Melbourne School of Psychological Sciences - Theses
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ItemFatigue after child brain injury( 2016)Objective: Traumatic brain injury (TBI) is one of the most frequent causes of childhood disability. Fatigue is commonly reported during the acute and chronic phases of TBI recovery. Fatigue is defined as reduced performance in response to prolonged or unusual exertion and leads to reduced quality of life and school participation in children. Despite the prevalence of fatigue following TBI, there is little examining its nature and course. In particular, patterns of fatigue over time and predictors of longitudinal outcome after child TBI are unclear. The aim of this thesis is to address identified gaps in the existing research within the field of fatigue after child TBI. Throughout, we adopt a model of fatigue that is developmentally sensitive and multidimensional – including physical, sleep/rest, and cognitive elements. First, through systematic review of the literature we identify a psychometrically robust fatigue assessment instrument for use in child TBI. We then use this multidimensional fatigue measure to assess fatigue at three time-points after child TBI: 6 weeks, 6- and 12-months in order to meet the following study aims. First, we aim to compare fatigue in our TBI sample to published control data (at 6-weeks and 12-months post-injury), by TBI severity. Second, we examine fatigue over time (6- to 12-months post-injury) within our sample. Fourth, we explore factors predictive of worse fatigue on the fatigue measure at 6-weeks (child and parent perspectives) and 12-months (parent perspectives) post-injury. Our hypotheses were that fatigue following child TBI (a) would be higher than reported in published healthy children control data, (b) would reduce over time post-injury and (c) would be associated with more severe TBI and other hypothesised risk factors (such as sociodemographic characteristics). Method: Phase 1: A systematic review of fatigue assessment instruments used in children was conducted using key academic databases. Study quality and the psychometric properties of the instruments were assessed. Phase 2: We included participants already recruited to a larger prospective longitudinal study comprising 159 children (0-17 years at injury) with mild, moderate or severe TBI, presenting to one of three participating sites (two Canadian, one Australia). From the larger cohort, a subsample of 47 adolescents (8-18 years at injury) also participated in follow-up- 6-weeks post-injury. As part of the larger study protocol, at the time of child TBI, parents provided pre-injury child data based on retrospective report, including report of pre-injury fatigue and sleep difficulties. Healthy control data published from an American sample of children age 2-19 years was used for group comparisons (Panepinto et al., 2014). Results: Phase 1: Systematic Review identified twenty fatigue instruments, and two demonstrated strong measurement properties. Phase 2: Fatigue was rated by 35 participants (parents and adolescents) 6-weeks post-injury. At 6-weeks post-injury, fatigue in child TBI was significantly worse relative to control data (47 per cent and 29 per cent rated severe fatigue respectively). Between 6- and 12-months post-injury there was no detectable improvement in fatigue. Rather, cognitive fatigue worsened over time. Fatigue 12-months post-injury was again worse relative to control data (parent ratings). Fatigue was predicted by multiple variables, including pre-injury sociodemographic factors (female sex), psychological well-being (general fatigue) and pre-injury fatigue (sleep/rest fatigue). Symptoms after injury in multiple domains (physical/motor, pain, sleep psychological or inattention) additionally predicted fatigue 12 months post-injury. Conclusions: Fatigue is a complex, severe and persistent complaint after child TBI. Interventions are required to help reduce fatigue after child TBI.