Date of Graduation

12-2023

Document Type

Thesis

Degree Name

Master of Science in Exercise Science (MS)

Degree Level

Graduate

Department

Health, Human Performance and Recreation

Advisor/Mentor

R.J. Elbin

Committee Member

McDermott, Brendon

Second Committee Member

Washington, Tyrone

Keywords

post-concussion assessment outcomes

Abstract

Introduction. The COVID-19 pandemic spanned across the globe in March 2020 and has since significantly impacted human life. There is evidence that supports symptom exacerbation and an increase in anxiety and depression in clinical presentation post-COVID-19 pandemic compared to pre-COVID-19 for multiple medical diagnoses. These medical diagnoses include migraines, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and mild cognitive impairment. The effect that the pandemic had on the clinical presentation of sports-related concussions is understudied. It is possible that the COVID-19 pandemic has altered the clinical presentation of concussions as seen in other medical diagnoses. Given the increased reporting of depression and anxiety, as well as symptom exacerbation in other patient populations, an examination of these trends in sport-related concussion patients is warranted. Purpose. The purpose of this study was to examine changes in the clinical presentation of sport-related concussions before and after the COVID-19 pandemic in adolescents and adults. Methods. This study involved a retrospective review of electronic health records (EHRs). Participant information was gathered via the standard clinical visit. Anxiety was evaluated using the State-Trait Anxiety Inventory (STAI). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Post-concussion symptoms and symptom clusters were assessed using the Post-Concussion Symptom Scale (PCSS). There were 212 participants (M=19.72, SD=9.70yrs, 55% female) included in the final sample yielding a 7% (212/3,000) response rate. All participants completed their first concussion clinical visit approximately 8.98 days (SD=6.36) after injury (range 1–30 days). Participants were divided into Pre-COVID-19 (n=126) and Post-COVID-19 groups (n=86). These groups did not differ on any demographic or concussion-related variables. Based on previous literature the hypothesis was that the post-COVID-19 group would have significantly higher STAI, PHQ-9, PCSS, and symptom clusters than pre-COVID-19 pandemic scores in patients with a sport-related concussion. Results. The results of a series of independent-sample t-tests did not reveal significant between-group differences for STAI (t (179) = -.91 p=.36), PHQ-9 (t (114) = -1.46, p=.15), PCSS Total Symptom Score (t(197)=.54 p=.59), Affective (t (196) = .54 p=.59), Cognitive (t (197) = -.17 p=.87), Somatic (t (197) = 1.01, p=.31), or Sleep (t (197) = 2.32 p=.02) symptom factors (See Table 2). Conclusion. There were no statistically significant differences in post-pandemic STAI, and PHQ-9 scores compared to pre-pandemic STAI and PHQ-9 scores. In addition, there were no between-group differences for the affective, cognitive, somatic, or sleep post-concussion symptom factors. These findings suggest that the COVID-19 pandemic did not significantly influence post-concussion anxiety, depression, overall symptoms, and symptom clusters.

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