Trajectories of Fatigue, Psychological Distress, and Coping Styles After Mild Traumatic Brain Injury: A 6-Month Prospective Cohort Study

Objective: To analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery tra-jectories and investigate influencing factors, including emotional distress and coping styles. Design: An observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and cop-ing at 2 weeks and 3 and 6 months postinjury. Setting: Three level 1 trauma centers. Participants: Patients with mild TBI (N=456). Interventions: Not applicable. Main Outcome Measures: Fatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25). Results: From the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%) and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavorable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%) and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often women and more often experiencing sleep disturbances and pain. Conclusions: The prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury based on the presence of high fatigue, high passive coping, and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of dis-ease-related processes over time. Archives of Physical Medicine and Rehabilitation 2021;102:1965-71 (c) 2021 The Authors. Published by Elsevier Inc. on behalf of The American Congress of Rehabilitation Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Automated summary

The study analyzed fatigue after mild traumatic brain injury (TBI) using latent class growth analysis (LCGA) to identify distinct recovery trajectories and investigate influencing factors. Results showed four patient clusters with different patterns of fatigue, emotional distress, and coping styles. Favorable recovery from posttraumatic fatigue was observed in 55% of mild TBI patients.