Impact of optimized AFOs on functional outcomes in children with spastic cerebral palsy.

Mild traumatic brain injury (mTBI) is common in civilian and non-professional/-elite athlete populations (). Despite a longstanding view that full recovery occurs for approximately 80% of individuals by 3 months post-injury (), more recently it has been shown over 50% of individuals continue to report incomplete subjective recovery 1 year after injury (; ). A range of factors have been identified that increase the risk of incomplete longer term subjective recovery, including past psychiatric history (), depression (), psychological distress (; ) and female sex (, ; ). Coping style and aspects of illness perceptions have also been shown to predict incomplete subjective recovery (; ). Coping style and illness perceptions represent pillars of Leventhal’s Common Sense Model (CSM) of health and illness behaviour (), which has been used to understand outcome after mTBI (; ; ). Coping is a multidimensional concept that can be differentiated into relatively inter-situationally stable ways of handling stressful situations. There two broad coping styles: functional (e.g. seeking help, taking problem-focused action) and dysfunctional (e.g. avoidance, venting; ). Illness perceptions are the ways in which an individual perceives, or personally constructs, their illness with respect to illness identity, timeline, cause, consequences and personal control (). The CSM posits that illness perceptions have both a direct and mediating effect on coping styles and outcome. Research examining coping style has found varying support for the notion that an active, problem solving, approach-type coping style is associated with better self-reported outcome (; ; , ). Most of these studies included individuals with mTBI who had also had previous experience of traumatic injury and/or psychiatric history, which limited the understanding of the role of active coping in managing a specific mTBI event. One study did control for these factors, however and found a significant predictive relationship between active coping and self-reported outcome (). Research examining illness perceptions has also shown varying outcomes, with some researchers finding that a belief that an individual will experience negative consequences from the injury to be associated with poor subjective outcome (; ; ). After controlling for the impact of psychological factors, however, others have found no such association (). Other aspects of illness perceptions have been less consistently associated with subjective outcome. Without controlling for psychological factors, researchers have found that the belief that the injury had an emotional impact on the individual () as well as a generally negative perception of the injury () were associated with poor self-reported outcome, but these relationships were not identified after controlling for psychological factors (). In contrast, it has been shown that the more generic physical symptoms an individual is experiencing that they believe to be directly due to the injury (Identity beliefs) the more likely that the individual will have poorer subjective outcome (; ). That is, it is not the absolute number of symptoms the individual experiences that is key, but the number of symptoms they believe to be due to the mTBI that is important. Unlike other reported associations between illness perceptions and outcome, this relationship is present even after controlling for psychological factors ().