Influence of factors within the context of daily life on the reporting of post concussion-like symptoms in university students

Background: Concussions commonly occur in contact and collision sports. Following a concussion, serial assessments of symptoms are conducted to track recovery of a concussed athlete for 7–10 days and beyond to assist in making decisions on return-to-play. Several studies have reported the presence of base-rates of postconcussion-like symptoms in normal (non-concussed) individuals. However, factors within the context of daily life that can potentially influence the reporting of these postconcussion-like symptoms in a non-concussed cohort are yet to be explored. Thus, the purpose of this study was to explore the natural variation of postconcussion-like symptoms and also investigate factors within the context of daily life that influence the symptoms reported over a definitive period of time (7 days) in university students. Methods: University students aged 18–30 years were recruited to participate in this time series study. The symptoms experienced by participants on a daily basis were sampled by adopting an ecological momentary approach using the Sport Concussion Assessment Tool 2 (SCAT2) postconcussion symptom scale. Each participant was signaled randomly each day via text message to complete a mini online questionnaire which lasted for seven consecutive days. In this questionnaire, they were asked to report their symptoms experienced at that moment they were texted along with other factors (predictors) such as stress, anxiety and their location at a time of reporting etc. The effect of predictors on the total symptom score (TSS) was estimated using a mixed-effects model with the level of significance set at p < 0.05. Results: 110 university students (26 males and 84 females) consented to participate in this 7-day study. On average, each student had their TSS decrease (Estimate = −0.29) on each day across the 7-day period. Out of the 10 predictors included in the stepwise multivariate mixed-effects model, 3 predictors that include location at the time of reporting, physical fatigue (Estimate = −0.98) and mental fatigue (Estimate = −0.53) contributed to the prediction of TSS. Post-hoc analysis for the predictor of location at the time of reporting revealed that, students reported increased TSS at university or a cafe/restaurant compared to their flat/college of residence. Discussion: This daily variation and the influence of potential factors within the context of daily life on these symptoms in non-concussed individuals serve as a forewarning for clinicians to account for these factors while interpreting symptom scores associated with making decisions on return-to-play of a concussed athlete