Early intervention for patients at risk for persisting disability after mild traumatic brain injury: A randomized, controlled study

Matuseviciene, Giedre; Borg, Jörgen; Stålnacke, Britt-Marie; Ulfarsson, Trandur; Boussard, Catharina de

doi:10.3109/02699052.2012.750740

Cited by 35 publications

(44 citation statements)

References 34 publications

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“…Whether intensified follow-up could help dealing with this uncertainty towards recovery is largely uninvestigated. Two recent papers reported on the effect of an information intervention aimed at high-risk patients (≥three complaints 10 days after injury), in which the authors conclude that the intervention had no effect on activity or participation nor on PTC level after three months [24,25]. Since we found no differences in the average number of complaints between our two groups after two weeks, it might be argued that the identification of at-risk patients based on number of complaints is not appropriate for assessing the need for outpatient follow-up.…”

Section: Discussionmentioning

confidence: 99%

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

et al. 2017

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Outpatient follow-up after mild traumatic brain injury de Koning, M.E.; Scheenen, M.E.; van der Horn, Harm J.; Hageman, G.; Roks, G.; Yilmaz, T.; Spikman, Jacoba; van der Naalt, Joukje Link to publication in University of Groningen/UMCG research database Citation for published version (APA): de Koning, M. E., Scheenen, M. E., van der Horn, H. J., Hageman, G., Roks, G., Yilmaz, T., ... van der Naalt, J. (2017). Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study. Brain Injury, 31, 1102-1108. DOI: 10.1080/02699052.2017 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Objective: To investigate outpatient follow-up after mild traumatic brain injury (mTBI) by various medical specialists, for both hospitalized and non-hospitalized patients, and to study guideline adherence regarding hospital admission. Methods: Patients (n = 1151) with mTBI recruited from the emergency department received questionnaires 2 weeks (n = 879), 3 months (n = 780) and 6 months (n = 668) after injury comprising outpatient follow-up by various health care providers, and outcome defined by the Glasgow Outcome Scale Extended (GOS-E) after 6 months. Results: Hospitalized patients (60%) were older (46.6 ± 19.9 vs. 40.6 ± 18.5 years), more severely injured (GCS <15, 50% vs. 13%) with more Computed Tomography (CT) abnormalities on admission (21% vs. 2%) compared to non-hospitalized patients (p < 0.01) . Almost half of the patients visited a neurologist at the outpatient clinic within six months (60% of the hospitalized and 25% of the non-hospitalized patients (χ 2 = 67.10, p < 0.01)), and approximately ten per cent consulted a psychiatrist/psychologist. Outcome was unfavourable (GOS-E <7) in 34% of hospitalized and 21% of non-hospitalized patients (χ 2 = 11.89, p < 0.01). Conclusion: Twothirds of all mTBI patients consult one or more specialists within six months after injury, with 30% having an unfavourable outcome. A quarter of non-hospitalized patients was seen at the outpatient neurology clinic, underling the importance of regular follow-up of mTBI patients irrespective of hospital admittance. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

et al. 2017

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“…Compared to other studies, our study was adequately powered for evaluation of the secondary outcomes [44]. One strength of our study was that we used sick-leave data from a national register, avoiding high rates of missing outcome data that could bias the results [20,45].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

et al. 2017

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Objective: To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury. Design: Randomised controlled trial.Patients: One hundred fifty-one patients, 16-56 years.Methods: Multidisciplinary outpatient rehabilitation with individual contacts and a psychoeducational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after a multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient's impressions of change and psychological distress.Results: Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p=0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p=0.041). No group differences were observed for disability (p=0.193), patients impression of change (p=0.285) or psychological distress (p=0.716).2 Conclusion:The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms.Additional studies should focus on which factors exhibit a direct impact on return-to-work.

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“…Highlights include a Phase III randomized trial of hypothermia in children, termed the ‘Cool Kids’ study, which recently reported that 48 hours of hypothermia followed by rewarming does not reduce mortality or positively affect recovery from pediatric brain injury (Adelson et al, 2013). An intervention trial randomizing high-risk post-concussion syndrome patients to an early visit to a physician similarly was negative, with similar outcomes to the treatment as the control group (Matuseviciene et al, 2013). Chesnut et al recently reported on their much anticipated trial of continuous invasive ICP monitoring following severe traumatic brain injury, showing no advantage over imaging and clinical examination alone (Chesnut et al, 2012).…”

Section: Pathophysiology Classification and Clinical Management Of Tbimentioning

confidence: 99%

Towards clinical management of traumatic brain injury: a review of models and mechanisms from a biomechanical perspective

Namjoshi

Good²,

Cheng

et al. 2013

Disease Models &Amp; Mechanisms

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Traumatic brain injury (TBI) is a major worldwide healthcare problem. Despite promising outcomes from many preclinical studies, the failure of several clinical studies to identify effective therapeutic and pharmacological approaches for TBI suggests that methods to improve the translational potential of preclinical studies are highly desirable. Rodent models of TBI are increasingly in demand for preclinical research, particularly for closed head injury (CHI), which mimics the most common type of TBI observed clinically. Although seemingly simple to establish, CHI models are particularly prone to experimental variability. Promisingly, bioengineering-oriented research has advanced our understanding of the nature of the mechanical forces and resulting head and brain motion during TBI. However, many neuroscience-oriented laboratories lack guidance with respect to fundamental biomechanical principles of TBI. Here, we review key historical and current literature that is relevant to the investigation of TBI from clinical, physiological and biomechanical perspectives, and comment on how the current challenges associated with rodent TBI models, particularly those involving CHI, could be improved.

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Early intervention for patients at risk for persisting disability after mild traumatic brain injury: A randomized, controlled study

Abstract: An early intervention, offered to patients with an estimated high risk for persisting disability, had no additional effect on symptom level at 3 months after MTBI as compared to TAU.

Cited by 35 publications

References 34 publications

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Towards clinical management of traumatic brain injury: a review of models and mechanisms from a biomechanical perspective

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