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Heidi Losoi. 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland. 2 Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
Noah D. Silverberg. 3 Division of Physical Medicine and Rehabilitation, GF Strong Rehab Centre, University of British Columbia, Vancouver, British Columbia, Canada.
Minna Wäljas. 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
Senni Turunen. 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
Eija Rosti-Otajärvi. 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
Mika Helminen. 4 School of Health Sciences, University of Tampere and Science Center, Pirkanmaa Hospital District, Tampere, Finland.
Teemu M. Luoto. 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
Juhani Julkunen. 2 Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
Juha Öhman. 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
Grant L. Iverson. 5 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown Navy Yard, Charlestown, Massachusetts; Spaulding Rehabilitation Hospital; and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts.
Address correspondence to: Heidi Losoi, Psych L, Department of Neurosciences and Rehabilitation, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland, E-mail: [email protected]
Introduction
There is considerable heterogeneity across studies of clinical outcome from mild traumatic brain injury (MTBI),1 with conclusions ranging from full recovery in most patients to high rates of chronic problems. Methodological inconsistencies have likely contributed to these discrepant findings. According to a recent synthesis by the International Collaboration on MTBI prognosis,2 there still exists many methodological concerns and gaps in the knowledge, such as: (1) inconsistent definitions of MTBI; (2) inadequate control for confounding factors; (3) the lack of a nonhead injury comparison group; (4) overlooking selection and attrition biases; (5) poor description of the source populations and samples; (6) use of cross-sectional designs or prospective studies with insufficiently long follow-up (less than 12 months post-injury); and (7) outcome measures with inadequate or unknown reliability, validity, and responsiveness.2 Well-designed confirmatory studies that address these methodological limitations are needed to enhance understanding about consequences of MTBI.3
Another major barrier to understanding clinical outcome from MTBI is that "outcome" is not universally defined. Different dimensions of outcome from MTBI have been investigated, including...