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

Abstract

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.

Effectiveness of Combining Compensatory Cognitive Training and Vocational Intervention vs. Treatment as Usual on Return to Work Following Mild-to-Moderate Traumatic Brain Injury: Interim Analysis at 3 and 6 Month Follow-Up

“…Compared to TAU, a higher proportion of participants in the CCT-SE intervention group had returned to work at 3 months. In line with previous studies ( 28 , 29 ), both groups had significant improvement regarding RTW, in addition to work percentage and hours worked during the 6-month study period.…”

“…Compared to TAU, a higher proportion of participants in the CCT-SE intervention group had returned to work at 3 months. In line with previous studies (28,29), both groups had significant improvement regarding RTW, in addition to work percentage and hours worked during the 6-month study period. The difference between the two groups regarding RTW proportion was seen during the first 3 months (11%, adjusted for group difference at baseline), i.e., while the participants were receiving both CCT and SE.…”

“…As such, both groups received rather extensive follow-up, although the content of the two treatments differed. The effect of the multidisciplinary follow-up was assessed in a previous publication and found to reduce number of post-concussive symptoms, but did not improve RTW (29). Previous studies have reported that the CCT program can reduce subjective complaints and improve neurocognitive function in veterans with mild-to-moderate TBI (31,32,35), while SE has been shown to significantly improve work outcomes in individuals with mental health issues in the Norwegian context (36).…”

“…Previous interventions aimed at returning individuals to competitive employment after mild or moderate TBI have focused mainly on providing information and advice (27) or trying to increase work participation through alleviation of postconcussive symptoms (28)(29)(30). For example, Man et al (30) assessed the efficacy of virtual reality-based training vs. a psychoeducational program in a civilian sample with mild-to-moderate TBI, and found no significant differences in vocational outcome between the two groups.…”

“…For example, Man et al ( 30 ) assessed the efficacy of virtual reality-based training vs. a psycho-educational program in a civilian sample with mild-to-moderate TBI, and found no significant differences in vocational outcome between the two groups. Vikane et al ( 29 ) evaluated the effect of multidisciplinary follow-up program vs. follow-up by general practitioners (GPs) for patients with persistent symptoms 2 months after mTBI. The multidisciplinary program reduced the number of symptoms, but there was no difference between the groups regarding RTW.…”