Exploring Heterogeneity of Stepped Collaborative Care Treatment Response Trajectories after Adolescent Sports Injury Concussion.
Exploring Heterogeneity of Stepped Collaborative Care Treatment Response Trajectories after Adolescent Sports Injury Concussion.
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DOI：
10.1080/00332747.2021.2004784
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发表时间：
2022
影响因子：
2.4
通讯作者：
Zatzick, Douglas F.
中科院分区：
文献类型：
--
作者：
Hilt, Robert J.;McCarty, Carolyn A.;Rivara, Frederick P.;Wang, Jin;Marcynyszyn, Lyscha A.;Chrisman, Sara P. D.;Johnson, Ashleigh M.;Zatzick, Douglas F.
很少有创伤后干预的临床试验利用症状轨迹模型来探索治疗反应的异质性。本调查的目的是对一项随机临床试验进行二次分析，该试验对患有运动和娱乐相关脑震荡且持续症状超过 1 个月的青少年进行阶梯式协作护理。轨迹模型用于检查随机化对干预措施的影响以及人口、临床和损伤特征对青少年脑震荡后症状轨迹的影响。 200 名男性和女性青少年在脑震荡后 1 个月内接受了评估，并在 3、6 和 12 个月后使用脑震荡症状的标准化指标——健康和行为量表 (HBI) 进行了评估。使用多项逻辑回归来比较干预、人口统计、临床和损伤特征与轨迹组成员资格之间的关联。出现了四种脑震荡后症状轨迹：恢复、缓解、低持续性和高持续性。在调整后的分析中，干预条件的随机化与 HBI 恢复轨迹组成员资格的几率显着增加相关（OR 3.29 95% CI 1.06–10.28）。相对于所有其他轨迹，女性性别和既往脑震荡史与高持续轨迹组成员资格的几率显着较高相关。对于受伤前有焦虑和/或抑郁症史的青少年，观察到高持续组轨迹成员资格与恢复组轨迹成员资格的几率更大。与高持续性脑震荡后症状轨迹相比，逐步协作护理与恢复几率增加相关，而易于识别的基线特征与高持续性症状相关。未来的脑震荡后临床试验和实践改进工作可以纳入这些观察结果。
Few clinical trials of posttraumatic interventions have utilized symptom trajectory modeling to explore heterogeneity of treatment responses. The goal of this investigation was to conduct a secondary analysis of a randomized clinical trial of stepped collaborative care for adolescents with sports and recreational related concussion and persistent symptoms of >1 month. Trajectory modeling was used to examine the impact of randomization to the intervention as well as demographic, clinical, and injury characteristics on adolescent post-concussive symptom trajectories. Two hundred male and female adolescents were assessed >1 month after a concussion, and then 3-, 6- and 12-months later with a standardized measure of concussive symptoms, the Health and Behavior Inventory (HBI). Multinomial logistic regression was used to compare the association between intervention, demographic, clinical and injury characteristics with trajectory group membership. Four post-concussive symptom trajectories emerged: recovery, remitting, low-persistent, and high-persistent. In adjusted analyses randomization to the intervention condition was associated with significantly greater odds of HBI recovery trajectory group membership (OR 3.29 95% CI 1.06–10.28). Female gender and prior concussion history were associated with significantly greater odds of high-persistent trajectory group membership relative to all other trajectories. Greater odds of high-persistent versus recovery group trajectory membership was observed for adolescents with a pre-injury history of anxiety and/or depressive disorders. Stepped collaborative care was associated with an increased odds of recovery versus high-persistent post-concussive symptom trajectories, while readily identifiable baseline characteristics were associated high-persistent symptoms. Future post-concussive clinical trials and practice improvement efforts could incorporate these observations.
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