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Concussion in the Wild: Clinical Utility of Ambulatory Assessment of Symptoms and Everyday Exposures in Adolescents and Adults with Concussion
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DOI：10.1093/arclin/acaf111.png)
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Abstract
En 中文
Objective To describe the degree of correspondence between ecological momentary assessment (EMA) symptom ratings and cognitive performance derived from the Mobile Neurocognitive Health Project (MNCH) and clinic-based standard-of-care assessments in adolescents and adults with concussion. Environmental exposures, avoidance behavior, and symptom reactivity data were documented, and the clinical utility of the MNCH protocol for predicting protracted recovery was examined.Method 89 patients (13-25 yrs) with concussion enrolled in the MNCH study on their smartphones within one week of injury. Participants completed four brief surveys per day for a 7-day period. The surveys included assessments of environmental exposures, avoidance of symptom-provoking environments, symptom ratings, ultra-brief performance-based cognitive assessments, and ratings of symptom reactivity to the surveys and cognitive assessments. The primary criteria used for determining the utility of EMA-based data were the degree of correspondence with in-clinic symptom ratings and cognitive performance, and the ability of EMA-based measures to predict risk for protracted recovery.Results Symptom scores and cognitive performance outcomes obtained via EMA were significantly associated with in-clinic symptom ratings (PCSS) and computerized neurocognitive testing (ImPACT). Multiple logistic modeling results indicated that EMA total symptom scores were stronger predictors of protracted recovery than in-clinic symptom ratings. Additionally, ratings of avoidance behavior and reactivity to the EMA surveys and assessments were significantly associated with protracted recovery.Conclusions Valid estimates of concussion symptoms may be obtained via remote, unsupervised, high-frequency assessment. In addition to EMA-based symptom scores, avoidance behavior and symptom reactivity may yield prognostic information about risk for protracted recovery.
Keywords:
Ecological momentary assessment
Concussion
Cognitive function
Post-concussion symptoms
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