Background: Affective post-concussion symptoms negatively impact psychological health-related quality of life (HRQoL), contributing to anxiety and depression symptoms in athletes. Additionally, daily fluctuations in these symptoms remain unclear. Ecological Momentary Assessment (EMA) methodologies allow subjects to repeatedly report their experiences and perceptions in real-time. Recovering Concussion Update on Progression of Symptoms (ReCoUPS), a mobile, web-based EMA platform that administers daily symptom surveys via text messages, is a reliable and feasible tool for monitoring concussion symptoms in real time. However, this tool has yet to be used to track psychological HRQoL following a concussion.Purpose: This dissertation aimed to: 1) investigate the psychometric properties of momentary psychological HRQoL inventories and a post-concussion symptom checklist via ReCoUPS to healthy participants, 2) assess the feasibility for ReCoUPS for montoring traditional post-concussion affective symptoms and psychological HRQoL throughout concussion recovery, and 3) compare changes in affective symptoms and psychological HRQoL throughout concussion recovery using ReCoUPS between concussed college-aged athletes and healthy controls. Methods: For Aim 1, healthy participants (ages 17-30) completed momentary assessments of post-concussion symptoms and psychological HRQoL via ReCoUPS daily for 7 days, with recalled versions administered at the study closure to assess evidence of test-retest reliability and construct validity. For Aims 2 and 3, college-aged athletes diagnosed with a concussion were enrolled within 3 days post-injury and completed ReCoUPS daily survey text messages daily until the study closure (i.e., within 48 hours after full medical clearance). Healthy matched controls (age, sex, sport) followed the same procedures. All participants completed demographics, injury/ medical history information, and enrolled in the ReCoUPS platform at the acute visit. The SCAT6 Symptom Checklist, PROMIS-SF Anxiety, and PROMIS-SF Depression were completed via ReCoUPS text messages daily throughout recovery. Recovery information and recalled psychological HRQoL were collected at the study closure visit. Results: For Aim 1, 93 college-aged healthy athletes (mean age: 21.37±2.63 years; 64 female, 29 male) completed the study with 86.02% (n=80) completing over 70% of daily ReCoUPS surveys. Momentary PROMIS-SFs demonstrated moderate-to-excellent agreement with recalled measures and acceptable reliability. Both PROMIS-SFs were strongly correlated with affective symptoms. For Aim 2, we enrolled 36 college-aged athletes with a concussion (mean age: 20.36±1.25 years; 23 female, 13 male), with 66.67% (n=24) completing over 70% of daily surveys. Both momentary PROMIS-SFs were strongly correlated with affective symptoms. Descriptive statistics and heat plots demonstrated variability in outcome measures throughout concussion recovery. For Aim 3, in addition to concussed participants, 34 healthy controls (mean age: 20.35±1.37 years; 21 female, 13 male) were enrolled. Multi-level mixed-effects models revealed that concussed athletes reported significantly higher symptoms than healthy matched controls. Symptom variance was explained by within-athlete and between-athlete differences. Conclusion: Among healthy college-aged athletes, momentary assessments of psychological HRQoL via ReCoUPS demonstrated evidence of strong reliability and validity. ReCoUPS was a feasible, usable, and effective method of tracking psychological HRQoL and affective symptoms throughout concussion recovery in injured athletes. Concussed athletes reported significantly higher affective symptom and psychological HRQoL scores than healthy controls, with both between-athlete and within-athlete symptom variability. These results support ReCoUPS as a remote symptom monitoring tool, allowing clinicians to make timely and targeted treatment decisions. Further, we support variability in concussion symptoms daily throughout recovery.
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