The impact of persistent post-concussion symptoms and exercise intolerance on patient-specific functioning after mild traumatic brain injury: a biopsychosocial perspective

OBJECTIVE: To explore activity limitations in a biopsychosocial context in a randomized controlled trial studying sub-symptom threshold aerobic exercise after mild traumatic brain injury. DESIGN: Qualitative and quantitative approaches. PATIENTS: Eighty-one participants (58% female; median age 32.3) with persistent post-concussion symptoms and exercise intolerance. METHODS: Activity limitations assessed with the Patient Specific Functional Scale were categorized into main and subcategories using thematic analyses. Subcategories were linked to the International Classification of Functioning, Disability and Health. Group differences and changes over time were examined using linear mixed-effects models. RESULTS: Of 390 activities, 6 main categories and 24 subcategories were identified: physical activity and exercise (31%), work/education (16%), activities of daily living (15%), social activities (15%), cognition/energy (14%), and sensory-demanding environments (9%). Most subcategories (86%) were linked to the activity and participation domain. There were no group differences in activity limitations at 3 (p = 0.60) and 6 (p = 0.48) months. However, all patients improved from 3.3 (2.9-3.7) at baseline to 5.4 (5.0-5.9, p < 0.001) at 3 months, and 6.2 (5.8-6.7, p < 0.001) at 6 months. CONCLUSION: Limitations in daily activities were reported across multiple domains. While no differences were found between groups, patient‑reported limitations showed significant improvement over time and may inform individualized rehabilitation strategies.