MedicalResearch.com Interview with:
Kelly Russell PhD
Department of Pediatrics and Child Health
University of Manitoba
MedicalResearch.com: What is the background for this study?
Response: Health-related quality of life (HRQOL) is an important patient-reported outcome that measures the patient’s perception on how their condition effects various aspects of their life, such as their physical, emotional, social and school quality of life. HRQOL can measure the more subtle or hidden consequences of a condition, such as concussion. Patient reported outcomes are important because they give a more complete picture of the patient’s condition than just reporting symptoms or outcomes that are only measured by their clinician. We wanted to compare the effects of sport-related concussions versus sport-related limb fractures on HRQOL in adolescents after their injury and during their recovery.
We chose to compare adolescents with sport-related concussions to a sport-related limb fracture group because we wanted to be able to attribute the results to having a concussion since not being able to play sports with their friends and teammates may decrease HRQOL regardless of the actual type of injury. We also wanted to identify which clinical variables were associated with worse HRQOL in adolescent patients with sports-related concussion.
MedicalResearch.com: What are the main findings?
Response: We included 135 adolescents with a sport-related concussion and 96 with a sport-related limb fracture. At their initial clinical appointment (approximately one week after their injury), those with a concussion had significantly lower cognitive functioning, school, and overall HRQOL than those with a fractured limb. The physical, emotional, and social HRQOL was similar between the two groups. For the adolescents with a concussion, history of a previous concussion and higher symptom burden predicted lower HRQOL at their initial clinical appointment.
With the exception of adolescents with a fractured limb who still reported lower physical HRQOL than health norms at physician documented clinical recovery, all other indicators of HRQOL among both concussion and extremity limb fracture groups was similar to normative data collected among healthy adolescents. There were 51 (38%) adolescents who experienced delayed physician-documented clinical recovery and took longer than 28 days to recover from their concussion. Adolescents with a concussion who recovered within 28 days recovered significantly faster than those with a limb fracture (17 days versus 31 days). However, those with a concussion and recovered after than 28 days took significantly more days to achieve physician-documented clinical recovery than those with an limb fracture (51 days versus 31 days).
MedicalResearch.com: What should readers take away from your report?
Response: Adolescents who sustain a concussion experience significantly greater impairments in cognitive, school, and overall HRQOL approximately one week after injury than those who fracture a limb. There is greater impairment in HRQOL for those with a concussion if they have had a previous concussion or report a greater symptom burden. However, there was no evidence of persistent impairments in HRQOL among adolescents with a concussion who were followed to physician-documented clinical recovery. Clinicians could ask their patients to report their HRQOL at their initial visit and this would assist them in predicting if their patients will take longer to recover.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Important areas for concussion-related HRQOL research remain, such as determining if there are additional subsets of adolescents who have greater impairments in HRQOL. For example, future research could determine if boys and girls have similar HRQOL experiences or if certain clinico-pathological features result in greater HRQOL impairments. Also, future work could examine if early multi-disciplinary targeted rehabilitation interventions improve the HRQOL of adolescents recovering from a concussion.
Russell K, Selci E, Black B, Ellis MJ: Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study. Journal of Neurosurgery: Pediatrics, published online, ahead of print, January 15, 2019;
DOI: 10.3171/2018.8.PEDS18356. (http://www.thejns.org/doi/full/10.3171/2018.8.PEDS18356)
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