A non-negligeable proportion of individuals who have sustained a mild traumatic brain injury (TBI) are at risk of developing persistent symptoms. The impact of persistent post-mTBI symptoms can be profound, causing significant disruptions in well-being, functioning and quality of life (Agtarap, et al., 2021). Reduced social participation often extends beyond the acute recovery period and continues to be associated with lower quality of life for many months after mTBI (Voormolen et al., 2019). Coping was found to be essential in order to decrease physical symptoms, have better psychological health, as well as increase social participation (Vos et al., 2019). The variables of perceived stress and depression were also linked directly and indirectly to mild post-TBI adjustment in terms of their return-to-work status (Strom and Kosciulek, 2007). Furthermore, a greater percentage of individuals with mTBI report chronic pain as compared to individuals with more severe TBIs (Weyer Jamora, Schroeder & Ruff, 2013). Given these implications and the growing concern for mTBI as a potentially disabling and chronic medical condition, it is important to focus on identifying the processes that can lead to persistent symptoms and related preventive interventions that can be applied. This present study aimed to investigate the association between coping and social participation according to anxiety, depression, and pain symptomatology, before and after rehabilitation in a mild TBI population benefiting from an outpatient rehabilitation program.

A prospective longitudinal cohort study design was employed, with two-time points for outcome assessment (i.e., start and end of rehabilitation). This study included 70 adults aged between 18 and 78 who experienced a mTBI between February 2016 and January 2020 and received interdisciplinary outpatient rehabilitation services at a major rehabilitation centre in the Greater Montreal region.Measures administered pre and post rehabilitation included the Rehabilitation Survey of Problems and Coping (R-SOPAC), the Mayo-Portland Adaptability Inventory-4 (MPAI-4), the Depression Anxiety Stress Scales 21 (DASS-21), and the Brief Pain Inventory-Short Form (BPI-SF). Mediation analyses were carried out via PROCESS macro for SPSS, model 4 and 6 (Hayes, 2013).

Mediation analyses indicated a partial indirect link between coping, anxiety, and pain on the level of social participation at the pre-rehabilitation time point. Post-rehabilitation, a significant partial mediating relationship regarding the impact of pain on the link between coping and social participation, was found. In addition, a statistically significant mediation relationship was found, where anxiety mediated the relationship of coping and social participation. These relationships suggest that lower levels of coping appear to be linked to a higher self-reported level of psychological distress and pain, resulting in lower social participation.

This observational rehabilitation cohort study demonstrates how anxiety and pain are associated with coping and social participation outcome following mTBI. These results are quite pertinent for clinical purposes in that paying close attention to the level of anxiety and perceived impact of pain during rehabilitation, and applying targeted interventions at these levels, in particular to increase coping, may prove particularly beneficial to improve social participation outcome.