A Review of Analytical Methods Used for Evaluating Clustering in Concussion-Related Symptoms
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INJURY EPIDEMIOLOGY (S MARSHALL, SECTION EDITOR)
A Review of Analytical Methods Used for Evaluating Clustering in Concussion-Related Symptoms Avinash Chandran 1,2 & Melissa C. Kay 3 & Aliza K. Nedimyer 2,4,5 & Sarah N. Morris 1 & Zachary Y. Kerr 2,5,6 & Johna K. Register-Mihalik 2,5,6 Accepted: 6 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Clinicians often use symptom cluster presentations to inform concussion diagnosis and provision of care. The current review appraises the analytical methods used for the identification of clinically meaningful clusters based on symptom assessments. Recent Findings Symptom clustering was commonly examined in relation to scores calculated using established assessment instruments. The majority of studies utilized Factor Analysis techniques for examining clustering, although statistical analyses were heterogeneously described by authors. Other techniques employed included time series network models, and cluster analysis using the joining tree method. Summary While there exists strong evidence to suggest multidimensionality in symptom presentations, the analytical foundations of these conclusions warrant further consideration. Future work in reconciling the underlying structure of symptom presentations may consider the nuances of the data captured using symptom assessment instruments, and the applicational limitations of commonly utilized data reduction techniques. Techniques that accommodate temporal dynamics of symptom presentations also warrant exploration in conducting this work. Keywords Concussions . Symptom clustering . Symptom assessment
Introduction Concussions have gained traction as a significant public health concern in recent years, and the understanding of concussions This article title is Topical Collection on Injury Epidemiology * Avinash Chandran [email protected] 1
NCAA Injury Surveillance Program, Datalys Center for Sports Injury Research and Prevention, 401 W. Michigan Street, Suite 500, Indianapolis, IN 46202, USA
2
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
3
School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA
4
Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC, USA
5
Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC, USA
6
Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
has evolved over time. While sport participation is considered a primary risk factor, concussions result from varying mechanisms [1, 2]. Although concussions impact different populations, they constitute a particular burden among children and adolescents given their developing brain [2–4]. Importantly, concussions affect all aspects of an individual’s health including physical, mental, and emotional components. In terms of physical health, concussions primarily impact areas of cognition and postural control [
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