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Interdisciplinary rehabilitation for persisting post-concussion symptoms after mTBI: N=15 single case experimental design - 19/11/23

Doi : 10.1016/j.rehab.2023.101777 
Jack V.K. Nguyen 1, 2, , Adam McKay 1, 2, Jennie Ponsford 1, 2, Katie Davies 3, Michael Makdissi 4, 5, Sean P.A. Drummond 1, Jonathan Reyes 1, 2, 5, Jennifer Makovec Knight 1, Tess Peverill 3, James H. Brennan 5, 6, Catherine Willmott 1, 2, 5
1 Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia 
2 Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia 
3 Neurological Rehabilitation Group, Melbourne, Australia 
4 Olympic Park Sports Medicine Centre, Melbourne, Australia 
5 Australian Football League, Melbourne, Australia 
6 Epworth Sports and Exercise Medicine Group, Melbourne, Australia 

Corresponding author at: Turner Institute for Brain and Mental Health, 18 Innovation Walk, Clayton VIC 3800, Australia.Turner Institute for Brain and Mental Health18 Innovation WalkClaytonVIC3800Australia

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Abstract

Background

Despite clinical guidelines recommending an interdisciplinary approach to persisting post-concussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant.

Objectives

This pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs.

Method

A single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility outcomes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-centred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1- and 3-month follow-ups. Other secondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau-U. Clinically significant changes in secondary outcomes were explored descriptively.

Results

16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1- and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1- and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clinically significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved.

Conclusions

This pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that progressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisciplinary treatments.

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Keywords : Concussion, Mild traumatic brain injury, Interdisciplinary, Rehabilitation

Abbreviations : BCTT, CBT, CTRS, DASS-21, GAS, i-RECOveR, ISI, LOC, MBD, mTBI, PPCSs, QoL, RCT, REDCap, RoBiNT, RPQ, SF-36, SPNTT, TBI, VOMS, WAIS


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Vol 66 - N° 7

Article 101777- octobre 2023 Retour au numéro
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