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Does the fear avoidance model explain persistent symptoms after traumatic brain injury?

Does the fear avoidance model explain persistent symptoms after traumatic brain injury?
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Wijenberg MLM, Stapert SZ, Verbunt JA, Ponsford JL, Van Heugten CM,


Wijenberg MLM, Stapert SZ, Verbunt JA, Ponsford JL, Van Heugten CM, (click to view)

Wijenberg MLM, Stapert SZ, Verbunt JA, Ponsford JL, Van Heugten CM,

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Brain injury 2017 10 05() 1-8 doi 10.1080/02699052.2017.1366551
Abstract
BACKGROUND
A minority of patients with mild traumatic brain injury (mTBI) experience a persistent symptom complex also known as post-concussion syndrome. Explanations for this syndrome are still lacking.

OBJECTIVE
To investigate if the fear avoidance model, including catastrophizing thoughts and fear avoidance behaviour, poses a possible biopsychosocial explanation for lingering symptoms and delay in recovery after traumatic brain injury (TBI) with special focus on mTBI.

DESIGN
Cross-sectional study.

PARTICIPANTS
48 patients with TBI, of which 31 patients with mTBI, had persistent symptoms (mean time since injury 48.2 months); 92% of the entire sample fulfilled the criteria for post-concussion syndrome.

OUTCOME VARIABLES
catastrophizing, fear-avoidance, depression and post-concussion symptoms.

RESULTS
High levels of catastrophizing were found in 10% and high levels of fear avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour, depressive symptoms and post-concussion symptoms correlated significantly with each other (p < 0.05). CONCLUSION
The fear-avoidance model proposes a possible explanation for persistent symptoms. Validation and normative data are needed for suitable measures of catastrophizing and fear avoidance of post-concussion symptoms after TBI. Longitudinal prospective cohort studies are needed to establish its causal and explanatory nature.

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