward more symptomatic or anxious patients. All data, including concussion history and symptoms, were self-reported without verification of injury severity or timing. The functional impairment questionnaire was bespoke and not previously validated. As an observational study, it cannot establish causality between symptom clusters and functional impairments. The 12-month cutoff for 'prolonged' symptoms differs from the standard 3-month definition of persistent post-concussion syndrome, limiting comparability with some other studies.
Declared interests
The study was funded by Mindset Technologies, the developer of the smartphone application used for data collection. All authors are employees or have been employees of Mindset Technologies. The company designed the app and collected the data but did not analyze the study or write the manuscript.
The easy way to misread this
Do not assume that cognitive symptoms are the primary driver of disability in all patients with prolonged post-concussion symptoms. This study found that mild sleep and fatigue symptoms were associated with more functional impairments than mild cognitive symptoms. Attributing all daily life difficulties to cognition may lead to overlooking treatable sleep disturbances.