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Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury

Some people experience persistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI). A meaningful clinical classification and scientific progress are hampered by a lack of consensus regarding the phenomenology, assessment, and operationalization of PPCS. Here we demonstrate an...

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Autores principales: Karaliute, Migle, Saksvik, Simen B., Smevik, Hanne, Follestad, Turid, Einarsen, Cathrine, Vik, Anne, Håberg, Asta K., Iverson, Grant L., Skandsen, Toril, Olsen, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mary Ann Liebert, Inc., publishers 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8742292/
https://www.ncbi.nlm.nih.gov/pubmed/35018362
http://dx.doi.org/10.1089/neur.2021.0028
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author Karaliute, Migle
Saksvik, Simen B.
Smevik, Hanne
Follestad, Turid
Einarsen, Cathrine
Vik, Anne
Håberg, Asta K.
Iverson, Grant L.
Skandsen, Toril
Olsen, Alexander
author_facet Karaliute, Migle
Saksvik, Simen B.
Smevik, Hanne
Follestad, Turid
Einarsen, Cathrine
Vik, Anne
Håberg, Asta K.
Iverson, Grant L.
Skandsen, Toril
Olsen, Alexander
author_sort Karaliute, Migle
collection PubMed
description Some people experience persistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI). A meaningful clinical classification and scientific progress are hampered by a lack of consensus regarding the phenomenology, assessment, and operationalization of PPCS. Here we demonstrate and evaluate how the methodology used to assess and define persistent symptoms after mTBI influences PPCS as a binary outcome. We present empirical data from 15 classification methods reflecting procedures found in the literature and clinical practice. In total, 221 patients with mTBI, 73 patients with orthopedic injuries, and 77 community controls were included in the study. The prevalence rate of PPCS in the mTBI group varied between 10% and 47%, depending on the method used to assess and define unfavorable outcome. There was generally low positive agreement between the different methods; even the two methods yielding the most similar prevalence rates (89.2% overall proportion agreement) agreed on less than half (45.5% positive agreement) of the PPCS cases. Using a liberal but not uncommon threshold for symptom severity, there was a considerable misclassification rate of PPCS in both comparison groups. Our results highlight the importance for researchers to be aware of the limitations of using binary approaches for classification of PPCS. The poor agreement between methods should be considered when (1) interpreting the heterogeneity in the existing PPCS literature and (2) developing new improved methods. An empirically informed consensus regarding classification of PPCS should be a priority for the research community.
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spelling pubmed-87422922022-01-10 Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury Karaliute, Migle Saksvik, Simen B. Smevik, Hanne Follestad, Turid Einarsen, Cathrine Vik, Anne Håberg, Asta K. Iverson, Grant L. Skandsen, Toril Olsen, Alexander Neurotrauma Rep Original Article Some people experience persistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI). A meaningful clinical classification and scientific progress are hampered by a lack of consensus regarding the phenomenology, assessment, and operationalization of PPCS. Here we demonstrate and evaluate how the methodology used to assess and define persistent symptoms after mTBI influences PPCS as a binary outcome. We present empirical data from 15 classification methods reflecting procedures found in the literature and clinical practice. In total, 221 patients with mTBI, 73 patients with orthopedic injuries, and 77 community controls were included in the study. The prevalence rate of PPCS in the mTBI group varied between 10% and 47%, depending on the method used to assess and define unfavorable outcome. There was generally low positive agreement between the different methods; even the two methods yielding the most similar prevalence rates (89.2% overall proportion agreement) agreed on less than half (45.5% positive agreement) of the PPCS cases. Using a liberal but not uncommon threshold for symptom severity, there was a considerable misclassification rate of PPCS in both comparison groups. Our results highlight the importance for researchers to be aware of the limitations of using binary approaches for classification of PPCS. The poor agreement between methods should be considered when (1) interpreting the heterogeneity in the existing PPCS literature and (2) developing new improved methods. An empirically informed consensus regarding classification of PPCS should be a priority for the research community. Mary Ann Liebert, Inc., publishers 2021-12-13 /pmc/articles/PMC8742292/ /pubmed/35018362 http://dx.doi.org/10.1089/neur.2021.0028 Text en © Migle Karaliute et al., 2021; Published by Mary Ann Liebert, Inc. https://creativecommons.org/licenses/by/4.0/This Open Access article is distributed under the terms of the Creative Commons License [CC-BY] (http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Karaliute, Migle
Saksvik, Simen B.
Smevik, Hanne
Follestad, Turid
Einarsen, Cathrine
Vik, Anne
Håberg, Asta K.
Iverson, Grant L.
Skandsen, Toril
Olsen, Alexander
Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury
title Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury
title_full Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury
title_fullStr Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury
title_full_unstemmed Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury
title_short Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury
title_sort methodology matters: comparing approaches for defining persistent symptoms after mild traumatic brain injury
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8742292/
https://www.ncbi.nlm.nih.gov/pubmed/35018362
http://dx.doi.org/10.1089/neur.2021.0028
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