Browsing by Author "Hunzinger, Katherine J."
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Item Clinical Mental Health Measures and Prediction of Postconcussion Musculoskeletal Injury(Journal of Athletic Training, 2023-07-31) Buckley, Thomas A.; Bryk, Kelsey N.; Enrique, Alexander L.; Kaminski, Thomas W.; Hunzinger, Katherine J.; Oldham, Jessie R.Context The rate of lower extremity musculoskeletal injury (LE MSK) is elevated after concussion; however, the underlying mechanism has not been elucidated. Physical characteristics have been investigated despite poorer mental health being a common postconcussion complaint and linked to MSKs. Objective To evaluate the role of mental health as a predictor of postconcussion LE MSK. Design Case-control study. Setting Intercollegiate athletic training facility. Patients or Other Participants A total of 67 National Collegiate Athletic Association Division I student-athletes (n = 39 females) who had been diagnosed with a sport-related concussion. Main Outcome Measure(s) The Brief Symptom Inventory-18, Hospital Anxiety and Depression Scale, and Satisfaction With Life Scale (SWLS) measures were completed at baseline (preseason) and on the day participants were cleared for unrestricted return to play (RTP) after a concussion. Two binary logistic regressions were used to predict postconcussion LE MSK within a year, one for the baseline time point and the second for the RTP time point. A 2 (group: LE MSK, no LE MSK)-by-2 (time: baseline, RTP) repeated-measures analysis of variance compared performance between baseline and RTP. Results Subsequent LE MSKs were sustained by 44 participants (65.7%). The only significant predictor of postconcussion LE MSK was the SWLS score at RTP, with Exp(B) = 0.64, indicating that an increased (improved) SWLS score was associated with a lower LE MSK rate. No significant interactions were present between mental health measures and subsequent MSK (P values = .105–.885). Conclusions Limited associations were evident between postconcussion LE MSK and scores on commonly used measures of anxiety, depression, and satisfaction with life. Reported increased satisfaction with life was associated with a decreased injury risk, which warrants further attention. Our results suggest that these measures of anxiety, depression, and satisfaction with life have limited value in assisting sports medicine clinicians with determining which student-athletes are at elevated risk of postconcussion LE MSK. Key Points Measures of anxiety and depressive symptoms were not predictive of elevated postconcussion lower extremity musculoskeletal injury. Greater satisfaction with life was associated with a decreased risk of postconcussion lower extremity musculoskeletal injury.Item Concussion is not associated with elevated rates of lower-extremity musculoskeletal injuries in National Football League Players(Physician and Sportsmedicine, 2022-05-27) Buckley, Thomas A.; Browne, Steven; Hunzinger, Katherine J.; Kaminski, Thomas W.; Swanik, Charles BuzObjective: Emerging evidence has identified an ~2x elevated risk of musculoskeletal (MSK) injury in the year following a concussion. Most of these studies have examined a single college/university athletic department and may lack generalizability to professional sports. Therefore, the purpose of this study was to assess the odds of post-concussion MSK injury utilizing publicly available National Football League (NFL) injury reports. Methods: Concussions were identified through a review of published NFL injury reports during the 2015, 2016, and 2017 regular seasons. Concussed players were matched by team and position, and injuries were tracked for both groups for the remainder of the season. A chi-square analysis compared the frequency of MSK injury in both groups and a Cox Proportional Hazard model calculated the risk of sustaining a subsequent MSK injury. Results: There were 322 concussed NFL players who met inclusion criteria and were successfully matched. From the time of concussion through the remainder of the season, 21.4% of the concussed players were injured and 26.4% of control participants were injured. There was no difference in MSK injury rates (p = 0.166), and the relative risk ratio was 0.90 for subsequent injury in the concussion group. There was no difference in the time to event for subsequent MSK between the two groups (p = 0.123). Conclusion: The primary finding of this study was no elevated risk of post-concussion MSK in NFL football players.Item Contact or Collision Sport History, Repetitive Neurotrauma, and Patient-Reported Outcomes in Early to Midadulthood(Journal of Athletic Training, 2023-12-18) Hunzinger, Katherine J.; Caccese, Jaclyn B.; Mannix, Rebekah; Meehan, William P.; Swanik, C. Buz; Buckley, Thomas A.Context Data on the early to midlife effects of repetitive neurotrauma on patient-reported outcomes have been delimited to homogeneous samples of male athletes without comparison groups or accounting for modifying factors such as physical activity. Objective To determine the effect of contact or collision sport participation and repetitive neurotrauma on patient-reported outcomes among early to middle-aged adults. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants A total of 113 adults (53 [46.9%] men, 60 [53.1%] women; age = 34.88 ± 11.80 years) in 4 groups: (1) physically inactive individuals with no repetitive head impact (RHI) exposure (NON); (2) noncontact sport athletes and nonathletes with no RHI exposure who were currently physically active (NCA); (3) former high-risk sport athletes with an RHI history who were physically active (HRS); and (4) former rugby players with prolonged RHI exposure who remained physically active. Main Outcome Measure(s) The 12-Item Short-Form Health Survey (SF-12), Apathy Evaluation Scale–self-rated version (AES-S), Satisfaction With Life Scale (SWLS), and Sport Concussion Assessment Tool–5th Edition (SCAT5) Symptom and Symptom Severity Checklist. Results The NON group had worse self-rated physical function than the NCA group as assessed by the SF-12 physical component summary (P = .03) and worse self-rated apathy (AES-S) and satisfaction with life (SWLS) than the NCA (P = .03 for both) and HRS groups (P = .03 and P = .040, respectively). We observed no group differences for self-rated mental health (SF-12 mental component summary; P = .26) or symptoms (SCAT5; P = .42). Career duration was not associated with any patient-reported outcomes. Conclusions A history of contact or collision sport participation and career duration did not negatively affect patient-reported outcomes in physically active, early to middle-aged adults. However, physical inactivity status was negatively associated with patient-reported outcomes in these individuals in the absence of an RHI history. Key Points - The midlife and later-life effects of repetitive head impacts paired with physical activity on patient-reported outcomes need to be elucidated. - Contact or collision sport participation and career duration were unrelated to worse patient-reported outcomes in early to midadulthood among physically active individuals. - Physical inactivity may be a more important modifier of patient-reported outcomes in early to midadulthood than repetitive neurotrauma exposure.Item The cumulative effects of prolonged repetitive head impact exposure into adulthood(University of Delaware, 2022) Hunzinger, Katherine J.BACKGROUND: Roughly 70-90% of the 2.8 million traumatic brain injuries (TBIs) that occur annually are mild (mTBI). Although a fairly benign injury, acutely, with clinical sign and symptom resolution occurring devoid of intervention in a few weeks, subtle neurophysiological deficits may persist beyond standard clinical recovery timelines of about one month. These deficits may be linked to dual-task and/or neuromuscular control dysfunction which may be the cause for the increased risk of subsequent lower extremity musculoskeletal injury (LE-MSI) post-concussion reported in youth, collegiate, and professional athletes; however, data are limited on females and community athletes. Further, beyond concussion, the long-term effects of repetitive head impacts (RHI) or impacts that do not result in clinical signs and symptoms of concussion remain a concern. Data are mixed on the long-term effects of RHI measured by age of first exposure (AFE) to contact/collision sports with some studies suggesting cognitive and emotional dysfunction in middle age and other studies suggesting no effect. Yet, these studies are limited to football and soccer playing middle aged males in addition to lacking objective measures of neurophysiological health and comparison groups. Further, the sex-specific response to RHI and the moderating effect of physical activity remain to be elucidated across the age spectrum. PURPOSE: The overall purpose of this dissertation was to identify the long-term effects of collision sport participation across individuals with varying levels of lifetime RHI exposure and physical activity levels. METHODS: For Aim 1, 1,037 (31.6 + 11.3 years, 40.9% female) community level rugby players completed an online survey via Qualtrics detailing demographics, sport history and AFE to sport, concussion and LE-MSI history, and patient reported outcomes (Brief-Symptom Inventory-18 (BSI-18), Short-Form 12 (SF-12 Physical and Mental Component Summary (PCS/MCS), and Satisfaction with Life Scale (SWLS)). Odds ratios (OR) by sex were performed to determine the odds of LE-MSI given history of concussion and a binary logistic regression to determine if there were sex differences in risk. Mann-Whitney U tests were performed to compare AFE groups (<12 and > 12 yr) for BSI-18, SF-12, and SWLS. Generalized linear models were performed to examine the association between AFE (continuous) and patient reported outcomes; predictors included age, career duration (i.e., cumulative years contact/collision sports), and concussion history (yes/no). For Aims 2 and 3, 113 adults were recruited representing four groups: 1) Former non-contact athletes/non-athletes who are not physically active (NON; N=28, 35.4 + 14.1 years); 2) Former non-contact athletes who are physically active (NCA; N=29, 33.9 + 10.8 years); 3) Former contact/collision sport athletes who participated in high risk for RHI sports (i.e., boxing, football, ice hockey, lacrosse, soccer, wrestling) who are physically active (HRS; N=29, 33.3 + 8.4 years); and 4) current and former rugby players, with a history of playing rugby after the age of 22 (e.g., prolonged RHI exposure into adulthood after the age at which most collision sport participation ceases) (RUG; N=27, 38.1 + 13.0 years). All participants completed an online questionnaire of demographics, injury history, sport history, and patient reported outcomes, in addition to common concussion assessments measuring multiple domains and systems, and single (ST) and dual-task (DT) inertial measurement unit instrumented gait and tandem gait. For Aim 2, a multiple regression was used to predict ST and DT gait outcomes in collision sport athletes from career duration. Groups were compared on all outcomes using Kruskal-Wallis test with a pairwise comparison procedure and Bonferroni correction for multiple corrections. Follow up analyses utilized covariates (concussion, learning disorder history, and career duration) in a one-way ANCOVA to compare groups on all outcomes. The relationship between ST gait speed and performance on clinical tests and dual task cost (DTC) gait speed and performance on clinical tests were analyzed using multiple Spearman’s rank-order correlations. For Aim 3, a linear regression was utilized to understand the effect of career duration and sex on gait outcomes (i.e., ST & DT gait speed, double support, stride length, and tandem gait, and their corresponding DTC outcomes). Further, a dummy variable was created to model the sex*career duration interaction and was also included in the model alongside sex and career duration in Block 1 using the “Enter” method. A second block with potential confounding factors (i.e., concussion history, LD/ADHD history, age, height) was also performed. RESULTS: For Aim 1, there was a significant association between diagnosed concussion and any LE-MSI(χ(1) = 13.055, p < 0.001, OR = 2.30 [95%CI: 1.45, 3.65]). There were no differences between sex for risk of LE-MSI (R2 = 0.024, p = 0.999). Whether analyzed continuously or dichotomously, younger AFE was not associated with worse patient-reported outcomes for either men or women. For Aim 2, career duration did not predict any of the gait outcomes (p>0.05). In adjusted models, there were no group differences on multiple outcomes. However, on 6/25 outcomes (SF-12 PCS, Apathy Evaluation Scale, SWLS, Montreal Cognitive Assessment (MOCA), Balance Error Scoring System (BESS), ST tandem gait) the NON group did significantly worse than the NCA group. The NON group also performed worse than RUG on BESS and ST gait speed. Spearman correlations revealed weak correlations between ST gait speed and SCAT5 Symptom Severity (rs = 0.282, p=0.002), Trails B (rs=-0.219, p=0.021), and SWLS (rs =0.282, p=0.002). As well as weak correlations between DTC gait speed and Trails A (rs = -0.216, p=0.022), Trails B (rs = -0.306, p<0.001), and MOCA (rs = 0.248, p=0.008). For Aim 3, there was no effect of sex on the relationship between career duration and gait outcomes (p>0.05). DISCUSSION: Collectively, these results suggest that contact/collision sport participation does not affect early- to mid-adulthood neurophysiological health in males and females. Further, career duration was not a sensitive enough measure to detect any group differences on assessment of neurophysiological health, warranting future research utilizing more precise measures of lifetime RHI exposure to determine if there truly is not an effect present. However, concussion history remains a significant predictor of quality of life and wellness in addition to its relationship with increased odds of LE-MSI. Lastly, there does not appear to be a significant effect of RHI on sex among measurements of ST and DT gait implying that both sexes are equally unaffected. These findings add to the growing body of evidence that contact/collision sport participation and RHI do not negatively affect mid-life neurophysiological health and function.Item Effects of contact/collision sport history on gait in early- to mid-adulthood(Journal of Sport and Health Science, 2023-05-01) Hunzinger, Katherine J.; Caccese, Jaclyn B.; Mannix, Rebekah; Meehan, William P. III; Hafer, Jocelyn F.; Swanik, C. Buz; Buckley, Thomas A.Background: To determine the effect of contact/collision sport participation on measures of single-task (ST) and dual-task (DT) gait among early- to middle-aged adults. Methods: The study recruited 113 adults (34.88 ± 11.80 years, (mean ± SD); 53.0% female) representing 4 groups. Groups included (a) former non-contact/collision athletes and non-athletes who are not physically active (n = 28); (b) former non-contact/collision athletes who are physically active (n = 29); (c) former contact/collision sport athletes who participated in high-risk sports and are physically active (n = 29); and (d) former rugby players with prolonged repetitive head impact exposure history who are physically active (n = 27). Gait parameters were collected using inertial measurement units during ST and DT gait. DT cost was calculated for all gait parameters (double support, gait speed, and stride length). Groups were compared first using one-way analysis of covariance. Then a multiple regression was performed for participants in the high-risk sport athletes and repetitive head impact exposure athletes groups only to predict gait outcomes from contact/collision sport career duration. Results: There were no significant differences between groups on any ST, DT, or DT cost outcomes (p > 0.05). Contact/collision sport duration did not predict any ST, DT, or DT cost gait outcomes. Conclusion: Years and history of contact/collision sport participation does not appear to negatively affect or predict neurobehavioral function in early- to mid-adulthood among physically active individuals. Graphical abstract available at: https://doi.org/10.1016/j.jshs.2022.12.004Item National Collegiate Athletic Association athletic trainers’ response to the Arrington settlement: management, compliance, and practice patterns(The Physician and Sportsmedicine, 2022-09-05) Buckley, Thomas A.; Bryk, Kelsey N.; Hunzinger, Katherine J.; Costantini, KatelynThe primary purpose of this study was to assess Athletic Trainers’ (ATs) report of NCAA member institution compliance with the Arrington settlement, the concussion lawsuit vs. the NCAA, and to elucidate compliance predictors. A secondary purpose was to provide a contemporary concussion management clinical practice pattern description among NCAA collegiate athletic trainers. Head Athletic Trainers from NCAA Division I, II, and III completed an electronic questionnaire in August 2020 regarding their institution’s response to the Arrington Settlement and their current concussion management clinical practice patterns. The 37-item questionnaire included AT and institution demographics, current concussion management policies, and response to the Arrington settlement with a specific focus on the five settlement requirements. An overall compliance score on the five requirements, compliance on the individual requirements, and concussion management practices are reported with descriptives. Regression was used to identify specific predictors of both overall and individual settlement requirements. An ANOVA compared compliance by NCAA division level. Being pressured to be non-compliant was assessed between sexes by a chi-square. There were 223 respondents (21.8%), and overall compliance was high (4.1 ± 0.7) with the five required Arrington Settlement components. Settlement requirement 1, pre-season baseline testing, and requirement 5, presence of trained personnel at all contact sport practices, had the lowest compliance rates at 44.8% and 73.3%, respectively. The number of sports the institution offered was the only significant predictor of each requirement. There was no difference in compliance between NCAA divisions. Although the overall rate of being non-compliant pressure was low (13.8%), females were 3.28x more likely report being pressured than males. NCAA institutions are generally compliant with the Arrington settlement; however, lack of clarity in the requirements, particularly requirement 1, raises potential concerns. Concussion management practices continue to incorporate multifaceted approaches and are largely consistent with current best practices.