Anxiety, pain, and fear of pain: predictors of postural stability after a concussion

Abstract

A concussion can lead to anxiety, pain, kinesiophobia, and/or postural control deficits. We conducted a cross-sectional study evaluating adolescents with a recent concussion. We hypothesized that those reporting higher levels of anxiety, pain-interference, and kinesiophobia would perform worse on postural control tests. Participants completed anxiety, pain-interference, and kinesiophobia ratings and postural control tests (single/dual-task tandem gait and a modified balance error scoring system). Using a multivariable linear regression model, we evaluated the relationship among anxiety, pain-interference, and kinesiophobia (predictors) with postural control measures (tandem gait and a modified balance error scoring system, outcomes), adjusting for sex and anxiety history. We enrolled 128 participants (53% female, age=15.4±1.7 y, and 9.3±4.0 d post-concussion). Higher anxiety was weakly correlated with slower dual-task tandem gait times (r=0.31; p=0.001) and more modified balance error scoring system errors (r=0.22; p=0.01). Multivariable modeling indicated that a higher post-concussion anxiety rating was associated with a slower dual-task tandem gait time (β=0.21, 95% confidence interval=0.01–0.41; p=0.04). The female sex was associated with slower single-task tandem gait (β=−3.01, 95% confidence interval=−6.01, −0.01; p=0.049). Adolescents with a higher anxiety post-concussion performed worse on dual-task tandem gait assessments, while pain-interference and kinesiophobia were not associated with postural control. Anxiety and impaired postural control are independently associated with poor concussion outcomes; thus, this association may inform individualized concussion care strategies.

Keywords

balance - head injury - injury psychology - adolescent - clinical assessment

Publication History

Received: 06 November 2024

Accepted after revision: 13 March 2025

Accepted Manuscript online:
13 March 2025

Article published online:
01 April 2025

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