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  • Author: Andrew S. Williams x
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Krista M. Hixson, Alex N. Allen, Andrew S. Williams and Tamara C. Valovich McLeod

Clinical Scenario:

Mild traumatic brain injury, or concussion, has been associated with physical, cognitive, and emotional sequelae. Little is understood in regard to many characteristics, such as anxiety, and their effect on post-concussion symptoms.

Clinical Question:

Is state anxiety, trait anxiety, or anxiety sensitivity a clinical predictor of symptoms in those presenting with mild traumatic brain injury or concussion?

Summary of Key Findings:

A literature search returned 3 possible studies; 3 studies met inclusion criteria and included. One study reported in athletes that greater social support was associated with decreased state-anxiety, lower state anxiety post-concussion was associated with increased social support, and that those with greater social support may experience reduced anxiety, regardless of injury type sustained. One study reported baseline trait anxiety in athletes was not significantly associated with post-concussion state anxiety, but that symptoms of depression at baseline was the strongest predictor for post-concussion state anxiety. Three studies reported that state and trait anxiety are not related to increased post-concussion symptom scores. One study reported that greater anxiety sensitivity is related to higher reported post-concussion symptom scores, which may manifest as somatic symptoms following concussion, and revealed that anxiety sensitivity may be a risk factor symptom development.

Clinical Bottom Line:

There is low-level to moderate evidence to support that anxiety sensitivity is linked to post-concussion symptoms. State and trait anxiety do not appear to be related to post-concussion symptoms alone. Post-concussion state anxiety may occur if post-concussion symptoms of depression are present or if baseline symptoms of depression are present. Better social support may improve state anxiety post-concussion.

Strength of Recommendation:

There is grade B evidence to support that state and trait anxiety are not risk factors for post-concussion symptom development. There is grade C evidence to support anxiety sensitivity as a risk factor for developing post-concussion symptoms.

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Dale B. Read, Ben Jones, Sean Williams, Padraic J. Phibbs, Josh D. Darrall-Jones, Greg A.B. Roe, Jonathon J.S. Weakley, Andrew Rock and Kevin Till

Purpose: To quantify the frequencies and timings of rugby union match-play phases (ie, attacking, defending, ball in play [BIP], and ball out of play [BOP]) and then compare the physical characteristics of attacking, defending, and BOP between forwards and backs. Methods: Data were analyzed from 59 male rugby union academy players (259 observations). Each player wore a microtechnology device (OptimEye S5; Catapult, Melbourne, Australia) with video footage analyzed for phase timings and frequencies. Dependent variables were analyzed using a linear mixed-effects model and assessed with magnitude-based inferences and Cohen d effect sizes (ES). Results: Attack, defense, BIP, and BOP times were 12.7 (3.1), 14.7 (2.5), 27.4 (2.9), and 47.4 (4.1) min, respectively. Mean attack (26 [17] s), defense (26 [18] s), and BIP (33 [24] s) phases were shorter than BOP phases (59 [33] s). The relative distance in attacking phases was similar (112.2 [48.4] vs 114.6 [52.3] m·min−1, ES = 0.00 ± 0.23) between forwards and backs but greater in forwards (114.5 [52.7] vs 109.0 [54.8] m·min−1, ES = 0.32 ± 0.23) during defense and greater in backs during BOP (ES = −0.66 ± 0.23). Conclusions: Total time in attack, defense, and therefore BIP was less than BOP. Relative distance was greater in forwards during defense, whereas it was greater in backs during BOP and similar between positions during attack. Players should be exposed to training intensities from in-play phases (ie, attack and defense) rather than whole-match data and practice technical skills during these intensities.