The impact of persistent post-concussion symptoms and exercise intolerance on patient-specific functioning after mild traumatic brain injury – a biopsychosocial perspective

Ingerid Kleffelgård, Lars-Johan Viddal Valaas, Nada Andelic, Sophie Steenstrup, Helene Lundgaard Soberg, Mari Storli Rasmussen
Purpose:

The primary purpose of this study was to explore activity limitations perceived by patients with PPCS and exercise intolerance after sustaining mTBI. The secondary purpose was to link activity limitations reported on the Patient-Specific Functional Scale (PSFS) to the International Classification of Functioning, Disability and Health (ICF) to describe the activity limitations in a biopsychosocial context.

Methods:

This is a cross-sectional study. We included 81 patients diagnosed with mTBI, PPCS and exercise intolerance at a mean of 7 (SD 3.7) months post-injury. The mean age was 35.8 (SD 10.6) years, and 47 (58%) were female.  The PSFS was used as an interview to identify activity limitations and rate the difficulty of performing the activities on a numeric rating scale (NRS) ranging from 0=unable to perform the activity to 10=able to perform activity at the same level as before injury. Systematic text condensation was used to categorize the activities which subsequently were linked to the ICF to construct a biopsychosocial perspective on patient specific activity limitations.  



Results:

The 81 patients nominated 389 activities that were coded into 6 activity related main categories: Physical activity and exercise (31.4%); activities related to cognition and energy functions (15.9%); domestic activities/activities of daily living (15.2%); social activities (14.4%); work and education (13.6%); activities in sensory demanding environments (9.5%).  A total of 24 subgroups were organized under these main categories. The subgroups were linked to the ICF, with 75% linked to the domains of activity and participation, 17% were linked to the body function domain, and 8% were linked to environmental factors. The self-reported difficulty of performing the activities varied from 2.66 (SD 2.03) to 3.62 (SD 2.17) points. 


Conclusion(s):

PPCS and exercise intolerance affect many aspects of the lives of patients with PPCS and exercise intolerance after mTBI. As expected, given the context of the study, mTBI patients identified most restrictions in the activity and participation domain of the ICF, primarily related to physical activity and exercise.


Implications:

Activity limitations were related to a variety of activities in this population and suggests that rehabilitation should include patient-specific outcome measures to individualize the rehabilitation approach. 

Funding acknowledgements:
The study is funded by the Norwegian Fund for Post-Graduate Training in Physiotherapy.
Keywords:
Mild Traumatic Brain Injury
Exercise Intolerance
Patient-Specific Functional Scale
Primary topic:
Disability and rehabilitation
Second topic:
Neurology
Third topic:
Sport and sports injuries
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The Regional Ethical Committee for Medical and Health Research Ethics, Norway.
Provide the ethics approval number:
(#256109)
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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